Postoperative Peristomal Adhesions decreased by the use of Sodium Hyaluronate Gel and Chitosan
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Sodium Hyaluronate Gel and Chitosan are Effective in Preventing Postoperative Peristomal Adhesions after Defunctioning Enterostomy
Peristomal adhesions complicate closure of defunctioning enterostomy. The efficacy and safety of sodium hyaluronate gel and chitosan in preventing postoperative adhesion have not been extensively studied. This study aims to evaluate the safety and efficacy of sodium hyaluronate gel and chitosan in the prevention of postoperative peristomal adhesions.
This was a prospective randomized controlled study.
One hundred and fourteen patients undergoing defunctioning enterostomy were enrolled. Patients were randomly assigned to receive sodium hyaluronate gel (SHG group) or chitosan (CH group) or no antiadhesion treatment (CON group) during defunctioning enterostomy. The safety outcomes included toxicities, stoma-related complications, and short-term and long-term postoperative complications. Eighty-seven (76.3%) of the 114 patients received closure of enterostomy, during which occurrence and severity of intra-abdominal adhesions were visually assessed by a blinded assessor. Incidence of adhesion appears to be lower in patients received sodium hyaluronate gel or chitosan but differences did not reach a significant level (SHG group vs CH group vs CON group: 62.1% vs 62.1% vs 82.8%, P = 0.15). Compared with the CON group, severity of postoperative adhesion was significantly decreased in the SHG and CH group (SHG group vs CH group vs CON group: 31.0% vs 27.6% vs 62.1%; P = 0.01). There was no significant difference in the occurrence of postoperative complications and other safety outcomes among the 3 groups. Sodium hyaluronate gel or chitosan smeared around the limbs of a defunctioning enterostomy was safe and effective in the prevention of postoperative peristomal adhesions.
A total of 114 patients were enrolled and were randomly assigned to 3 groups (Fig. 1). Eighty-seven (76.3%) patients (29 patients in each group) underwent the closure of the enterostomy. Twenty-seven cases did not receive the closure of enterostomy because of death (n¼2, 1.8%, 1 in the SHG group due to tumor metastasis, 1 in the CON group due to cardiovascular accident), postoperative complications (n¼6, 5.3%), cancer progression (n¼4, 3.5%), closure in other hospitals (n¼2, 1.8%), personal reasons (n¼2, 1.8%), or in adjuvant chemotherapy (n¼11, 9.6%). Age (P¼0.74) and gender (P¼0.85) did not differ significantly among the 3 groups. The majority of the patients (83.3%) had an underlying disease of colorectal cancer (89.5%, 86.5%, and 74.4% for SHG, CH, and CON groups, respectively, P¼0.17). The proportion of patients having preoperative chemotherapy or radiotherapy was similar among the 3 groups (P¼0.36 and P¼0.70, respectively). No patient received steroids or immunosuppressant within 3 years before the enterostomy. The mean_SD age was 50.31_15.61 years (SHG group), 53.0_15.79 years (CH group), and 51.10_14.30 years (CON group), with no significant between-group difference (P¼0.79). There was a slight male preponderance in the CON group, but the difference was not significant (P¼0.21).
Jiancong Hu, et al. Safety and Efficacy of Sodium Hyaluronate Gel and Chitosan in Preventing Postoperative Peristomal Adhesions after Defunctioning Enterostomy Medicine (Baltimore). 2015 Dec; 94(51)
Available at: http://www.ncbi.nlm.nih.gov/pubmed/26705233/