New use of an absorbable adhesion barrier (INTERCEED) for temporary diverting ileostomy in minimally invasive rectal surgery

Objectives: Sometimes, severe adhesion occurs between the rectus abdominis muscle and the ileal intestinal limbs after temporary diverting ileostomy. This can make ileostomy reversal difficult. The aim of the present study is to assess whether absorbable adhesion barrier made of oxidized regenerated cellulose (INTERCEED) could contribute to improved surgical outcomes in stoma reversal. Methods: This was a single-institutional retrospective study. A total of 36 consecutive patients who underwent ileostomy reversal by a single surgeon were retrospectively reviewed. INTERCEED was inserted between the ileal limbs and the rectus abdominis muscle at the time of ileostomy creation in 12 patients. Surgical outcomes of the ileostomy reversal were compared between patients treated with and without INTERCEED. Results:The degree of adhesion formation between the ileal limbs and the rectus abdominis muscles, operating time, and estimated blood loss were significantly reduced in patients treated with INTERCEED compared with those treated by the conventional approach. None of the patients in the INTERCEED group had postoperative complications after the initial surgery and ileostomy reversal. Conclusions: INTERCEED is suitable for insertion between the ileal limbs and the rectus abdominis muscles because of its softness and flexibility. The use of INTERCEED for diverting ileostomy contributes to reduced adhesion formation, operative time, and blood loss in patients, and further research is needed to confirm our results. (AU)

Effects of interceed on endometrial receptivity in rabbits with intrauterine adhesion / 解放军医学杂志

Objective To observe the effect of anti-adhesion membrane made of oxidized regenerated cellulose (Interceed) on endometrial receptivity in New Zealand white rabbits with intrauterine adhesion (IUA). Methods-Forty-eight female rabbits were randomly divided into 4 groups (12 each): normal control group (group A), Interceed control group (group B), untreated model group (group C), and Inte rceed therapy group (group D). Rabbits in group A received sham operation and underwent no modeling. The Interceed was placed into the normal rabbits' uteruses in group B. The IUA rabbit models were reproduced in group C and group D by both mechanical injury and infection. Rabbits in group C were not treated, and in group D Interceed was put into their uteruses 7 days after modeling. Four rabbits in each group were sacrificed on the 28th day, the uterine tissues were collected. The endometrial glands count was performed after HE staining, and the degree of endometrial fibrosis was assessed after Masson staining. For the remaining animals in each group, ovulation was induced by stimulating the vagina in estrus, and they were sacrificed and the uterine tissue was collected on the 7th day after pseudopregnancy. The expression of pinopodes in endometrium was observed by scanning electron microscopy, and that of integrin αvβ3 protein was determined by immunohistochemistry. Results -The expression of glands and the degree of fibrosis in endometrium was obviously improved in group D as compared with that of group C (P<0.05), but no significant difference was found among the groups A, B and D. In group A, and developed pinopodes were abundantly expressed in endometrial surface, and similar changes were found in group B. The expression of pinopodes in group C was scarce, and the development was not synchronized. More pinopodes, with irregular shape and synchronized development, were expressed in group D than in group C. The expression of integrin αvβ3 protein was significantly lower in group C than in group A and group D (P<0.05). Conclusion-Interceed may alleviate the endometrial pathological changes, increase the expression of integrin αVβ3 protein, ameliorate the expression and development of pinopodes, thus improve the endometrial receptivity.

The clinical inflammatory reaction of Interceed(R) after laparoscopic surgery / 대한산부인과학회지

