The Effect of Sprayable Adhesion Barriers in Revisional Obesity Surgery

Abstract

Revision bariatric surgery is technically demanding and associated with high morbidity rates due to formation of adhesions and distortion of proximal gastric anatomy. Two cases of failed gastric band were presented who required gastric sleeve. The patient who received adhesive barrier during removal of the band had less adhesion during the second procedure. This finding leads to a study to assess whether the application of an adhesion barrier film onto the operative field after the removal of the gastric band had any impact on the number and amount of adhesions at the time of the revision surgery after failed gastric banding. A study with 19 patients having band removal followed by sleeve gastrectomy 3 months later was performed. The patients were randomized to either a control group (11 patients) who received band removal only or an active group (eight patients) who had a sprayable adhesion barrier applied at the time of band removal. The second procedures for both groups were independently graded for adhesions. All procedures were recorded and were assessed in a blind fashion as to the severity of adhesions (grade 1 - 5). The total adhesion score for the control group (n = 11) was 32 (mean 2.82). The active group (n = 8) had a total adhesion score of 12 (mean 1.5). Statistical adhesion scored P = 0.05. The average operative time for the control group and active group was 73 and 56 min (P = NS). In our study, an adhesion barrier leads to a statistically significant reduction in adhesion formation and operative time. This warrants consideration of a larger trial to assess whether adhesion barriers may reduce morbidity in re-operative bariatric surgery.




J Med Cases. 2018;9(3):92-95
doi: https://doi.org/10.14740/jmc3008w