Page 65 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Postoperative adhesion prevention with a new barrier
amount and severity of adhesions in all PVA/CMC gel groups. One animal died within 24h hours after the initial operation. Necropsy did not reveal a direct cause so most probably death was anaesthesia related. A small dose of 0,4ml PVA/CMC gel was enough to provide a significant adhesion reduction.
In experiment two 0.4ml PVA/CMC again showed adhesion reduction, 3 where icodextrin 4% failed to diminish adhesion formation confirming
the results of van ‘t Riet et al [28]. In contrast to the present study Verco
et al did show efficacy of Adept in a rabbit model [11]. As mentioned
earlier icodextrin 4% is metabolized by a-amylase, which is present in higher amounts in the rat compared to the rabbit. This may result in an accelerated metabolizing process leading to absorption of icodextrin 4% within the first seven days, which are critical in adhesion formation [11].
In the first two experiments remains of PVA/CMC gel were seen in the abdominal wall during histological examination. The aim of the third experiment was to investigate the microscopical presence of anti- adhesives after four and six weeks. Presence after more than six weeks might be undesirable because of foreign body reaction. Nevertheless residues of icodextrin 4% were not found in any of the three experiments suggesting complete absorption within two weeks. Additionally no PVA/ CMC was observed after four and six weeks conform the absorption time of three to four weeks found in the study by Lang et al [7] and neo- peritoneum was formed in all cases.
In conclusion, the present study shows that the new PVA/CMC gel A-Part® appears to be a safe and effective adhesion reduction agent for peroperative intra-abdominal use in the rat. These and earlier promising results have resulted in a clinical safety trial assembling the next step to clinical efficacy studies [29].
Author disclosure statements: The authors have no conflict of interest to disclose. This experiment was financially support by B. Braun Aesculap AG, Tuttlingen, Germany. The manufacturer of the PVA/CMC hydrogel was not involved in the study design, analysis of results or preparing the manuscript.
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