Effect of Different Barriers of Oxidized Regenerated Cellulose (ORC) on Cecal and Sidewall Adhesions in the Presence and Absence of Bleeding

Wiseman, David M.; Gottlick-Iarkowski, L.; Kamp, L.

doi:10.1080/089419399272539

Cited by 57 publications

(11 citation statements)

References 22 publications

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“…However, made of oxidized cellulose, it is considered as xenobiotics and has low biocompatibility and low adhesiveness to tissues. Furthermore, when bleeding is not com pletely controlled at the applied site, its efficacy is lowered [9,10]. Accordingly, it is necessary to develop a tissue adhesion barrier that has enhanced safety, flexibility, and adhesiveness to tissues.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of hyaluronate membrane in the rabbit cecum-abdominal wall adhesion model

Kim

Cho²,

Kim³

et al. 2013

J Korean Surg Soc

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PurposeTissue adhesion is a well-known postsurgical phenomenon, causing pain, functional obstruction, and difficult reoperative surgery. To overcome these problems, various synthetic and natural polymer membranes have been developed as postoperative tissue adhesion barriers. However, limitation in their use has hindered its actual application. We prepared a hyaluronate membrane (HM) to evaluate its efficacy and safety as an adhesion barrier compared to a commercialized product (Interceed, Ethicon).MethodsTo evaluate the antiadhesion effect, a cecum-abdominal wall abrasion model was adopted in a rabbit. The denuded cecum was covered by Interceed or HM or neither and apposed to the abdominal wall (each, n = 10). Four weeks after surgery, the level of adhesion was graded. Acute and chronic toxicity of the three groups were also evaluated.ResultsBlood samples drawn to evaluate acute toxicity at postoperative day 3 and 7 showed no significant difference among the three groups. The grade and area of adhesion were significantly lower in the HM compared to those of the control and Interceed at four weeks after surgery. Histologic evaluations, which was carried out to estimate tissue reactions at the site of application, as well as to assess chronic toxicity for the major organs, were not significantly different in the three groups.ConclusionThis study showed that the antiadhesion efficacy of HM was superior to commercialized antiadhesion membrane, Interceed. Low inflammatory response and nontoxicity were also demonstrated. From these results, we suggest that the HM is a good candidate as a tissue adhesion barrier.

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Section: Discussionmentioning

confidence: 99%

“…The representative antiadhesive agents are Interceed (Ethicon, Somerville, NJ, USA) [8-10], which was synthesized from ORC; Seprafilm (Genzyme Co., Cambridge, MA, USA) [9,10] crosslinked HA and CMC; and Surgiwrap (Mast Biosurgery, San Diego, CA, USA) [11,12] using Poly (lactic acid).…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of hyaluronate membrane in the rabbit cecum-abdominal wall adhesion model

Kim

Cho²,

Kim³

et al. 2013

J Korean Surg Soc

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“…Oxidized regenerating cellulose (Interceed®, Ethicon, Sommerville, NJ) is the only adhesion barrier that was proven to increase pregnancy rate in an RCT [23]. However, oxidized regenerating cellulose has limitations because it is difficult to handle laparoscopically and can cause adverse adhesiogenic effects in the presence of blood [24, 25]. Studies evaluating the efficacy of adhesion barriers in reducing the number of ASBO and enterotomies are rare.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of polyethylene glycol adhesion barrier after gynecological laparoscopic surgery

et al. 2011

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Postoperative adhesions are the most frequent complication of peritoneal surgery, causing small bowel obstruction, female infertility and chronic pain. This pilot study assessed the efficacy of a sprayable polyethylene glycol (PEG) barrier in the prevention of de novo adhesions. 16 patients undergoing laparoscopic gynecological surgery were randomly assigned by shuffled sealed envelopes to receive either the adhesion barrier or no adhesion prevention. Incidence and severity of adhesions were scored at eight sites in the pelvis and reassessed by second look laparoscopy. Adhesion prevention was considered successful if no de novo adhesion were found at second look laparoscopy. One patient was excluded before randomization. Nine patients were randomized to treatment and six patients to control group. De novo adhesions were found in 0/9 patients who received the PEG barrier compared to 4/6 without adhesion prevention (0% vs. 67%, P = 0.01). Reduction in adhesion score was significantly greater in patients receiving PEG barrier (−2.6 vs. −0.06, P = 0.03). Meta-analysis of three randomized trials demonstrated that PEG barrier reduces the incidence of adhesions (odds ratio [OR] = 0.27; 95% CI 0.11–0.67). From this study, PEG barrier seems effective in reducing postoperative formation of de novo adhesions.

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“…In contrast, several physical barriers are approved and available on the market as adhesion reduction agents. Nevertheless, their success in safety, costs and effectiveness vary [18,20,21,22,23,24,25]. A recent study revealed the results of 10-year follow-up after Hartmann’s procedure and the use of Seprafilm.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Adhesion Prevention with a New Barrier: An Experimental Study

Ditzel

Deerenberg²,

Komen³

et al. 2012

Eur Surg Res

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Introduction: Postoperative adhesion formation remains a major clinical problem. The aim of this study was to test the effect of a new hydrogel on adhesion formation in a rat model. Materials and Methods: A reproducible rat model was used to induce standardized adhesion formation in three experiments. In experiment 1, a cross-linked polyvinyl alcohol (PVA) and carboxymethylcellulose (CMC) hydrogel (PVA/CMC, A-Part®; B. Braun Aesculap, Germany) was tested in different dosages. In experiment 2, PVA/CMC gel was compared to icodextrin 4% (Adept®; Baxter USA). In both groups, animals were sacrificed after 2 weeks. In experiment 3, histological examination after 4 and 6 weeks was performed. The percentage of adhesions to the defect was measured and the density was determined according to the Zühlke scale. During histological examination of the abdominal wall, the formation of neoperitoneum and potential residues of the agents were assessed. Results: In experiment 1, a significant reduction in amount as well as density of the adhesions was visible with all dosages of PVA/CMC gel. In experiment 2, again quantity and density of the adhesions were diminished by PVA/CMC hydrogel compared to the control group. Icodextrin 4% showed no significant reduction in adhesion formation. In experiment 3, no residues of PVA/CMC gel or icodextrin 4% were found during histological examination after 4 and 6 weeks and neoperitoneum was present in all cases. Conclusion: PVA/CMC hydrogel appears to be a novel effective adhesion prevention agent. Together with an upcoming safety study, these data encourage to start clinical efficacy studies.

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Effect of Different Barriers of Oxidized Regenerated Cellulose (ORC) on Cecal and Sidewall Adhesions in the Presence and Absence of Bleeding

Cited by 57 publications

References 22 publications

Efficacy and safety of hyaluronate membrane in the rabbit cecum-abdominal wall adhesion model

Efficacy and safety of hyaluronate membrane in the rabbit cecum-abdominal wall adhesion model

Efficacy of polyethylene glycol adhesion barrier after gynecological laparoscopic surgery

Postoperative Adhesion Prevention with a New Barrier: An Experimental Study

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