Effective prevention of adhesions with hyaluronate.
OBJECTIVE
Hyaluronate sodium in the form of a bioresorbant membrane reduces the development of intra-abdominal adhesions frequently found after implantation of synthetic mesh in the context of surgical hernia repair.


METHODS
The effect of hyaluronate on the formation of adhesions was evaluated when applied laparoscopically as a bioresorbant membrane to protect the peritoneal surface of a synthetic mesh.


METHODS
Experimental animal model.


METHODS
A peritoneal defect 5 cm in diameter was bilaterally created in the abdominal wall of each of 9 pigs by laparoscopy. A polypropylene mesh was fixed with clips onto these defects on both sides. In each of the animals, only on one side, the synthetic mesh was also covered by a hyaluronate membrane.


METHODS
The incidence and severity of adhesions (grade 0-4, where 0 indicates no adhesion; 1, filmy avascular adhesions; 2, vascular adhesions; 3, cordlike fibrous adhesions; and 4, plain fibrous adhesions) were determined after 45 days, comparing treated and untreated sides by autopsy results and histological features.


RESULTS
Adhesions, mainly grades 3 and 4, occurred in 7 of the 9 animals in those meshes not covered by hyaluronate; 2 untreated animals did not develop adhesions. On the other hand, only 1 of the 9 animals developed adhesions (grade 2) at the mesh concealed by the hyaluronate membrane.


CONCLUSIONS
The bioresorbant hyaluronate membrane significantly reduced the formation of peritoneal adhesions (1-sided sign test, P<.05) induced by the insertion of a polypropylene mesh, when compared with the contralateral implants not protected by hyaluronate. Thus, hyaluronate membranes are efficient for reducing the incidence of peritoneal adhesions.
Kramer
Klaus
K
Department of Surgery, University of Muenster, Germany.
Senninger
Norbert
N
Herbst
Hermann
H
Probst
Wolfgang
W
D000818:Animals; D001672:Biocompatible Materials / Q000627:therapeutic use*; D002266:Carboxymethylcellulose Sodium / Q000627:therapeutic use; D004195:Disease Models, Animal; D006555:Hernia, Ventral / Q000601:surgery*; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D015994:Incidence; D010535:Laparoscopy; D008567:Membranes, Artificial; D011126:Polypropylenes / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D012720:Severity of Illness Index; D013526:Surgical Mesh / Q000009:adverse effects*; D013552:Swine; D000267:Tissue Adhesions / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*
D001672:Biocompatible Materials; D008567:Membranes, Artificial; D011126:Polypropylenes; D006820:Hyaluronic Acid; D002266:Carboxymethylcellulose Sodium