The Gore-Tex Surgical Membrane: effectiveness as a barrier to inhibit postradical pelvic surgery adhesions in a porcine model.
Radical pelvic surgery has well-defined side effects, many of which may be related to the formation of pelvic adhesions. The effectiveness of different agents at limiting the formation of postradical pelvic surgery adhesions (PRPSA) has been variable to date. Use of a barrier could be beneficial not only by limiting adhesion formation but by acting as a "pelvic lid" to elevate the bowel out of a radiation treatment field and therefore limit subsequent radiation injury and associated fistula formation. We investigated the ability of the Gore-Tex Surgical Membrane (Gore-SM) to inhibit PRPSA in 20 adult female hogs undergoing radical hysterectomy, bilateral salpingo-oophorectomy, and resection of pelvic peritoneum. After completion of the radical resection, animals were randomized to either no attempt at covering the peritoneal defect or covering it and a 1-cm margin of intact peritoneum with a tailored sheet of Gore-SM. The membrane was secured in place using a continuous running 4-O Prolene suture around the perimeter. No intraoperative deaths occurred. No animal evidenced signs of bleeding, infection, bowel obstruction, or abscess formation. Four weeks after the initial surgery, the animals were again anesthetized, exploratory celiotomy was performed, and adhesions were quantified with specific note being made of any segments of small bowel that were adherent into the pelvis. Animals were then sacrificed. Adhesion scores for the Gore-SM-treated animals (n = 10; mean, 0.14 +/- 0.12; median, 0.21) were significantly less than those of animals with the noncovered pelvis (n = 10; mean, 1.33 +/- 0.41; median, 1.42; P less than 0.001). Similarly, significantly fewer animals treated with Gore-SM had small bowel loops adherent in the pelvis when compared to control animals (10% vs 70%; P less than 0.01). In this model, meticulously suturing the membrane in place with continuous permanent suture, the Gore-SM was an effective barrier for postoperative adhesion prophylaxis and successfully limited small bowel adherence into the pelvis.
Montz
F J
FJ
Department of Obstetrics and Gynecology, University of California, Los Angeles 90024-1740.
Monk
B J
BJ
Lacy
S M
SM
D000818:Animals; D005260:Female; D007044:Hysterectomy; D008567:Membranes, Artificial; D010388:Pelvis / Q000601:surgery*; D010537:Peritoneum / Q000601:surgery; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000517:prevention & control*; D013552:Swine; D000267:Tissue Adhesions / Q000517:prevention & control
D008567:Membranes, Artificial; D011138:Polytetrafluoroethylene