Sodium Hyaluronate and Carboxymethylcellulose (Seprafilm) Seprafilm selleck chem Ganetespib is perhaps the most widely studied adhesion barrier, with more than 20 published studies that included over 4600 patients. Seprafilm is composed of chemically modified hyaluronic acid and carboxymethylcellulose. It is designed to separate planes of tissues after surgery for 3 to 7 days. To date, there is no evidence that Seprafilm is adhesiogenic in the presence of blood. The clinical trials reporting on the use of Seprafilm to prevent adhesion formation are summarized in Table 1, including population demographics, study design, sample size, and a brief summary of the results. Table 1 Seprafilm Clinical Overview Writing for the Seprafilm Adhesion Study Group, Diamond20 reported on the safety and efficacy of Seprafilm in preventing postoperative uterine adhesions after myomectomy.
This was a prospective, double-blind, multicenter, randomized, controlled study. After surgical treatment with or without Seprafilm, all patients were evaluated by early, second-look laparoscopy for the incidence, severity, and extent of adhesions. This study also evaluated the number of adhesion sites throughout the pelvis and the area of adhesions. In patients undergoing myomectomy, Seprafilm reduced the incidence, severity, extent, and average surface area of uterine adhesions. Approximately 48% of patients randomized to Seprafilm had at least 1 adnexa free of adhesions, and there was no increased risk of complications such as ileus, intra-abdominal bleeding, and postoperative fever.
20 Bristow and Montz21 studied the effectiveness of Seprafilm in preventing pelvic adhesions in women undergoing primary cytoreductive surgery with radical oophorectomy. In this cohort, Seprafilm significantly reduced the mean adhesion score by 84% compared with the internal controls and by 90% compared with historical control groups. The authors concluded that 73.2% of Seprafilm placement sites were free of adhesions compared with 35.7% for the abdominal wall and 14.3% for untreated pelvis. Moreover, in those Seprafilm placement sites that did have adhesions, the adhesions were significantly less severe than untreated sites. No complications were attributed to the presence of Seprafilm. The economic impact of adhesions and the cost effectiveness of Seprafilm treatment were studied by the same investigators.
By creating a theoretical decision model, they concluded that Seprafilm use offers an incremental savings of $383 (payers) and $1122 (society) per patient over a 10-year period. They concluded that the use of Seprafilm was cost Dacomitinib effective with a threshold of $1571 (7 sheets).22 Concerns about the use of Seprafilm include the learning curve required to achieve optimal placement and the fact that it cannot be applied laparoscopically. Adhesion Prevention at the Time of Cesarean Delivery Cesarean deliveries and adhesive disease deserve separate discussion.