Page 154 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Chapter 9
reduction agent for per-operative intra-abdominal use in the rat. These and earlier results from other authors encouraged us to test PVA/CMC under different circumstances [7-9].
In past years, several anti-adhesive agents have not entered widespread clinical use because of concerns about their interference with anastomotic site healing [10, 11]. A possible explanation for this phenomenon is that ‘advantageous’ adhesions serve to prevent the sequelae of a leak (fistula, abscess, peritonitis). When an anti-adhesive agent impairs the formation of adhesions around the anastomosis, this might result in an increased risk of clinical anastomotic leakage.
In Chapter 4 gaining more knowledge about the safety and efficacy of PVA/CMC gel in the presence of a ‘fresh’ bowel anastomosis an experiment investigating this was performed. This randomized study in rats showed no significant differences in anastomotic leakage, anastomotic bursting pressure, or collagen content of the anastomosis when the adhesion barrier PVA/CMC gel was delivered around colonic anastomoses. On the other hand, no differences in adhesion formation around the anastomosis were observed between the control and study group. Consequently, whether there is an influence of adhesions on anastomotic leakage cannot be known from this experiment.
In Chapter 5 the behaviour of PVA/CMC gel in a contaminated environment was described. Abdominal surgery for intra-abdominal infection with peritonitis is associated with high morbidity and mortality rates and frequently complicated by abscess formation. In peritonitis, severe inflammation of the peritoneum occurs, increasing adhesion formation. Prevention of adhesion formation after peritonitis seems the ultimate challenge for proving the effectiveness of an anti-adhesion barrier. It is also crucial that the barrier does not promote infection or abscess formation [12, 13]. To study this a combination of the cecal ligation and puncture (CLP) peritonitis model and the cecal abrasion side-wall defect (SWD) adhesion model were used [14-17]. This combination model resembles adhesion formation in a clinical situation after abdominal surgery in the presence of peritonitis. Adhesion
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