OBJECTIVE: Adhesions resulting from surgery may well be the most signigicant iatrogenic factor contributing to infertility and pelvic pain. Recently surgical barriers which mechanically separate opposing surfaces during tissue healing have been devised. Interceed(R) is an absorbable oxized regenerated cellulose barrier that adheres to the site of injury, converts into a gel, spontaneously maintains its position and dose not necessitate sutures. The goal of the study was whether the use of Interceed(R) elicits an inflammatory reaction when it remains foreign materials after laparoscopic surgery. METHODS: This randomized prospective study inculded 207 patients who had undergone laparoscopic operation at the department of Obstetric and Gynecology, Chosun University hospital, from January 2002 to December 2004. Of these 207 patients, 102 underwent laparoscopic operation with applying Interceed(R) (Group 1) and 107 underwent laparoscoic operation without applying Interceed(R) (Group 2). The WBC (White Blood Cell) count, ESR (Erythrocyte Sedimentation Rate), CRP (C-Reactive Protein), body temperature were compared postoperatively. P<0.05 was considered statistically signigicant. RESULTS: Preoperative WBC (White Blood Cell) count, ESR (Erythrocyte Sedimentation Rate), CRP (C-reactive protein), body temperature of two groups were no significant difference between Group 1 and 2. At postoperative 4th, 10th, 28th day, WBC (White Blood Cell) count, ESR (Erythrocyte Sedimentation Rate), CRP (C-reactive protein), body temperature, vaginal cuff tenderness of two groups were not significantly different between Group 1 and 2. DISCUSSION: We found that the use of Interceed(R) do not elicit an inflammatory reaction through laboratory finding and clinical finding although it remains foreign material after laparoscopic surgery. So we can use Interceed(R) for preventing adhesion safely.

The Combined Effect of Physical Barriers and 5-Fluorouracil on Delayed Adjustable Strabismus Surgery

In order to prevent the formation of postoperative adhesions and delay the time of adjustment, the authors tried 5-fluorouracil and physical barriers of polytetrafluoroethylene, Interceed, Viscoat in rabbits. Fluorouracil delayed the adjustment for up to one week after surgery in three out of four eyes. Combined use of Interceed and 5-fluorouracil of addition of Viscoat could delay the adjustment for up to two weeks after surgery I one out of four eyes. Combined use of pophtetrafluoroethylene and 5-fluorouracil of addition of Viscoat could delay the adjustment for up to four weeks after surgery in four out of five eyes. In conclusion, combined use of polytetrafluoroethylene, 5-fluorouracil and Viscoat could be more helpful for delayine adjustment in rabbits.

Use of Physical Barriers for the Surgical Treatment of Fat Adherence Syndrome: The Effect of Viscoat, Interceed, Polyglactin 910 Mesh and Polytetrafluoroethylene

The fat adherence syndrome is a type of restrictive strabismus resulting from the formation of adherence of orbital tissues to the globe or extraocular muscles in association with violation of Tenon`s capsule. The treatment of fat adherence syndrome has been extremely difficult. In order to determine the efficacy to prevent the development of restrictive scar tissue, the authors created adhesion of inferior rectus muscle to inferior orbital rim in 40 eyes of 20 rabbits. This was followed by placement of normal saline in control group, and Viscoat, Interceed(TC7), polyglactin 910 mesh and polytetrafluoroethylene(PTFE) in experimental groups as physical barriers between the inferior rectus muscle and hole of Tenon`s capsule. Forced ductions were performed 4 weeks postoperatively and histologic examinations were performed. Viscoat made less adhesion, although no difference was noted in terms of length and force for duction. Polyglactin 910 mesh failed to make less adhesion and any difference in length and force for duction. Interceed caused less force for duction, but no difference in the degree of adhesion and the length for duction. Polytetrafluoroethylene(PTFE) did prevent the formation of adhesion between the body of PTFE and the muscle, however the fibrous membrane formed at the edge of PTFE prevented the eye movement. Thus there was no difference in terms of length and force for duction as well as the degree of adhesion in PTFE group. In conclusion, these results may be helpful for studying the management of fat adherence syndrome.

The Effect of Physical Barriers on Delayed Adjustable Strabismus Surgery

Delayed reattachment of the muscle to the sclera may be desirable to correct the angle of deviation developed after the surgery of strabismus. In order to know the possible time for the delayed adjustment, the authors tried Viscoat(R). Interceed(TC7) and polyglactin 910 mesh(Vicryl mesh(R)) as physical barriers for preventing the formation of postoperative adhesions. These materials were placed around between the detached end of the muscle and the sclera in 29 rabbits and adjustment was performed thereafter. Viscoat(R) was effective in delaying the adjustment up to 6 days after surgery. Interceed(TC7) and polyglactin 910 mesh were effective in delaying the adjustment up to 1 week after surgery.