Polyvinyl Alcohol Hydrogel Decreases Formation of Adhesions in a Rat Model of Peritonitis

Deerenberg, Eva B.; Mulder, Irene M.; Ditzel, Max; Slieker, Juliette; Bemelman, Willem A.; Jeekel, J.; Lange, Johan F.

doi:10.1089/sur.2011.108

Cited by 22 publications

(17 citation statements)

References 33 publications

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“…Parietene™ showed the least shrinkage at 30 days after implantation (8(1‐25) per cent). Strattice™ and Omyra ® Mesh showed the least shrinkage 90 days after implantation (15 (13–20) and 15 () per cent respectively). Strattice™ showed the least shrinkage 180 days after implantation (13 (5–17) per cent).…”

Section: Resultsmentioning

confidence: 96%

Characteristics of different mesh types for abdominal wall repair in an experimental model of peritonitis

Kaufmann

Jairam

Mulder

et al. 2017

British Journal of Surgery

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This experimental study suggested that XCM Biologic was superior in terms of incorporation, macroscopic mesh infection, and histological parameters such as collagen deposition and neovascularization. There must be sufficient overlap of mesh during placement, as XCM Biologic showed a high rate of shrinkage. Surgical relevance The use of synthetic mesh to repair a potentially contaminated incisional hernia is not supported unequivocally, and may lead to a higher failure rate. A biological mesh might be considered as an alternative. There are few long-term studies, as these meshes are expensive and rarely used. This study evaluated the use of biological mesh in a contaminated environment, and investigated whether there is an ideal mesh. A new non-cross-linked biological mesh (XCM Biologic ) was evaluated in this experiment. The new non-cross-linked biological mesh XCM Biologic performed best and may be useful in patients with a potentially contaminated incisional hernia.

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Section: Resultsmentioning

confidence: 96%

Characteristics of different mesh types for abdominal wall repair in an experimental model of peritonitis

Kaufmann

Jairam

Mulder

et al. 2017

British Journal of Surgery

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“…Every abdominal operation can induce adhesion formation, although in general it has been shown that laparotomy results in more adhesion formation than laparoscopy [18-21]. Another cause for the formation of adhesions is the presence of localized or generalized peritonitis [22, 23]. In this respect, it has been shown that after perforated appendicitis, the incidence of adhesion-related small-bowel obstruction significantly increases compared to that of non-perforated appendicitis [24, 25].…”

Section: Discussionmentioning

confidence: 99%

Severity of Diverticulitis Does Not Influence Abdominal Complaints during Long-Term Follow-Up

et al. 2018

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Background: Diverticulitis can lead to localized or generalized peritonitis and consequently induce abdominal adhesion formation. If adhesions would lead to abdominal complaints, it might be expected that these would be more prominent after operation for perforated diverticulitis with peritonitis than after elective sigmoid resection. Aims: The primary outcome of the study was the incidence of abdominal complaints in the long-term after acute and elective surgery for diverticulitis. Methods: During the period 2003 through 2009, 269 patients were operated for diverticular disease. Two hundred eight of them were invited to fill out a questionnaire composed of the gastrointestinal quality of life index and additional questions and finally 109 were suitable for analysis with a mean follow-up of 7.5 years. Results: Analysis did not reveal any significant differences in the incidence of abdominal complaints or other parameters. Conclusion: This retrospective study on patients after operation for diverticulitis shows that in the long term, the severity of the abdominal complaints is influenced neither by the stage of the disease nor by the fact of whether it was performed in an acute or elective setting.

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“…Furthermore, it could be shown that there was no difference in tissue qualities regarding tensiometry-induced tissue rupture comparing test and control groups; however, once more splenomegaly was identified in the rabbit end-to-end anastomosis model, being related to phagocytosis of the PVA/CMC material. In contrast to rats [30,31,32,33], rabbits seem to be more sensitive to resorption and excretion of PVA/CMC gel. Therefore, the rabbit abdominal wall model as well as the rabbit anastomosis model treated with PVA/CMC gel indicate a limited and adjusted dosage before internal use, suggesting a dosage <2 ml PVA/CMC gel per kg body weight per rabbit and indicating the necessity of a careful adjustment of the dosage in human clinical studies as well.…”

