Efficacy of a hyaluronan derivative gel in postsurgical adhesion prevention in the presence of inadequate hemostasis.
BACKGROUND
We previously demonstrated that an auto-cross-linked hyaluronan-based antiadhesion agent (auto-cross-linked polysaccharide [ACP] gel) was effective in postsurgical adhesion prevention after open laparotomy and laparoscopic surgery with adequate hemostasis in animal models. This study assessed the ability of different preparations of ACP gel to prevent adhesions in the presence of bleeding or inadequate hemostasis.


METHODS
Ninety-seven female rabbits were subjected to a standardized surgical lesion with subsequent exudative abdominal bleeding (oozing model), and 97 animals were subjected to a standardized surgical lesion with severe abdominal bleeding (bleeding model). After injury, the animals were randomly assigned to 5 groups of treatment: 3 different preparations of ACP gel (20, 40, and 60 mg/mL), a hyaluronan-carboxymethylcellulose film, and no treatment. Three weeks after operation, the animals were killed, and the adhesions were assessed by a blinded observer who measured the length and area of the adhesions and who used the Blauer scoring system.


RESULTS
All 3 preparations of ACP gel and the hyaluronan-carboxymethylcellulose film reduced adhesion formation in both models (P <.01) as measured by the number of adhesion-free animals, mean Blauer score, and the mean length and surface area of the adhesions. There were no statistical differences between the different treatment groups.


CONCLUSIONS
These data suggest that different hyaluronan based agents in the presence of severe bleeding or exudative abdominal bleeding reduce de-novo postsurgical adhesion formation.
De Iaco
P A
PA
Department of Obstetrics and Gynecology, S. Orsola Hospital, University of Bologna, Italy.
Muzzupapa
G
G
Bigon
E
E
Pressato
D
D
Donà
M
M
Pavesio
A
A
Bovicelli
L
L
D000818:Animals; D002266:Carboxymethylcellulose Sodium / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D005782:Gels; D006487:Hemostasis; D006820:Hyaluronic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D015907:Hysteroscopy / Q000009:adverse effects*; D007813:Laparotomy / Q000009:adverse effects*; D011134:Polysaccharides / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control*; D011817:Rabbits; D000267:Tissue Adhesions / Q000517:prevention & control; D014591:Uterine Diseases / Q000517:prevention & control*; D014599:Uterus / Q000601:surgery*
D004338:Drug Combinations; D005782:Gels; D011134:Polysaccharides; C431864:auto-cross-linked polysaccharide; D006820:Hyaluronic Acid; D002266:Carboxymethylcellulose Sodium