From the Guidelines
Seprafilm (hyaluronic acid) is the preferred adhesion barrier for use in cesarean sections due to its ease of placement, better coverage of irregular surfaces, and effectiveness in reducing adhesion formation, as evidenced by a relative risk of 0.49 for reoperations for adhesive small bowel obstruction 1. When comparing Seprafilm and Interceed, several factors come into play, including their composition, application, and efficacy.
- Seprafilm is a hyaluronate carboxymethylcellulose adhesion barrier that has been shown to reduce the incidence of reoperations for adhesive small bowel obstruction in colorectal surgery 1.
- Interceed, on the other hand, is an oxidized regenerated cellulose barrier that has been studied primarily in gynecological procedures and has been found to reduce the incidence of adhesion formation, but its effectiveness in preventing subsequent risk of adhesive small bowel obstruction is not well established 1. Key differences between the two barriers include their suitability for open versus laparoscopic surgery, with Seprafilm being more versatile in this regard.
- Seprafilm can be used in both open and laparoscopic procedures, whereas Interceed is more suited for open surgery 1.
- Additionally, Seprafilm has been found to be cost-effective in open colorectal surgery 1. While both barriers have their advantages and disadvantages, the choice between Seprafilm and Interceed should be based on the specific surgical situation, surgeon preference, and cost considerations, with a focus on minimizing morbidity, mortality, and improving quality of life for the patient.
- Ultimately, the decision to use Seprafilm or Interceed should prioritize the patient's outcomes, and Seprafilm's proven efficacy in reducing adhesion formation and reoperations makes it the preferred choice 1.
From the Research
Comparison of Seprafilm and Interceed as Adhesion Barriers
- Seprafilm, composed of hyaluronic acid and carboxymethylcellulose, has been shown to be effective in preventing adhesion formation, especially following myomectomies 2, 3.
- Interceed, an oxidized regenerated cellulose adhesion barrier, is associated with a reduced incidence of pelvic adhesion formation at both laparoscopy and laparotomy when complete hemostasis is achieved 2, 4, 3.
- However, Interceed may increase the risk of adhesions if optimal hemostasis is not achieved 2.
- Seprafilm has been found to be effective in reducing adhesions following cesarean deliveries, although the evidence is preliminary 4.
- In a murine model, Adcon-P (a different adhesion barrier) was found to be more effective than Seprafilm in preventing adhesions, but using Seprafilm only in the relaparotomy was as effective as using it in both laparotomies 5.
- A pilot study found that Sepraspray Adhesion Barrier, a modified hyaluronic acid and carboxymethylcellulose powder, was associated with a trend toward a reduction in postoperative adhesion development after laparoscopic myomectomy 6.
Efficacy in Preventing Adhesions
- Interceed has been shown to reduce the incidence of adhesion formation, both new formation and re-formation, at laparoscopy and laparotomy 2, 3.
- Seprafilm has been found to be effective in preventing adhesion formation, especially following myomectomies, but there is limited evidence on its effectiveness in preventing adhesion formation in women following cesarean deliveries 2, 3.
- Gore-Tex, another adhesion barrier, has been found to be more effective than Interceed in preventing adhesion formation, but its usefulness is limited by the need for suturing and later removal 3.