Page 54 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Chapter 3
Abstract
Introduction:
Postoperative adhesion formation remains a major clinical problem. The aim of this study was to test the effect of a new hydrogel on adhesion formation in a rat model.
Materials and methods:
A reproducible rat model was used to induce standardized adhesion formation in three experiments. In experiment one a crosslinked polyvinyl alcohol and carboxymethylcellulose (PVA/CMC) hydrogel (A-Part®, B.Braun Aesculap) was tested in different dosages. In experiment two PVA/CMC gel was compared to icodextrin 4% (Adept®, Baxter). In both groups animals were sacrificed after two weeks. In experiment three histological examination after four and six weeks was performed. The percentage of adhesions to the defect was measured and the density was determined according to the Zühlke scale. During histological examination of the abdominal wall the formation of neo-peritoneum and potential residues of the agents were assessed.
Results
In experiment one a significant reduction in amount as well as density of the adhesions was visible with all dosages of PVA/CMC gel. In experiment two again quantity and density of the adhesions were diminished by PVA/ CMC hydrogel compared to the control group. Icodextrin 4% showed no significant reduction in adhesion formation. In experiment three no residues of PVA/CMC gel or icodextrin 4% were found during histological examination after four and six weeks and neo-peritoneum was present in all cases
Conclusion
PVA/CMC hydrogel appears to be a novel effective adhesion prevention agent. Together with an upcoming safety study these data encourage to start clinical efficacy studies.
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