Application of Adcon-P or Seprafilm in consecutive laparotomies using a murine model.
BACKGROUND
Intraabdominal administration of antiadhesive products may reduce postoperative adhesions. We compared two barriers, Adcon-P (Gliatech, Cleveland, Ohio) and Seprafilm (Genzyme, Cambridge, Massachusetts), in a relaparotomy murine model to evaluate whether using them during the first and second laparotomy reduces adhesion formation better than using them only during the relaparotomy.


METHODS
One-hundred and fifty mice underwent cecal abrasion, followed by complete adhesiolysis and cecal abrasion 21 days later. All were sacrified 21 days after the second operation. The mice (30 to a group) received Adcon-P in both surgeries (AA), Seprafilm in both surgeries (SS), Adcon-P in the second surgery (CA), Seprafilm in the second surgery (CS), or neither barrier (CC). Difficulty of adhesiolysis was blindly assessed with a 6-point scoring system and sites of adhesions were determined with a yes/no questionnaire.


RESULTS
The AA group had lower adhesiolysis score than SS, CS, and CC groups, and had fewer adhesions over cecum and between cecum and intra-peritoneal fat than all other groups. The numbers of the animals had adhesions between the cecum and abdominal wall were similar between the treatment groups. No difference was observed between SS and CS groups in any analysis.


CONCLUSIONS
Using Adcon-P starting with the first laparotomy more effectively reduce adhesion formation and difficulty of adhesiolysis. Using Seprafilm only in the relaparotomy is as effective as using it in both laparotomies. Adcon-P is more effective in preventing adhesions to different sites than Seprafilm except to the abdominal wall under the midline incision.
Oncel
Mustafa
M
Department of Colorectal Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave. A30, Cleveland, OH 44195, USA.
Remzi
Feza H
FH
Senagore
Anthony J
AJ
Connor
Jason T
JT
Fazio
Victor W
VW
D000818:Animals; D001672:Biocompatible Materials / Q000627:therapeutic use*; D002432:Cecum / Q000601:surgery; D005260:Female; D005782:Gels / Q000627:therapeutic use*; D006820:Hyaluronic Acid; D007813:Laparotomy / Q000009:adverse effects*; D008297:Male; D051379:Mice; D023421:Models, Animal; D009930:Organic Chemicals; D012086:Reoperation; D012720:Severity of Illness Index; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*
C472115:Adcon-P; D001672:Biocompatible Materials; D005782:Gels; D009930:Organic Chemicals; C118198:Seprafilm; D006820:Hyaluronic Acid