Page 34 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences
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                                Chapter 2
Icodextrin, ∂,1–4 linked glucose polymer
Icodextrin 7,5% (Adept; Baxter USA) is a high-molecular weight∂1,4- glucose polymer solution which is widely used for peritoneal dialysis. More recently 4% solutions of icodextrin were developed to investigate its use for abdominal adhesion prevention. It is metabolized by amylase to oligosaccharides, but since amylase is absent in the peritoneal cavity, icodextrin 4% has a prolonged absorption time up to 3–5 days. Absorption occurs via lymphatic drainage into the systemic system and the working principle is based on hydroflotation [19, 95, 96]. Icodextrin 4% can be easily instilled via trocar and has proven to be safe and effective in the prevention of peritoneal adhesion formation as shown by various clinical and experimental trials [97-100]. Nonetheless, a double-blinded randomized controlled study provided further confirmation of the safety of icodextrin 4% in routine surgery, but it did not show significant differences between icodextrin 4% and LRS in terms of the mean number of de novo adhesions [101]. Icodextrin 4% has been approved for use in open and laparoscopic surgery in Europe and it was the first anti-adhesive agent that has been approved by the FDA for use in laparoscopic surgery in the USA [44].
32% Dextran 70
Dextran (32% dextran 70; Hyskon; Pharmacia, Piscataway, New Jersey, USA) is a solution used for adhesion prevention working by the principle of hydroflotation. The dextran solution is slowly absorbed and draws fluid into the abdominal cavity. [28, 39, 61, 62]. Only few studies showed an anti-adhesive effect of Dextran [6, 62]. Additionally no differences in live birth and pregnancy rate were seen after the use of Dextran compared to placebo [102]. Moreover, significant side effects, such as ascites, weight gain, pleural effusion, labial edema, liver function abnormalities, and, albeit rare, disseminated intravascular coagulation and anaphylaxis, were noted [6, 81]. To conclude, there is insufficient evidence for the clinical use of Dextran at this moment.
Hyaluronic acid
Hyaluronic acid (HA) is a linear polysaccharide with repeating disaccharide units that are composed of sodium D-glucuronate and N-acetyl-D-
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