Postoperative Adhesion Prevention with a New Barrier: An Experimental Study

Abstract

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.

Prevention of Intraabdominal Adhesions: An Experimental Study Using Mitomycin-C and 4% Icodextrin

“…The authors concluded that the application of 4% Icodextrin to extensively de-serosalized surfaces was more convenient when compared to other antiadhesive barriers (22)(23)(24). In contrast to the above findings, Ditzel et al (25) showed that 4% Icodextrin was not effective in significantly reducing the formation of adhesions. Additionally, Bellon et al (26) investigated 4% Icodextrin and also failed to show a significant reduction in IAs.…”

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

“…Previously, a significant reduction of postoperative adhesion was recorded for PVA/CMC in rats [30,32], rabbits [27,29] and pigs [31], making the material suitable for consideration as an adhesion-prevention agent for hernia meshes. Fujino et al [39] used a 1.5 × 1.5 cm polypropylene mesh directly on the intact peritoneum of rabbits.…”

“…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]. …”

Effects of abdominal adhesion-preventing 4% icodextrin solution on healing of bowel anastomoses

“…Adezyonu azalttığını belirten çalışmalar olduğu gibi başarısız olduğunu belirten çalışmalarda mevcuttur. [2][3][4][5][6] Müller ve arkadaşlarının [21] yaptığı ça-lışmada ise peritonitli olgularda yapışıklığı azaltmadı-ğı gibi daha sık apse gelişimine neden olduğu bildirilmiştir. Çalışmamızda ise sonuçlar değerlendirildiğinde ikodekstrinin yapışıklık oluşumunu belirgin olarak azalttığı saptandı.…”

“…[1] Adezyon önleyici ajan olarak kullanılan %4'lük ikodekstrin solüsyonunun adezyonu önlemede etkin olduğunu belirten çalışmalar olduğu gibi aksi yönde görüş bildiren çalışmalar da vardır. [2][3][4][5][6] Gastrointestinal sistem anastomozları üzerine etkisi konusunda ise literatürde üç adet deneysel çalışmaya ulaşılmıştır. [7][8][9] Çalışmaların ikisinde anastomoz iyileşmesini olumsuz yönde etkilemediği belirtilirken bir tanesinde aksi yönde görüş bildirilmiştir.…”