Evaluation of a sprayable polyethylene glycol adhesion barrier in a porcine efficacy model.
BACKGROUND
The formation of adhesions following pelvic surgery remains one of the leading causes of infertility, small bowel obstruction and re-operation for pelvic pain. A novel hydrophilic polyethylene glycol based adhesion barrier (SprayGel) is formed by simultaneously spraying two liquid precursors onto surgical sites. The liquids polymerize to form a gel that effectively coats and adheres to tissue. After about 5 days, the hydrogel layer is absorbed and subsequently undergoes renal clearance. It is believed that the presence of such a barrier would inhibit the formation of adhesions following surgical insult.


METHODS
A porcine adhesion model was developed wherein bilateral uterine horn transection and re-anastomosis, along with peritoneal side wall excision was performed via laparotomy. In each animal (n = 10, including the pilot study) one pelvic side wall was treated with adhesion barrier, while the contralateral side remained untreated.


RESULTS
At second look laparoscopy, 90% of the untreated sites had adhesions, compared with 30% of the treated sites (P = 0.006). Also observed were statistically significant reductions in the adhesion extent (P = 0.029) and adhesion severity scores (P = 0.023) at the treated sites. However, if the pilot study was excluded (n = 8) the differences obtained were no longer significant.


CONCLUSIONS
Polyethylene glycol (SprayGel) merits further investigation as an effective barrier to the formation of post-operative adhesions in this porcine model.
Ferland
R
R
Women and Infants Hospital, Providence, RI 02905, USA. roger_ferland@brown.edu
Mulani
D
D
Campbell
P K
PK
D000336:Aerosols; D000818:Animals; D005260:Female; D020100:Hydrogels / Q000008:administration & dosage / Q000493:pharmacokinetics; D010535:Laparoscopy; D023421:Models, Animal; D010532:Peritoneal Diseases / Q000517:prevention & control; D010537:Peritoneum / Q000601:surgery; D011092:Polyethylene Glycols / Q000008:administration & dosage* / Q000493:pharmacokinetics; D011183:Postoperative Complications / Q000517:prevention & control*; D024162:Second-Look Surgery; D013552:Swine; D000267:Tissue Adhesions / Q000517:prevention & control*; D014599:Uterus / Q000601:surgery
D000336:Aerosols; D020100:Hydrogels; D011092:Polyethylene Glycols