A Trial Protocol to Investigate the Incidence of Postoperative Bowel Obstruction after Laparoscopic Colorectal Cancer Surgery Using an Absorbable Adhesion Barrier Material (INTERCEED) (Balsam CEED Study): A Prospective, Multicenter, Observational Study.

Background: Some studies have reported that adhesion prevention barriers (APBs) reduce adhesion after abdominal surgery; however, evidence showing that APBs reduce the incidence of postoperative small bowel obstruction (SBO), one of the most serious complications after abdominal surgery, is little. One concern is that APBs are usually applied only under the midline incision, although adhesion can occur at any place in the peritoneum where an incision is made during surgery. INTERCEED is an APB that reportedly prevents postoperative SBO after surgery. This study aims to assess the clinical utility of INTERCEED for the prevention of SBO after laparoscopic colorectal cancer surgery and determine whether the application site of INTERCEED affects the incidence of SBO.

Methods/design: This study is a prospective, multicenter, observational study conducted in Japan. The primary end point is the incidence of postoperative SBO 2 years after laparoscopic colorectal cancer surgery. The secondary end points include whether the site of the application of INTERCEED affects the incidence of SBO. Each surgeon selects one of the following three procedures: 1) INTERCEED is placed only under the midline incision; 2) INTERCEED is placed at the site of bowel mobilization and/or lymph node dissection, but not under the midline incision; and 3) INTERCEED is placed at both sites.

Discussion: This is the first study to assess whether the placement of APBs affects the incidence of SBO. The study results may lead to a subsequent randomized study.