POWH Journal Club Dr Anita Jacombs BST

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POWH Journal Club Dr Anita Jacombs BST

• Reduction in Adhesive Small-Bowel Obstruction
  by Seprafilm Adhesion Barrier After Intestinal
  Resection
• VW Fazio, Z Cohen, JW Fleshman et alDis
  Colon Rectum 2005 49(1) 1-11.

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Evaluating the Article- Background

• Hypothesis

Adhesive small bowel obstruction (ASBO) common
complication of abdominopelvic surgery.
Seprafilm reduces incidence, extent and severity
of adhesion formation in various abdominopelvic
surgery.

• Is there reduction in adhesive small bowel
  disease?

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Evaluating the Article- Background

• Clinical Question

Does the intraoperative use of Seprafilm reduce
the incidence of small-bowel obstruction due to
adhesions
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Evaluating the Article- Study Design

• Prospective, randomized, multicentre, patient
  blinded study

• Sample size 1700 with power 80 to detect a 25
  relative reduction in adhesive bowel reduction.

• Diagnosis of Bowel Obstruction at 1a -
  operation/autopsy 1b - confirmed
  radiologically 2 - suspected symptoms
  radiologically

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Evaluating the Article- Execution of the study

• Sample size n1701 (T840, C861)

• Operations as indicated by symptoms/diagnosis
  Inflammatory Disease (T61.5, C63.8)
  Diverticular Disease (T14.9, C11.4)
  Fistula Polyps (T15.4, C16.1)
  Other (T 9.2,
  C10.1)

• Randomized at conclusion of operation -
  treatment received 3-10 layers of Seprafilm

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Evaluating the Article- Execution of the study

• Attrition rate No drop out randomized at time
  of operation Low loss to follow-up

• Statistics analyzed by intention to treat

• Confounders lower rate of bowel obstruction
  inflammatory bowel (60)perioperative steroids
  2/3 had previous abdominal surgery88 evidence
  of bowel adhesions

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Assessment of Conclusions

• Rate of all bowel obstruction 12

• Majority managed non-operatively

• ASBO in operative group (1a)- Seprafilm 1.8
  v Control 3.4 (Plt0.05)- ARR 1.6- NNT 64

• All first ASBO occurred within 3 years- 50
  within 6 months- 30 in first 30 days

• Complications due to use of Seprafilm not
  documented

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Application of the Study

• Surgical Practice

Morbidity of post operative bowel obstruction

Rate of bowel obstruction unchanged
Halved the risk of requiring an operation for
ASBO (3.4 to 1.8),
Cost of using Seprafilm

• Further Researchother abdominopelvic
  surgerieslower rate of bowel obstruction

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Discussion