Combined Hemostasis and Adhesion Prevention with the Novel Agent 4DryField<sup>®</sup> PH—Initial Observations

Large size peritoneal trauma from extended surgery for high-grade expansive uterus pathology or endometriosis might result in severe diffuse bleeding and peritoneal adhesion formation with objectionable sequelae. This paper introduces 4DryField® PH polysaccharide powder certified for two indications: 1) given as powder 4DryField® PH provides hemostasis; 2) transformed into gel, 4DryField® PH forms an adhesion prevention barrier. Twenty-one women with expanded uterus pathology and/or deep infiltrating endometriosis had surgery including repair of intestine lesions (n = 8), ureterolysis/repair of bladder, including retrograde ureteric stents (n = 5). Subjective impression of hemostatic effect, drain loss and infection parameters were recorded. Six women had scheduled second look laparoscopy. 4DryField® PH applied as powder showed an immediate significant hemostatic effect in all instances, especially in profound diffuse bleeding. Mean drain loss was 497 ± 339 mL, moderate considering the extent of disease. Dripped with saline solution, 4DryField® PH immediately formed a viscous gel acting as a barrier for adhesion prevention. Second look laparoscopy revealed only one patient with significant adhesions. No adverse events were observed; discharge was at Day 6.2 ± 1.4. In this cohort with extended gynecological laparoscopic surgery 4DryField® PH was very effective for hemostasis. The results of second look laparoscopies showed mainly no or minor adhesions. This can be considered very favorable regarding the extent of disease in these patients. Considering the twofold effect in hemostasis and adhesion prevention, 4DryField® PH is a very helpful tool especially in extensive and complicated surgeries. Prospective randomized studies are necessary to prove these promising results in larger series.