Use of an oxidized, regenerated cellulose absorbable adhesion barrier at laparoscopy

The use of an oxidized, regenerated cellulose absorbable adhesion barrier has been shown to significantly reduce the incidence, extent and severity of postoperative gynecologic adhesions in a multicenter, randomized, prospective trial. Since an increasing proportion of gynecologic surgery is being performed laparoscopically, a prospective, multicenter, open-label study was initiated to evaluate the feasibility of using the adhesion barrier laparoscopically and to establish techniques for applying the barrier during those procedures. Eighty patients were studied: 42 underwent lysis of adhesions; 35, removal of endometriosis implants; and 14, tuboplasty/fimbrioplasty. An average of two pieces were placed per patient, with an average piece size of 3 x 3 cm and an average time required per piece of 2 minutes, 40 seconds. Seventy-five percent of the cases required less than three pieces each for application. Eighteen percent of the pieces were difficult to place, generally because of problems unfolding the material, excessive size or nonadherence. For similar reasons, replacement was necessary for 27 of 157 pieces placed (17.2%). The barrier can be applied with relative ease during operative laparoscopy. The fabric can be placed through either the suprapubic or umbilical sleeve, depending on the size of the piece of barrier required.