2008 Annual Meeting Abstracts
Hyaluronic Acid/Carboxymethylcellulose (HA/CMC) Adhesion Barrier is Only Effective in Reducing Adhesion Formation at the Site of Placement in a Rat Model
Rizal Lim, MD1, Jonathan M. Morrill, MS1, Ryan C. Lynch, BA2, Karen L. Reed, PhD.1, Adam C. Gower, MS1, Susan E. Leeman, PhD.1, Arthur F. Stucchi, PhD.1, James M. Becker, MD1.
1Boston University Medical Center, boston, MA, USA, 2Boston University Medical Center, Boston, MA, USA.
Objective: Postoperative intra-abdominal adhesions are a source of morbidity to patients and may cause pain, infertility, bowel obstruction, and bowel ischemia. Seprafilm™ (Genzyme) is a frequently used adhesion-reducing barrier composed of HA/CMC that separates adhesive surfaces. However, the effectiveness of HA/CMC barrier may be strictly limited to their region of placement. We aim to evaluate the effectiveness of HA/CMC in preventing adhesions at sites away from barrier placement.
Design: Controlled animal study performed on 29 male Wistar rats. Adhesion formation was induced by creating 3-4 ischemic buttons of the parietal peritoneum on each side of the midline incision. Experimental groups received either midline HA/CMC placement (beneath laparotomy incision), or unilateral placement (covering half of the ischemic buttons). Untreated operative controls were used. Animals were CO2-euthanized at postoperative day 7 and reopened. Adhesions were scored as the percentage of ischemic buttons with formed adhesions.
Setting: University-based research laboratory and animal facility
Interventions: Not applicable
Main Outcome Measures: Decreased adhesion formation at postoperative day 7 compared to controls.Results: Adhesion formation was 80±7.9% in control animals (n=6). Animals receiving midline applications of HA/CMC showed no significant decrease in adhesion formation to ischemic buttons (72±7.0%, n=6). Animals receiving unilateral HA/CMC placement showed a significant decrease in adhesion formation at HA/CMC covered ischemic buttons (35± 7.0%, n=17, p<0.05), while adhesion formation at ischemic buttons without HA/CMC were not significantly different from control (80±5.0%).
Conclusions: HA/CMC barriers significantly reduce adhesion formation only in areas where applied. This demonstrated a limitation to the adhesion preventing function of HA/CMC. More research into a method that prevents adhesions throughout the abdomen is warranted.