Hyaluronic Acid/Carboxymethylcellulose Membrane Barrier versus Taurolidine for the Prevention of Adhesions to Polypropylene Mesh

Abstract

Background: A hyaluronic acid/carboxymethylcellulose (HA/CMC) membrane is an effective measure to prevent polypropylene mesh induced adhesions. We hypothesized that taurolidine 2% solution might be a cost-effective alternative to decrease adhesion formation. Materials and Methods: Twenty-four rats were randomized into three groups: mesh alone (group 1), mesh + taurolidine 2% (group 2), and mesh + HA/CMC (group 3). Polypropylene mesh (4 cm²) was used to repair surgically induced anterior abdominal wall defects. Taurolidine 2%or a HA/CMC membrane was used as an antiadhesive measure. The animals were sacrificed 6 weeks after the operation, and adhesions to the prosthetic material were evaluated with digital image analysis. Results: Group 1 (mesh alone) had the highest adhesion ratio (58.5 ± 4.8%) compared with groups 2 and 3 (p < 0.05). The differences between groups 2 (mesh + taurolidine 2%; adhesion ratio 42.9 ± 1.6%) and 3 (mesh + HA/CMC; adhesion ratio 40.3 ± 3.0%) were not significant (p > 0.05). Conclusions: The animals of both treatment groups (2 and 3) had lower adhesion ratios compared with the controls (group 1). In particular, the HA/CMC membrane did not present with a superior antiadhesive effect compared with taurolidine. Therefore, taurolidine is a cost-effective alternative to HA/CMC membranes when a polypropylene mesh is used in direct contact with the abdominal viscera.

Evaluation of 4DryField® PH as Adhesion Prevention Barrier Tested in an Optimized Adhesion Model in Rats

“…As compared to results recently published in the literature using Adept® (Baxter Healthcare Corporation, USA) [28,29,30,31,32,33], Interceed® (Ethicon, Inc., USA) [25,27,29,34,35,36,37,38,39], and Seprafilm® (Genzyme Corporation, USA) [26,27,31,34,38,39,40,41,42,43,44] in rat models, the results obtained with 4DryField PH in this study are in the upper range of benefit and are comparable with the data of Kaptanoglu et al [43] and Wallwiener et al [29]. …”

Intra-Abdominal Use of Taurolidine or Heparin as Alternative Products to an Antiadhesive Barrier (Seprafilm®) in Adhesion Prevention: An Experimental Study on Mice

“…Many experimental and clinical studies have revealed that taurolidine has significant antiadherent activity on pathogen microorganisms, and although the data are conflicting, possibly decreases postoperative peritoneal adhesion formations. [17][18][19]27 Opitz et al 17 showed in an experimental study that the use of heparin and taurolidine led to a significant reduction of intraperitoneal tumor growth, however, did not decrease the severity of adhesions. In contrast, a recent study comparing the effectiveness of Seprafilm \ and taurolidine revealed similar results when the products were used for the purpose of preventing mesh-induced adhesions.…”

“…16 Finally, experimental studies have demonstrated that the product may be used as an antiadhesive, probably as a consequence of its antimicrobial and antiproliferative effects. [17][18][19] In addition, advantages, such as cost effectiveness and liquid form of the product, may lead the acceptance of its use in open and laparoscopic surgery.…”

Prevention of Abdominal Adhesions – Present State and What’s beyond the Horizon?

“…Other authors have, however, seen an increase in adhesions after antibiotic abdominal irrigation [46] . The bactericidal taurolidine has reduced adhesions experimentally [47] . Chemotherapeutics such as 5-FU [48] and mitomycin C [49] have also been evaluated and demonstrated to reduce the extent of adhesions.…”