腹腔鏡手術における癒着防止材アドスプレー^®の有用性に関する検討

抄録

Objective: Intestinal obstruction and infertility are significant adverse effects related to the formation of postoperative adhesions after gynecological surgery. INTERCEED^® (Ethicon) and Seprafilm^® (Kaken Pharmaceutical Co., Ltd.) are widely used adsorbable-type adhesion barriers suited for open surgery. However, in December 2016, AdSpray^® (Terumo), a spray-type adhesion barrier that allows the insertion of a long nozzle through a trocar, became available for use in Japan. We studied the utility of AdSpray^® during laparoscopic surgeries.

Methods: We studied 37 patients who underwent a total laparoscopic hysterectomy at our hospital between April 2016 and August 2017. Patients were categorized into 2 groups to receive either AdSpray^® or INTERCEED^®. A retrospective intergroup comparison was performed based on the distribution/adhesion time, white blood cell count, and the C-reactive protein levels on day 1 postoperatively, and the number of days hospitalized after surgery.

Results: The AdSpray^® group showed a shorter distribution/adhesion time than the INTERCEED^® group (118 ± 25 s vs. 170 ± 61 s, respectively, p = 0.013). No significant differences were observed in terms of any other outcomes. Neither group showed perioperative complications.

Conclusion: The tip of the nozzle of AdSpray^® can be bent freely to allow passage through the trocar for distribution over uneven surfaces. Thus, AdSpray^® is easier and safer to use during laparoscopic surgeries than adsorbable-type adhesion barriers.