Our Solution

Surgeons appreciate the AbSolute™ Viscera Barrier shield for its excellent performance characteristics - strength, flexibility, and rapid dissolution.

The Challenge:

Every year in the U.S., ~4 million surgeries involve an incision into the abdominal cavity (laparotomy). Closure of the peritoneal cavity requires thorough re-approximation of the fascia (the strength layer of the abdominal wall) to minimize risk of incisional hernia. Incidental bowel perforations from the suture needle during closure cause significant complications.

  • Lack of adequate visualization can result in either direct needle injury to the bowel, or strangulation of the intestine as the fascial suture is tightened, which may entrap the intestine between the suture and the abdominal wall. 5,6

  • Although uncommon, when these injuries do occur, because of their occult nature they inevitably result in significant morbidity including bowel obstruction and necrosis, which in turn leads to spillage of bowel contents, sepsis and even death. 5–10

  • Fear of injuring the bowel (especially during the final phase of closure when visualization of the bowel is limited) may cause the surgeon to take insufficient purchase of the fascia leading to suture pull through, fascial separation, and ultimately an incisional hernia. 5,6

  • Current methods - the Glassman Visceral Retainer or a metal malleable retractor - are only partially effective at protecting bowel and underlying tissue. They must be removed prior to placement of the final fascial sutures, leaving the bowel at risk for injury when visualization is poorest.

As seen in this “typical” laparotomy, closure involves safely and expeditiously closing the fascial edges (yellow arrows) over the bowel (white arrow)

Injury to the bowel may occur due to insufficient visualization during closure, leading to either direct puncture by the surgical needle or strangulation by suture material (white arrow) that has ensnared a loop of bowel (yellow arrow)

 

Our Solution:

Developed by Cornell University with expert material science and clinical insight, the AbSolute Viscera Barrier is transparent, strong, and absorbable, and dissolves in situ in approximately 4-6 hours.

 

Key Features:

  • High strength to prevent needle puncture and material tear until closure is completed

  • Flexibility to allow easy and rapid placement; handles much like the FISH device

  • Only requires initial placement no longer need to frequently reposition like a retractor

  • Broader coverage facilitates complete protection of viscera

  • Transparent for increased visualization of fascial edges for more rapid and reliable closure

  • Biocompatible materials for strong safety profile

  • Rapidly dissolves (approximately 4-6 hours after closure) eliminating need for removal

  • Physical mixture of materials no new molecules formed

 

Dissolution Profile and Puncture Resistance:

Strong enough for long enough, then rapidly dissolves

Dissolution profile

Puncture resistance

 

References:

1. Harris HW (2022) Innovations for Incisional Hernia Prevention, J. of Abdom. Wall Surg. 1:109451.

2. A. Kurian, S. Gallagher, A. Cheeyandira, R. Josloff, Laparoscopic repair of primary versus incisional ventral hernias: time to recognize the differences?,Hernia 14 (2010) 383–387

3. C.E.H. Scott-Conner, Scott-Conner & Dawson Essential Operative Techniques and Anatomy, fourth ed., Lippincott

Williams and Wilkins, Philadelphia, 2014,pp. 224–234.

4. A. Schachtrupp, J. Hoer, C. Tons, U. Klinge, U. Reckord, V. Schumpelick, Intraabdominal pressure: a reliable criterion for laparostomy closure?, Hernia 6 (2002) 102–107

5. M.G. Franz, Complications in abdominal surgery, in: M.W. Hulholland, G.M. Doherty (Eds.), Complications in Surgery, Lippincott Williams and Wilkins, Philadelphia, 2006, pp. 523–545.

6. R.J. Nauta, General laparotomy, in: S.R.T. Evans (Ed.), Surgical Pitfalls: Prevention and Management, Saunders,

Philadelphia, 2009, pp. 67–96.

7. J.A. Margenthaler, W.E. Longo, K.S. Virgo, F.E. Johnson, E.M. Grossmann, T.L. Schifftner, W.G. Henderson, S.F. Khuri,

Risk factors for adverse outcomes following surgery for small bowel obstruction, Ann. Surg. 243 (2006) 456–464.

8. L.M. Wancata, Z.M. Abdelsattar, P.A. Suwanabol, D.A. Campbell, S. Hendren, Outcomes after surgery for benign and malignant small bowel obstruction, J. Gastrointest. Surg. 21 (2017) 363–371.

9. K. Bielecki, P. Kamin´ ski, M. Klukowski, Large bowel perforation: morbidity and mortality, Tech. Coloproctol. 6 (2002) 177–182.

10. J.A. Weigelt, R.G. Kingman, Complications of negative laparotomy for trauma, Am. J. Surg. 156 (1988) 544–547.

11. C. Fink, P. Baumann, M.N. Wente, P. Knebel, T. Bruckner, A. Ulrich, J. Werner, M. W. Buchler, M.K. Diener, Incisional

hernia rate 3 years after midline laparotomy, Br. J. Surg. 101 (2014) 51–54.