- Design
- Multicentre randomised trial with blinded end-point assessment
- Population
- 118 adults after open rectal resection with planned ileostomy closure, Japan
- Primary outcome
- Adhesions under the incision at second surgery
- Effect
- 45% vs 93% (p < 0.001)
This multicentre randomised trial at 53 Japanese hospitals enrolled patients undergoing open rectal resection for cancer with a planned later ileostomy closure, which allowed adhesions to be inspected directly at the second operation. Patients received 2–3 g of a cross-linked chondroitin sulfate powder before closure, or nothing. Assessors on a central review board were blinded.
Adhesions under the incision were found in 45% of the barrier group (26 of 58) against 93% of controls (56 of 60), and severity and extent were reduced. No safety concerns were reported.
The primary outcome is adhesion incidence seen at reoperation, not adhesive bowel obstruction, infertility or pain, which are what patients care about. The product is not widely available, and trials of earlier barriers that reduced visible adhesions have not consistently reduced obstruction. This is promising for easing future re-entry, not yet a reason to change routine closure.
- The trial measured visible adhesions at stoma closure, not adhesive obstruction.
- A powder form may suit uneven pelvic surfaces where sheet barriers are hard to place.
- Availability outside Japan is uncertain; do not expect it on Indian theatre shelves yet.
- Watch for trials reporting obstruction and readmission before adopting routinely.
Why it matters
Adhesions drive much of the burden of reoperation, and few barriers work well in the pelvis.
Don't overread it
Adhesion incidence is a surrogate; the trial did not show fewer obstructions.
The statistics, in plain English
The difference from 93% to 45% is large and unlikely to be chance. But it is a surrogate outcome: fewer adhesions seen at surgery does not automatically mean fewer bowel obstructions later.
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