Powdered adhesion barrier halved adhesions under the wound after open rectal resection

Design

Multicentre randomised trial, blinded endpoint (PROBE)

Population

131 adults undergoing open rectal resection with planned ileostomy closure, Japan

Primary outcome

Adhesions under the incision at ileostomy closure

Effect

45% (26/58) vs 93% (56/60), P < .001

A multicentre randomised trial at 53 Japanese hospitals enrolled 131 adults undergoing open rectal resection for cancer with a planned later ileostomy closure. Patients and central assessors were blinded. The intervention group had 2 to 3 g of a cross-linked, powdered chondroitin sulfate barrier applied to the abdominal or pelvic cavity before closure. Published in JAMA Surgery on 1 October 2026.

At ileostomy closure, adhesions under the incision were found in 26 of 58 (45%) treated patients and 56 of 60 (93%) controls. Severity and extent were also lower, and no safety concerns were reported.

The endpoint is the adhesion seen at a planned second operation, not bowel obstruction, infertility or pain, so the trial does not yet show the clinical outcomes that matter to patients. It was a pivotal trial of a single product whose availability outside Japan is unknown. It is a promising option in open surgery, not yet a reason to change routine closure.

• Note this as an adhesion-barrier option for open surgery rather than a new standard
• Look for evidence on obstruction and readmission before adopting any barrier routinely
• Check local availability and regulatory status, which are unknown in India
• Record adhesion findings at stoma closure, since that is the outcome this trial measured

Why it matters

Existing sheet barriers are hard to place in the pelvis; a powder addresses that practical problem.

Don't overread it

Fewer adhesions at second look is a surrogate; the trial did not measure obstruction or readmission.

The statistics, in plain English

Adhesions fell from 93% to 45%, an absolute drop of about 48 percentage points, so roughly one in two patients would avoid adhesions under the wound. The large effect is on what the surgeon sees, not on symptoms.

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