Auto-cross-linked hyaluronic acid gel does not reduce intra-abdominal adhesions or abscess formation in a rat model of peritonitis.
BACKGROUND
Prevention of adhesion and abscess formation would decrease mortality and morbidity after peritonitis. In this study the effect of a new anti-adhesive, auto-cross-linked hyaluronic acid polysaccharide (ACP) gel, on adhesion and abscess formation was studied in a rat peritonitis model.


METHODS
In experiment 1, bacterial peritonitis was induced in 24 Wistar rats, using a cecal ligation and puncture model. Animals were randomized to receive 4 mL ACP gel (4%) or 4 mL phosphate buffered saline (PBS). After 2 weeks animals were killed and adhesions and abscesses were scored. In experiment 2, 72 rats underwent the same procedure but were randomized to receive 2 mL ACP gel, 4 mL ACP gel, or 4 mL PBS. After 1 and 3 weeks, respectively, half of the animals in each group were killed and adhesions and abscesses were scored.


RESULTS
The median total adhesion score was 12 (range, 3-20) in the ACP group and was 9 (range, 6-12) in the PBS group (not significant) in experiment 1. 91% of rats in the ACP group developed abscesses, versus 90% in the control group. There were no significant differences in abscess size or number of abscesses. In experiment 2, total adhesion scores in the 2 mL ACP group, 4 mL ACP group, and PBS group were 4 (range, 2-20), 6 (range, 1-11), and 6 (range, 1-18), respectively, (not significant) after 1 week and 3.5 (range, 1-8), 5 (range, 2-15), and 4 (range, 0-9), respectively, (not significant) after 3 weeks. All rats in the 2 mL ACP group and the PBS group and 83% of the 4 mL ACP group had developed abscesses after 1 week. After 3 weeks these percentages were 80, 75, and 73, respectively. There were no significant differences in size or number of abscesses between groups both after 1 and 3 weeks.


CONCLUSIONS
ACP does not reduce adhesion and abscess formation in a rat peritonitis model.
Sikkink
Cornelis J J M
CJ
Radboud University Nijmegen Medical Center, Department of Surgery, Nijmegen, The Netherlands.
de Man
Ben
B
Bleichrodt
Robert P
RP
van Goor
Harry
H
D000005:Abdomen; D000038:Abscess / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D000276:Adjuvants, Immunologic / Q000494:pharmacology*; D000818:Animals; D002432:Cecum / Q000382:microbiology; D003432:Cross-Linking Reagents / Q000494:pharmacology; D004195:Disease Models, Animal; D005782:Gels; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000401:mortality; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000401:mortality; D006820:Hyaluronic Acid / Q000494:pharmacology*; D008026:Ligation; D008297:Male; D010538:Peritonitis / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D051381:Rats; D017208:Rats, Wistar; D018805:Sepsis / Q000150:complications / Q000401:mortality; D000267:Tissue Adhesions / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D014951:Wounds, Stab
D000276:Adjuvants, Immunologic; D003432:Cross-Linking Reagents; D005782:Gels; D006820:Hyaluronic Acid