Pumactant in the prevention of postoperative adhesions: a randomized trial

Postoperative intraperitoneal adhesions are a considerable source of morbidity. Supplementing compromised endogenous intraperitoneal phospholipids can reduce postoperative adhesions. A randomised, controlled, parallel group study was performed to evaluate the efficacy, safety and tolerability of pumactant in the prevention of peritoneal adhesions after abdominal colorectal surgery.

A total of 134 patients undergoing partial colectomy and colostomy or ileostomy were randomized to receive either 240 mg of pumactant or placebo (carbon dioxide) sprayed into the peritoneal cavity. The outcome measures were efficacy (adhesion incidence and extent and severity at the second surgery) and the safety of pumactant in the peritoneal cavity after abdominal surgery.

The mean adhesion score increased from surgery 1 to surgery 2 in the pumactant group and decreased in the placebo group, and the incidence and extent of adhesions increased in both groups. A total of 2149 adverse events were reported, of which 158 were serious. The overall adverse event profile for the two groups (pumactant and placebo) was very similar.

Although pumactant is relatively safe by the intraperitoneal route, 240 mg powdered pumactant is not effective in reducing postoperative peritoneal adhesions.