title: Effects of hyaluronic acid/carboxymethylcellulose gel on bowel anastomoses in the New Zealand white rabbit.
abstract: Intra-abdominal adhesions form in more than 90% of patients undergoing major abdominal surgery and can lead to significant complications. Application of a bioresorbable gel consisting of chemically modified hyaluronic acid (HA) and carboxymethylcellulose (CMC) has shown promise as a means of preventing intra-abdominal adhesions, but there have been concerns that the presence of the gel might interfere with the integrity and healing of bowel anastomoses. We tested the effects of HA/CMC gel on adhesion formation and anastomotic healing in 60 New Zealand white rabbits after transection and complete (100%) or incomplete (90%) anastomosis of the ileum. Half of the animals underwent application of HA/CMC gel and half served as control subjects. Animals were killed at 4, 7, or 14 days after surgery. Anastomotic adhesions were scored in a blinded fashion. Integrity of the anastomosis was tested by measuring bursting pressure at the anastomotic site and in an adjacent section of intact bowel. With complete anastomosis, HA/CMC gel significantly reduced adhesion formation at 7 and 14 days after surgery (P<0.05), but gel application did not inhibit adhesion formation when the anastomosis was incomplete. Anastomosed segments of bowel burst at a lower pressure than intact bowel 4 days after surgery, but bursting pressures were normal at 7 and 14 days. Burst pressures of anastomoses receiving an application of HA/CMC gel were nearly identical to control anastomoses at all three time points. HA/CMC gel did not interfere with the normal healing process of bowel anastomoses. Furthermore, HA/CMC gel decreased adhesion formation after complete anastomoses, yet it did not affect adhesion formation in the presence of anastomotic disruption.
authors.affiliation: Division of Surgery, Boston University School of Medicine, Boston, MA 02118, USA.
authors.forename: A
authors.initials: A
authors.lastname: Hadaegh
authors.forename: J
authors.initials: J
authors.lastname: Burns
authors.forename: L
authors.initials: L
authors.lastname: Burgess
authors.forename: R
authors.initials: R
authors.lastname: Rose
authors.forename: E
authors.initials: E
authors.lastname: Rowe
authors.forename: W W
authors.initials: WW
authors.lastname: LaMorte
authors.forename: J M
authors.initials: JM
authors.lastname: Becker
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D000818:Animals; D002266:Carboxymethylcellulose Sodium / Q000494:pharmacology*; D005782:Gels; D006820:Hyaluronic Acid / Q000494:pharmacology*; D007082:Ileum / Q000187:drug effects* / Q000601:surgery*; D007410:Intestinal Diseases / Q000517:prevention & control; D011817:Rabbits; D000267:Tissue Adhesions / Q000517:prevention & control; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D005782:Gels; D006820:Hyaluronic Acid; D002266:Carboxymethylcellulose Sodium