Page 71 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Adhesion barrier and colon anastomoses
Introduction
The formation of fibrous adhesions almost always follows abdominal surgery1,2, and is a significant cause of morbidity3-5. Adhesions are a physiologic response to surgical trauma or infection that are the most
common cause of small-bowel obstruction and female infertility and may
lead to major difficulties during subsequent operative procedures6-10.
The underlying mechanism is local tissue ischemia and mesothelial
injury produced by surgical intervention, which disrupts the balance
between coagulation and fibrinolysis, causing fibrous bands that result in 4 adhesions11. Inflammation intensifies adhesion formation by attracting
and activating fibroblasts and disrupting fibrinolysis12,13. Numerous products have been tested to minimize the formation of adhesions, based on barriers that separate the injured surfaces long enough to allow repair without adhesions. A new adhesion barrier consisting of polyvinyl alcohol (PVA) and carboxymethylcellulose (CMC) gel (A-Part Gel®; Aesculap AG, B. Braun, Tuttlingen, Germany) has shown promising results in in vitro as well as in vivo studies14-16. However, in past years, several anti-adhesive agents have not entered widespread clinical use because of concerns about their interference with anastomotic site healing17,18. The primary aim of this study was to investigate the effect of the adhesion barrier PVA on the healing of colonic anastomoses using a rat model.
Methods
Animals
Thirty-two male Wistar rats (Harlan Laboratory, Horst, The Netherlands), weighing approximately 400 g each were divided randomly into two groups of 16: the control group and the study group that received PVA gel. The study was approved by the local ethical committee on animal welfare in accordance with animal protection laws. Animals were kept under standard laboratory conditions with individually ventilated cages and fed chow and water ad libitum throughout the study.
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