Satoshi Okubo1, Junichi Shindoh1,2, Yuta Kobayashi1, Masaji Hashimoto1. 1. Hepato-Biliary-Pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, Toranomon, Minatoku, Japan. 2. Okinaka Memorial Institute for Medical Disease, Minatoku, Japan.
Abstract
BACKGROUND: Although adhesion barriers are increasingly used in liver surgery, there are no sufficient data yet in support of their safety. METHODS: Data of 104 consecutive patients in whom a spray-type adhesion barrier (AdSpray®) was used after hepatectomy were compared with those of 94 control subjects in whom no adhesion barriers were used, and the risk factors for major morbidity after hepatectomy were investigated. RESULTS: The incidence of major morbidity was not significantly different between the AdSpray group and the control group (17% vs. 15%, P=0.645), although multivariate analyses revealed that the use of AdSpray was associated with an increased risk of abdominal abscess (odds ratio [OR], 4.42; P=0.043). Similar tendency was also confirmed after propensity score adjustment to account for the potential selection bias. A sub-group analysis revealed that incidence of abscess formation decreased as operators' experience in the used of AdSpray increased, and multivariate analysis identified preoperative chemotherapy (OR, 3.96; P=0.043) as being independent predictors of abscess formation after the use of AdSpray. CONCLUSIONS: AdSpray used was not associated with global incidence of major morbidity after liver surgery, although surgeon's experience would be needed for adequate use of AdSpray to minimize the risk of postoperative abscess formation. This article is protected by copyright. All rights reserved.
BACKGROUND: Although adhesion barriers are increasingly used in liver surgery, there are no sufficient data yet in support of their safety. METHODS: Data of 104 consecutive patients in whom a spray-type adhesion barrier (AdSpray®) was used after hepatectomy were compared with those of 94 control subjects in whom no adhesion barriers were used, and the risk factors for major morbidity after hepatectomy were investigated. RESULTS: The incidence of major morbidity was not significantly different between the AdSpray group and the control group (17% vs. 15%, P=0.645), although multivariate analyses revealed that the use of AdSpray was associated with an increased risk of abdominal abscess (odds ratio [OR], 4.42; P=0.043). Similar tendency was also confirmed after propensity score adjustment to account for the potential selection bias. A sub-group analysis revealed that incidence of abscess formation decreased as operators' experience in the used of AdSpray increased, and multivariate analysis identified preoperative chemotherapy (OR, 3.96; P=0.043) as being independent predictors of abscess formation after the use of AdSpray. CONCLUSIONS: AdSpray used was not associated with global incidence of major morbidity after liver surgery, although surgeon's experience would be needed for adequate use of AdSpray to minimize the risk of postoperative abscess formation. This article is protected by copyright. All rights reserved.