Page 92 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences
P. 92

                                Chapter 5
induced by bowel perforation, and subsequent surgical source control followed by post-operative adhesion and abscess formation [28]. In peritonitis models, abscess formation increases until two weeks postoperatively and then decreases in the following weeks [22,23]. The CLP model combines an acceptable mortality rate of 15%–30% with a high incidence of abscess formation [29–31]. The SWD model promotes adhesion formation and mimics peritoneal trauma caused by laparotomy. It is a dependable, predictable, and readily quantifiable model that allows objective measurement of the extent of adhesion coverage [32,33].
In this experiment, the SWD and other visceral adhesions (except to the cecum) were significantly fewer in the groups in which the PVA/CMC hydrogel was used as a barrier. The PVA/CMC probably remained in place on the SWD because of the flat surface of the abdominal wall and the prostrate position of the rodents. There was no reduction of adhesion formation to the cecal stump. This might be the result of the PVA/CMC hydrogel not remaining at the site because of the roundness and gravity making the gel shift from the cecum, losing its barrier function. Also, the non-absorbable suture and possible microscopic fecal leakage from the cecal stump might have given rise to adhesion formation.
In this experiment, the PVA/CMC hydrogel was safe and efficient in reducing adhesion formation in a peritonitis model. Because both concentrations (1 mL and 2 mL) of the hydrogel provided the same reduction of adhesion formation and no difference in abscess formation, we conclude that 1 mL of A-Part® is an adequate dosage to reduce adhesion formation in a Wistar rat weighing 300–350mg. The promising efficacy demonstrated by the A-Part® hydrogel in this experiment stimulated us to investigate this product further, focusing on its safety when applied around an intestinal anastomosis and in the presence of synthetic material such as intra-abdominally placed meshes [33]. The promising experimental results also led to initiation of a clinical trial of the safety and efficacy of the hydrogel [34].
90






























































































   90   91   92   93   94