Preoperative leuprolide acetate combined with Interceed* optimally reduces uterine adhesions and fibrosis in a rabbit model.
OBJECTIVE
To determine the optimal approach to prevent adhesions comparing leuprolide acetate (GnRH-a), Interceed (oxidized regenerated cellulose; Johnson & Johnson Medical, Inc., New Brunswick, NJ), and a combination of leuprolide with Interceed in a rabbit uterine horn adhesion model.


METHODS
Prospective, randomized, blinded study.


METHODS
Certified animal care facility.


METHODS
Twenty-eight sexually mature, female New Zealand White rabbits.


METHODS
Animals were prospectively randomized (by number generator) to receive GnRH-a or saline. After 6 weeks, standard surgical manipulations were performed at three sites in each uterine horn by [1]. suture, [2]. unipolar cautery, and [3]. superficial abrasion. Interceed was applied over one randomly assigned uterine horn only. Six weeks after surgery, uterine adhesions were assessed visually, and tissue fibrosis was assessed by histology.


METHODS
Presence or absence of adhesions and microscopic tissue fibrosis.


RESULTS
Gonadotropin-releasing hormone agonist significantly decreased adhesions, whereas Interceed alone did not reduce adhesions. However, GnRH agonist plus Interceed was the most effective measure to reduce tissue fibrosis.


CONCLUSIONS
Preoperative GnRH-a is more effective than Interceed in preventing surgical adhesions in the rabbit uterine horn. However, preoperative GnRH-a plus Interceed may provide optimal results in this animal model, because microscopic tissue fibrosis is minimized with this combination.
Marshburn
Paul B
PB
Department of Obstetrics and Gynecology, Carolinas Medical Center, Charlotte, North Carolina 28232, USA. paul.marshburn@carolinashealthcare.org
Meek
James M
JM
Gruber
Helen E
HE
Gordon
Brian E
BE
Norton
James H
JH
Hurst
Bradley S
BS
D000818:Animals; D002483:Cellulose, Oxidized / Q000627:therapeutic use*; D004195:Disease Models, Animal; D004359:Drug Therapy, Combination; D005260:Female; D005355:Fibrosis / Q000517:prevention & control; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D016729:Leuprolide / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D011817:Rabbits; D011897:Random Allocation; D012044:Regression Analysis; D000267:Tissue Adhesions; D014599:Uterus / Q000473:pathology / Q000601:surgery*
D002483:Cellulose, Oxidized; C060002:INTERCEED; D007987:Gonadotropin-Releasing Hormone; D016729:Leuprolide