Date of Graduation

8-11-2012

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Mark Pedemonte, MD

Second Advisor

Annjanette Sommers, PA-C, MS

Abstract

Background: Post-operative adhesions are an expected outcome with nearly every abdominal operation. Adhesions are not always symptomatic, but when they are, they can cause a variety of problems. Small bowel obstructions are a potential complication and are caused by abdominal adhesions in 75% of cases. This complication would be one best avoided, and as a result numerous prophylactic agents have been developed in hopes of decreasing the occurrence of adhesions.

Seprafilm Adhesion Barrier has been used since 1996 and has been largely effective in decreasing the incidence and severity of abdominal adhesions. A thin sheet of Seprafilm placed in the abdominal cavity before closure, keeps the organs from sticking to each other and forming scar tissue as the surgical site heals. The purpose of this systematic review is to evaluate the available research and determine if Seprafilm reduces the incidence of small bowel obstruction after laparotomy, as it does with adhesions.

Methods: An exhaustive search of medical literature was completed using Medline-OVID, CINAHL and EBM Reviews Multifile. The keywords Seprafilm, Hyaluronic Acid, Carboxymethylcellulose, biocompatible materials, artificial membranes, laparotomy, tissue adhesions and intestinal obstruction were used as search terms. The search was limited to articles written in English with human subjects. Only randomized controlled trials were included. Studies with pediatric subjects or gynecological surgeries were excluded.

Results: Three articles met the inclusion criteria and were incorporated in this review. Small bowel obstruction as an outcome after laparotomy was explored as well as several study-specific outcomes. The trials used Seprafilm in a randomized treatment group before closing the incision. Post-operative monitoring was completed in order to screen for the incidence of small bowel obstruction between the treatment and control groups. None of the studies found that the use of Seprafilm reduced the incidence of post-operative bowel obstruction, although some positive findings were additionally presented.

Conclusion: Although Seprafilm has been proven to decrease the incidence and severity of abdominal adhesions; the research available at this time does not show the same decreased incidence for post-operative small bowel obstructions. Additional large-scale, randomized controlled trials would be beneficial to further investigate this topic.

Keywords: Seprafilm, Hyaluronic Acid, Carboxymethylcellulose, biocompatible materials, artificial membranes, laparotomy, tissue adhesions, intestinal obstruction

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