Page 55 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Postoperative adhesion prevention with a new barrier
Introduction
Postoperative peritoneal adhesions remain a major clinical problem with
an incidence up to 95% after abdominal surgery [1]. The most severe complication is small bowel obstruction which is caused by adhesions in
60-70% of all cases [2]. Other complications include infertility, chronic
pain and more difficult access at reoperation. Parker et al showed the 3 clinical impact of these problems in the SCAR1-study. They established
that 32,6% of all patients after open lower abdominal surgery were readmitted to the hospital with adhesion related problems within 10 years [3]. The impact of this readmission rate is represented by a major economic burden of adhesions on healthcare emphasizing the importance of a low-cost and effective adhesion prevention modality [4, 5].
In recent years many, studies have been performed in an attempt to find an effective adhesion prevention method following abdominal operations. These methods include pharmacological agents, site-specific physical barriers and broad coverage physical barriers. The barriers have in common that a temporary chemical interface prevents adhesions to develop between the parietal peritoneal defect and the visceral peritoneum. Unfortunately, despite all efforts, no product has been adopted for general clinical use in abdominal surgery [6]. The physically crosslinked polyvinyl alcohol (PVA) and carboxymethylcellulose (CMC) (PVA/CMC; A-Part®, B.Braun Aesculap) hydrogel is a new physical barrier which can be applied at the end of the operation on the viscera. In few earlier animal studies with this gel a significant adhesion reduction effect was found, however more data were necessary to confirm the anti adhesive properties of this product [7-9]. In the present study PVA/ CMC gel is compared to icodextrin 4% (Adept®, Baxter), which is one of the most used anti-adhesive agents in abdominal surgery with level I evidence for an anti-adhesive effect following gynaecological operations [10]. The aim of this study was to test the effect of PVA/CMC hydrogel on adhesion formation in a rat model.
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