Page 35 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Current status postoperative abdominal adhesions
glucosamine. It is a naturally occurring component of many body tissues
and fluids, where it provides mechanically protective and physically supportive roles [44, 103]. This polymer is therefore biocompatible, non-immunogenic, non-toxic and naturally bio-absorbable. HA is used 2 as an ingredient in the development of different solid barriers, solutions (Sepracoat®) and gels (Intergel®). In different experiments Intergel®
(Lifecore Biomedical Inc, Chaska, MN, USA) showed a reduction in adhesion formation. However, despite the auspicious results in animal models, the gel was finally withdrawn as a result of disappointing clinical results and unacceptable side effects, such as anastomotic dehiscence and prolonged ileus [104]. Sepracoat coating solution (Bard Medical Division, Covington, GA, USA) is a liquid composed of 0.4% sodium HA in phosphate buffered saline and is applied intra-operatively, prior to dissection, to protect peritoneal surfaces from indirect surgical trauma or postoperatively to separate surfaces after they are traumatized. In animal models, this solution reduced serosal damage, inflammation and postsurgical adhesions [93, 105]. Additionally in a prospective, randomized, blinded, placebo-controlled multicenter study Sepracoat was significantly more effective than placebo and was safe in reducing the incidence, extent, and severity of de novo adhesions to multiple sites indirectly traumatized by gynecologic surgery via laparotomy [106]. Nevertheless, Sepracoat has currently no FDA approval and no recent studies of Sepracoat in abdominal surgery can be detected in literature [38].
Carboxymethylcellulose (CMC)( Intercoat®, Oxiplex®, Sepraspray®)
CMC is a high-molecular-weight polysaccharide, derivative of cellulose. The mechanism of absorption is not completely clear, but it works by separating raw surfaces and allowing independent healing of traumatized peritoneal surfaces [44, 48, 69]. It has been used as anti-adhesion agent in combination with different substances with product names as Intercoat® (Ethicon), Oxiplex® (Fziomed) and Sepraspray® (Genzyme) [107-110]. Nevertheless, these products are for different reasons not available anymore. In a recent experimental study a significant reduction in adhesion formation was seen after topical application of tiny doses heparin in combination with CMC gel. The authors suggest that this should be evaluated in human clinical trials [111].
33