Surgical sutures has been applied from ancient surgery untul now. Some Doctor has been implemented some addesive into the new ones. Postoperative adhesions occur when fibrous strands of internal scars attach to anatomical structures. Previous intra-abdominal surgical interventions are a common cause of peritoneal adhesions. The most severe complications based on the occurrence of intra-abdominal adhesions are small bowel obstruction (60–70 %), female infertility (20–40 %), chronic abdominal pain and technical difficulties in the case of a reoperatio. A variety of adhesion barriers and strategies have been developed in order to prevent or at least to reduce postoperative adhesions. These include films, viscous gels or intra-abdominal solutions, but so far no standard treatment has been established. The most common method in adhesion prevention is to apply a barrier between the wounded surfaces. Barrier materials should be easy to apply and should remain in place for several days to allow serosal re-epithelium formation and should be absorbed afterwards and excreted without systemic reactions or inappropriate accumulation. Materials that are non-inflammatory, non-reactive and not interfering with the healing process of incision wounds or anastomoses are well suitable. Until today, the problem of peritoneal adhesions remains in general largely unsolved and an effective prevention method is not routinely used in abdominal surgery leading to significant clinical and economical consequences. Annual costs of peritoneal adhesion related problems are estimated in Sweden to be €40–60 million; and more than 300,000 patients are estimated to undergo treatment due to adhesion induced small bowel obstruction in the US annually.
Thus, the hydrogel A-Part Gel® which is a bio-absorbable transparent gel composed of polyvinylalcohol (PVA) and carboxymethylcellulose (CMC) was developed. Both components are used for various biomedical applications and their biocompatibility have been confirmed. A-Part Gel® is intended to operate as a physical barrier between injured surface to reduce post-surgical adhesions.
Intra-abdominal surgical intervention can cause the development of intra-peritoneal adhesions. To reduce this problem, different agents have been tested to minimize abdominal adhesions; however, the optimal adhesion prophylaxis has not been found so far. Therefore, the A-Part® Gel was developed as a barrier to diminish postsurgical adhesions; the aim of this randomized controlled study was a first evaluation of its safety and efficacy.
sientist as reported from paper A-Part Gel, an adhesion prophylaxis for abdominal surgery: a randomized controlled phase I–II safety study from Reinhold Lang, Petra Baumann,Claudia Schmoor, Erich K. Odermatt, Moritz N. Wente, and Karl-Walter Jauch.
It has method 62 patients received either the hydrogel A-Part-Gel® as an anti-adhesive barrier or were untreated after primary elective median laparotomy. Primary endpoint was the occurrence of peritonitis and/or wound healing impairment 28 ± 10 days postoperatively. As secondary endpoints anastomotic leakage until 28 days after surgery, adverse events and adhesions were assessed until 3 months postoperatively.
A-Part Gel® is safe as an adhesion prophylaxis after abdominal wall surgery but no reduction of postoperative peritoneal adhesion could be found in comparison to the control group. This may at least in part be due to the small sample size as well as to the incomplete coverage of the incision due to the used application.