New Use of an Absorbable Adhesion Barrier (INTERCEED) for Temporary Diverting Ileostomy in Minimally Invasive Rectal Surgery

Nagasaki, Toshiya; Akiyoshi, Takashi; Mukai, Toshiki; Hiyoshi, Yukiharu; Yamaguchi, Tomohiro; Fukunaga, Yosuke

doi:10.1055/s-0042-1748838

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Journal of Coloproctology (Rio de Janeiro)

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Original Article • J. Coloproctol. (Rio J.) 42 (2) • June 2022 • https://doi.org/10.1055/s-0042-1748838 copy

New Use of an Absorbable Adhesion Barrier (INTERCEED) for Temporary Diverting Ileostomy in Minimally Invasive Rectal Surgery

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives

Sometimes, severe adhesion occurs between the rectus abdominis muscle and the ileal intestinal limbs after temporary diverting ileostomy. This can make ileostomy reversal difficult. The aim of the present study is to assess whether absorbable adhesion barrier made of oxidized regenerated cellulose (INTERCEED) could contribute to improved surgical outcomes in stoma reversal.

Methods

This was a single-institutional retrospective study. A total of 36 consecutive patients who underwent ileostomy reversal by a single surgeon were retrospectively reviewed. INTERCEED was inserted between the ileal limbs and the rectus abdominis muscle at the time of ileostomy creation in 12 patients. Surgical outcomes of the ileostomy reversal were compared between patients treated with and without INTERCEED.

Results

The degree of adhesion formation between the ileal limbs and the rectus abdominis muscles, operating time, and estimated blood loss were significantly reduced in patients treated with INTERCEED compared with those treated by the conventional approach. None of the patients in the INTERCEED group had postoperative complications after the initial surgery and ileostomy reversal.

Conclusions

INTERCEED is suitable for insertion between the ileal limbs and the rectus abdominis muscles because of its softness and flexibility. The use of INTERCEED for diverting ileostomy contributes to reduced adhesion formation, operative time, and blood loss in patients, and further research is needed to confirm our results.

Keywords:
INTERCEED; diverting ileostomy; laparoscopic rectal surgery

	INTERCEED group (n = 12)	No INTERCEED group (n = 24)	p-value
Primary tumor			0.3974
Adenocarcinoma	8	20
Neuroendocrine tumor	4	4
Clinical stage of primary tumor			1.000
I	9	17
II/III	3	7
Neoadjuvant treatment for primary tumor			1.000
No	9	19
Yes	3	5
Type of initial anastomosis			0.2784
Double stapling technique	12	20
Coloanal hand-sewn anastomosis	0	4
Operation time of the initial surgery, minutes (range)	278 (174–345)	278.5 (147–451)	0.6748
Blood loss during the initial surgery, ml (range)	10 (5–50)	15 (3–290)	0.2981
Postoperative complications after rectal surgery			0.5429
No	12	22
Yes	0	2
Enteritis		2
Laboratory results on postoperative day 1
White blood cell count, /µL (range)	9,650 (4,000–11,700)	8,750 (4,,600–13000)	0.5568
Neutrophil count, /µL (range)^# # Neutrophil counts were not available for 3 patients in the INTERCEED® group and for 6 patients in the No INTERCEED group.	7,570 (3,160–9,300)	7,715 (3,580–11,610)	0.9385
C-reactive protein, mg/dL (range)	4.77 (2.27–7.71)	3.81 (1.84–9.61)	0.2082
Hospitalization after primary surgery, days (range)	13.5 (11–-20)	13 (10–19)	0.9730
Adjuvant treatment for primary tumor			0.6910
No	10	18
Yes	2	6
Time to ileostomy closure, days (range)	99.5 (85–213)	120.5 (64–366)	0.2902

	INTERCEED group (n = 12)	No INTERCEED group (n = 24)	p-value
Gender			0.1753
Male	5	16
Female	7	8
Age, years old (range)	66.5 (48–77)	62.5 (31–79)	0.2605
Body mass index, kg/m² (range)	22.8 (14.7–31.7)	22.7 (16.1–26.3)	0.9331
ASA performance status			1.000
1	5	10
2	7	14
Degree of the adhesion between the ileal limbs and the rectus abdominis muscles			0.0163
Not severe	12	15
Severe	0	9
Intraoperative bowel perforation or serosal tears	0	2	0.5429
Operation time, minutes (range)	58 (46–64)	64 (47–98)	0.0357
Estimated blood loss, ml (range)	5 (2–10)	10 (2–70)	0.0060
Laboratory results on postoperative day 1
White blood cell count, /µL (range)	9,100 (5,300–13,100)	9,000 (5,100–15,100)	0.7753
Neutrophil count, /µL (range)^# # Neutrophil counts were not available for 3 patients in the INTERCEED group and for 7 patients in the No INTERCEED group.	9,870 (3,850–10,860)	7,400 (3,560–10,610)	0.7059
C-reactive protein, mg/dL (range)	2.30 (0.74–7.11)	2.95 (0.88–6.81)	0.5798
Postoperative complication^* *Postoperative complications were defined as Clavien-Dindo grade 2 or higher.			0.5429
No	12	22
Yes	0	2
Enteritis		2
Postoperative hospital stay, days (range)	7.5 (6–13)	8 (4–17)	0.2903

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[1] Address for correspondence Toshiya Nagasaki, MD, PhD, Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan (e-mail: toshiya.nagasaki@jfcr.or.jp).