Page 91 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Abscesses
The amount and size of intra-abdominal abscesses were not significantly different among the three groups (p = 0.48 and p = 0.10). In the control group, four abscesses were found in three animals, with an abscess score ranging from 1 to 4. In the PVA/CMC 1-mL group, seven abscesses were found in six animals, with a score between 0.5 and 2. In the PVA/ CMC 2-mL group, five abscesses were found in five animals, with a score of 0.5 and 1.
Cultures
The feces of the rats contained no bacteria other than what was expected
in view of their specified pathogen-free status. The culture taken on day
1 proved fecal peritonitis in all 40 rats. During sacrifice, no bacteria were 5 found intra-abdominally. All abscesses contained one or more fecal
bacteria.
Discussion
The formation of adhesions begins with injury to two opposing layers of the peritoneum, with exudate contributing to the deposit of fibrin. The PVA/CMC hydrogel separates the damaged peritoneal surfaces during the crucial remesothelialisation phase in the first two postoperative weeks and reduces initial adhesion formation [11–13]. This hydrogel is completely biodegradable, and no residues are found after two weeks [27].
A serious concern about barriers is their influence on infection. It was especially interesting that in our experiment, the risk of abscess formation was equal in all groups, with or without PVA/CMC gel. We believe that our experimental model combining peritonitis and adhesions resembles adhesion formation after clinical abdominal surgery in the presence of peritonitis. The CLP model produces generalized peritonitis with an immunologic response secondary to the spill of the animal’s own stool into the peritoneal cavity through the devascularized and punctured cecum. This model closely mimics the clinical situation of peritonitis
Adhesion barrier and peritonitis
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