Published in:
01-01-2009 | 2008 ssat plenary presentation
Practical Limitations of Bioresorbable Membranes in the Prevention of Intra-Abdominal Adhesions
Published in: Journal of Gastrointestinal Surgery | Issue 1/2009
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Introduction
Intra-abdominal adhesions are a significant source of postoperative morbidity. Bioresorbable barriers composed of hyaluronic acid and carboxymethylcellulose (HA/CMC) reduce adhesion formation by physically separating injured or healing peritoneal surfaces. To assess whether the efficacy of a physical barrier can extend beyond the site of application, we evaluated the effectiveness of an HA/CMC barrier in preventing adhesions distal to the site of placement.
Methods
Adhesions were induced in rats by creating peritoneal ischemic buttons on either side of a midline incision. An HA/CMC barrier (Seprafilm™ Genzyme) was intraoperatively placed either under the midline incision, unilaterally over half the ischemic buttons, or bilaterally over all ischemic buttons. Control buttons received no HA/CMC. On day 7 adhesions were scored. In similar experiments, peritoneal fluid was collected at 24 h to assess the effects of HA/CMC on tissue plasminogen activator activity.
Results
Placement of HA/CMC under the midline incision did not reduce adhesion formation to distal ischemic buttons (72 ± 7%) compared to controls (80 ± 8%). Unilateral placement of HA/CMC significantly (p < 0.05) reduced adhesion formation to those ischemic buttons over which the barrier was applied (35 ± 7%) compared to both contralateral (83 ± 9%) and control (80 ± 8%) ischemic buttons. The bilateral application of HA/CMC also significantly (p < 0.05) reduced adhesion formation to all ischemic buttons compared to controls (22 ± 7% vs. 66 ± 7%, respectively). HA/CMC did not affect peritoneal tPA activity.
Conclusions
Effective adhesion reduction by the physical barrier HA/CMC appears to be limited to the site of application in this rat model. Despite the presence of a bioresorbable membrane at predicted sites of adhesion formation in the peritoneal cavity, adhesions readily form to distal unprotected sites.