Page 90 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Chapter 5
Adhesions
Adhesions to the surface of the SWD were significantly different among the groups (p=0.009) (Table 3). There were significantly more adhesions (median 26%–50%) to the SWD in the control group than in the PVA/CMC groups (median 0)(p = 0.02), but no difference in adhesions between the two PVA/CMC groups (p=1.00). The tenacity of the adhesions also was significantly different among the groups (p = 0.004) (Table 4). There was a significant difference in adhesion tenacity between the PVA/ CMC groups (both having a median Zühlke score of 0) and the control group (median Zühlke score 2) (p = 0.01 and p = 0.02), but no difference between the PVA/CMC groups (p = 0.74). Visceral adhesions between intestinal loops or between intestinal loops and the abdominal wall (including the midline scar) appeared in 70% of the control group, 50% of the PVA/CMC 1-mL group, and 40% of the PVA/CMC 2-mL group (p = 0.31). The tenacity was the greatest in the control group (median Zü̈hlke score 3.5) compared with the PVA/CMC 1mL (median Zü̈hlke score 0.5) and PVA/CMC 2mL (median Zühlke score 0), but this difference was not statistically significant. In all surviving animals, adhesions to the cecal stump occurred with comparable tenacity in all groups (median Zü̈hlke score 3–3.5) (p = 0.32).
Table 3 Adhesion coverage of side wall defect by treatment group
Adhesion coverage (%) Control A-Part® 1 mL A-Part® 2 mL
0398 1-25 2 0 1 26-50 1 0 1 51-75 0 0 0 76-100 4 1 0
A-Part® = cross-linked polyvinyl alcohol-carboxymethylcellulose gel. Table 4 Zühlke score of adhesion on side wall defect by treatment group
Score Control A-Part® 1 mL A-Part® 2 mL
0398 1201 2010 3101 4400
A-Part® = cross-linked polyvinyl alcohol-carboxymethylcellulose gel.
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