癒着防止吸収性バリア（再生酸化セルロース）の腹腔内搬入法（袴（はかま）法）の工夫

抄録

Purpose: Following gynecologic surgery, postoperative adhesions commonly cause intestinal obstruction; therefore, the anti-adhesion materials used are of great importance. Currently, various anti-adhesion materials are used, including regenerated cellulose (Interceed, Johnson and Johnson, Ltd) and carboxymethylcellulose hyaluronate (Seprafilm, Kaken Pharmaceutical, Ltd).

　At our hospital, total laparoscopic hysterectomy (TLH) is performed using only 5 mm ports in four places (diamond placement) to reduce the wound pain and need for plastic surgery. The adhesion preventive material is placed intraperitoneally, which is sometimes difficult.

　Here, we demonstrate a new method for placing large-sized Interceed in the abdominal cavity, which we call the “Hakama” method. The purpose of this method is to reduce the placement and application time compared to the conventional method.

Methods: Twenty patients (10 treated with the Hakama method and 10 with the conventional method) who underwent TLH at our hospital between April 2018 and April 2019, were included in this study. To evaluate and compare both methods, the time to place the Interceed in the abdominal cavity and the time taken for it to adhere (time from placement to adhesion) were noted.

Results: The median (range) placement times were 16.5 s (12-35 s) and 24.5 s (13-34 s) and the application times (range) were 106.5 s (64-156 s) and 140.5 s (89-200 s) for the Hakama and conventional methods, respectively (p = 0.15 and 0.02; Fig. 2a and 2b, respectively,). Neither method resulted in damage to the large-sized Interceed.

Conclusion: We devised a new method for the intraperitoneal delivery of a large-sized Interceed in TLH using only 5 mm ports. The Hakama method requires only a simple incision and no other special materials or procedures. In addition, the procedure is relatively easy, and it is possible to quickly place the Interceed in the abdominal cavity with a single motion. Moreover, since the shape of the Interceed matches the open part of the retroperitoneum, the relative ease and convenience of attachment is enhanced. With this method, it is possible to use the anti-adhesion agent safely and quickly, while contributing to a shortened TLH operation time using only 5 mm ports.