A Sprayable Hydrogel Adhesion Barrier Facilitates Closure of Defunctioning Loop Ileostomy: A Randomized Trial

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Abstract

Purpose:

Closure of defunctioning loop ileostomy often is associated with division of complex peristomal adhesions through a parastomal incision with limited exposure. The goal was to determine whether sprayable hydrogel adhesion barrier (SprayGel™) will reduce peristomal adhesions and facilitate closure of ileostomy.

Methods:

Patients undergoing closure of loop ileostomy were randomized to have hydrogel adhesion barrier sprayed around both limbs of ileostomy for 20 cm (SprayGel™ group, n = 19), or to control without adhesion barrier (control group, n = 21). Ileostomy was reversed at ten weeks after construction. Extent of peristomal adhesions was scored in blinded manner (each quadrant, range, 1-3: 3 = most severe; total, range, 4-12: 12 = most severe).

Results:

Use of adhesion barrier was associated with significant reduction in overall adhesion scores (mean, 6.11vs.9.67;P< 0.0005), four-quadrant adhesion scores (Quadrant A: 1.68vs.2.52,P= 0.002; Quadrant B: 1.42vs.2.33,P< 0.0005; Quadrant C: 1.42vs.2.24,P< 0.0005; Quadrant D: 1.58vs.2.48,P= 0.002), and proportion of patients with dense (scores ≥ 8) adhesions (0.11vs.0.71;P< 0.0005). Time taken to mobilize (16.53vs.21.67 minutes;P= 0.008) and close ileostomy (35.37vs.41.90 minutes;P= 0.008) was significantly reduced. Postoperative complications were comparable.

Conclusions:

A sprayable hydrogel adhesion barrier placed around the limbs of a defunctioning loop ileostomy reduced peristomal adhesions and might facilitate closure of ileostomy.

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