Section: Discussionmentioning

confidence: 97%

“…Medical devices, such as adhesion-preventing agents, must fulfill extensive requirements regarding biocompatibility, safety and efficacy before their admission into common practice [[35], FDA Guidance for resorbable adhesion barrier devices for the use in abdominal and/or pelvic surgery: guidance for industry]. Different study groups have shown the positive anti-adhesion properties of PVA/CMC membranes and gels in different and complex animal models [32,33,37]. Despite the fact that PVA and CMC are commonly used substances for topological medical use, little is known about their internal reactions in the body, although the clearance of PVA out of the body has been described accurately [38].…”

Section: Discussionmentioning

confidence: 99%

“…In addition to promising results regarding functional efficiency, PVA/CMC gel or membrane has been demonstrated to have both the physical and chemical properties necessary to support their use as an adhesion-prevention barrier [26,27,28]. In this case, PVA/CMC gel formed a stable as well as elastic barrier that could be easily and effectively applied [29,30,31] and that yielded a resorption half-life of about 2 weeks, a period that allows sufficient time for the most critical phase of wound healing to occur [32,33]. …”

Section: Introductionmentioning

confidence: 99%

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Standard Biocompatibility Studies Do Not Predict All Effects of PVA/CMC Anti-Adhesive Gel in vivo

Freytag¹,

Odermatt²

2016

Eur Surg Res

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Purpose: PVA/CMC (polyvinyl alcohol/carboxymethyl cellulose) hydrogel fulfills various physiochemical properties required for an adhesion barrier and has shown good anti-adhesion properties in previous in vivo studies. In this investigation, we assessed the in vitro and in vivo biocompatibility of PVA/CMC gel and compared this to the functionality and promotion of wound healing for two surgical indications. Methods: Standardized ISO10993 in vitro and in vivo biocompatibility studies, comprising cytotoxicity, genotoxicity, acute systemic toxicity, delayed contact and maximization sensitization test, intracutaneous reactivity and local muscle implantation, were performed on PVA/CMC gel. In the functional studies, PVA/CMC gel was applied - on the one hand - to a rabbit abdominal wall model enforced with a polypropylene mesh for testing the anti-adhesion properties and - on the other hand - to an end- to-end anastomosis model that was selected for surveying potential influences of different dosages of PVA/CMC gel on anastomotic wound healing. Results: The ISO10993 methods indicated generally good biocompatibility properties, such as the absence of cytotoxic and mutagenic effects as well as no signs of systemic toxicity and sensitization potentials. No irritation effects were observed after the intracutaneous injection of lipophilic PVA/CMC sesame oil extract. However, the injection of hydrophilic PVA/CMC physiologic saline extract induced slight irritation. Following rabbit muscle implantation of the PVA membrane for 2, 4, 12, 26 and 52 weeks, a slight irritant effect was observed at 12 weeks due to the peak of phagocytosis. In the functionality tests, PVA/CMC gel showed good anti-adhesive effects in the abdominal wall model enforced with the mesh, with significantly lower and less tense adhesions compared to the untreated control. However, moderate signs of inflammation, especially in the spleen were observed after the intra-abdominal implantation of 3.3 ml PVA/CMC gel per kg body weight. In the end-to-end anastomosis model, PVA/CMC gel had no influence on wound healing. For dosages of 1-6 ml gel per treatment, no signs of intestinal leaks were detected, and tensile strength was equal to that of the untreated control, but again more moderate signs of inflammation in the spleen were observed at a dosage >3 ml. Conclusion: Comparing the standardized ISO10993 methods, anti-adhesive PVA/CMC gel displays good biocompatibility. However, those methods do not seem to be sensitive enough because the rabbit abdominal wall and the end-to-end anastomosis models display more effects with respect to the dosage and routes of the intra-abdominal resorption of PVA/CMC gel - with the recommended <2 ml PVA/CMC gel per kg body weight as a secure dosage.

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Polyvinyl Alcohol Hydrogel Decreases Formation of Adhesions in a Rat Model of Peritonitis

Cited by 22 publications

References 33 publications

Characteristics of different mesh types for abdominal wall repair in an experimental model of peritonitis

Characteristics of different mesh types for abdominal wall repair in an experimental model of peritonitis

Severity of Diverticulitis Does Not Influence Abdominal Complaints during Long-Term Follow-Up

Standard Biocompatibility Studies Do Not Predict All Effects of PVA/CMC Anti-Adhesive Gel in vivo

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