Hideto Oishi, MD, PhD1, Takayuki Iino, MD, PhD1, Takahiro Okamura, MD, PhD2. 1Department of Surgery, Murayama Medical Center, National Hospital Organization, 2Department of Surgery 2, Tokyo Women’s Medical University
Objective: We describe our experiences of using an effective new device to insert adhesion barrier film during reduced port surgery. In Japan, there are many cases of both gastrectomy and postcholecystectomy. When we perform distal gastrectomy, if patients have already undergone cholecystectomy, they might also have severe abdominal adhesions. Seprafilm is a mechanical bioresorbable adhesion barrier that is an effective tool to avoid surgical adhesions. Its placement is also simple and easy in open surgery. Its placement in laparoscopic surgery, however, is not always simple or easy, especially in reduced port surgery. We believe that it is very important to avoid adhesions not only of laparotomy wounds but also in the area of the cholecystectomy. Sepralap is a new device for winding up Seprafilm prior to inserting it through a 5-mm laparoscopic trocar to make the operation simpler and easier.
Materials and methods: A 37-year-old man with gallbladder polyps underwent laparoscopic cholecystectomy by reduced port surgery. Our reduced port surgery was constructed with the umbilical single-incision method with multi-port glove platform, and with two puncturing ports with needle-like forceps. The multi-port glove platform was equipped with 12-mm and 5-mm trocars. Two 2.4-mm Endo Relief needle-like forceps were inserted through each of the two puncturing ports. After cholecystectomy, we used the Sepralap to insert a quarter pack (97.35 cm * 6.35 cm) of Seprafilm into the abdominal cavity through the 5-mm trocar and placed the Seprafilm in the area ablated for the cholecystectomy.
Results: Insertion of Seprafilm by Sepralap was smooth, simple, and easy. We could insert it without crack. The Seprafilm was easily released from the Sepralap and was also easily positioned on the ablated area of the liver bed. There were no complications or difficulties.
Conclusions: Surgical adhesions do not always occur at the site of the incisional scar on the abdominal wall; they may also occur by avulsion at the liver bed during cholecystectomy. Sepralap allowed Seprafilm to be inserted smoothly and easily into the abdominal cavity through a 5-mm trocar without crack. Sepralap might make the effectiveness of Seprafilm for adhesion avoidance in incisional wounds of the abdominal wall also available to many kinds of laparoscopic surgical sites, such as at the suture site in the peritoneum during transabdominal preperitoneal hernia repair.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78920
Program Number: P418
Presentation Session: Poster (Non CME)
Presentation Type: Poster