What is the comparison between Seprafilm (hyaluronic acid) and Interceed (oxidized regenerated cellulose) for adhesive barrier?

From the Guidelines

Seprafilm (hyaluronic acid) is the preferred choice over Interceed (oxidized regenerated cellulose) for adhesive barrier due to its broader coverage, longer persistence, and proven efficacy in reducing the incidence of reoperations for adhesive small bowel obstruction (ASBO) in colorectal surgery, as evidenced by a relative risk of 0.49 (95% CI 0.28–0.88) 1.

Key Differences Between Seprafilm and Interceed

• Seprafilm is a solid barrier most suitable for open surgery, although laparoscopic placement has been described, and it reduces adhesion formation as well as the risk for reoperations for ASBO 1.
• Interceed is also a solid barrier but is most suitable for open surgery and has only been studied in gynecological procedures, reducing the incidence of adhesion formation but with no available studies on the subsequent risk of ASBO 1.
• The choice between Seprafilm and Interceed may depend on the surgical site, with Seprafilm being more versatile for general surgery and abdominal/pelvic surgeries, and Interceed being recommended for gynecological procedures.

Efficacy and Safety Considerations

• Both Seprafilm and Interceed have demonstrated effectiveness in reducing adhesion formation, but Seprafilm has a more established record in general surgery and for preventing ASBO 1.
• Seprafilm's composition of hyaluronic acid and carboxymethylcellulose allows it to transform into a gel within 24-48 hours after placement, providing a longer-lasting barrier against adhesions.
• Interceed, made of oxidized regenerated cellulose, dissolves more quickly and must be applied to completely dry surfaces to be effective, limiting its use in situations with expected bleeding.

Clinical Decision Making

• The decision to use Seprafilm over Interceed should be based on the specific surgical needs, including the type of surgery, the area to be covered, and the surgeon's preference, considering the efficacy, safety, and cost-effectiveness of each option 1.
• Given the moderate evidence supporting the use of hyaluronate carboxymethylcellulose (Seprafilm) in reducing the incidence of reoperations for ASBO, it is a preferable choice for surgeries where adhesion prevention is critical, such as in colorectal surgery 1.

From the Research

Comparison of Seprafilm and Interceed

• Seprafilm (hyaluronic acid) and Interceed (oxidized regenerated cellulose) are two types of adhesion barriers used to prevent postoperative adhesions.
• Studies have shown that both Seprafilm 2, 3, 4, 5 and Interceed 4, 6 can reduce the incidence of postoperative adhesions.
• Seprafilm has been shown to be effective in reducing adhesions in abdominal and pelvic surgery, with a significant reduction in the incidence, extent, and severity of adhesions 2, 3, 5.
• Interceed has also been shown to be effective in reducing adhesions, particularly in gynecological surgery, but its use may be associated with an increased risk of adhesions if optimal hemostasis is not achieved 6.
• A comparison of the two barriers suggests that Seprafilm may be more effective in preventing adhesions, especially in patients undergoing myomectomies 6.
• However, both barriers have been shown to be safe and effective in reducing postoperative adhesions, and the choice of barrier may depend on the specific surgical procedure and patient population 4, 6.

Key Differences

• Seprafilm is a bioresorbable membrane made of chemically modified hyaluronic acid and carboxymethylcellulose, while Interceed is made of oxidized regenerated cellulose.
• Seprafilm has been shown to be effective in reducing adhesions in a wider range of surgical procedures, including abdominal and pelvic surgery 2, 3, 5.
• Interceed may be more effective in gynecological surgery, particularly in patients with endometriosis or pelvic inflammatory disease 6.

Clinical Implications

• The use of adhesion barriers such as Seprafilm and Interceed can reduce the incidence of postoperative adhesions and improve patient outcomes 4, 6.
• Surgeons should consider using an adhesion barrier in patients who are at high risk of forming clinically significant adhesions, such as those with endometriosis or pelvic inflammatory disease 6.
• The choice of adhesion barrier should be based on the specific surgical procedure and patient population, as well as the surgeon's preference and experience 4, 6.