title: Choice of hemostatic agent influences adhesion formation in a rat cecal adhesion model.
abstract: BACKGROUND
  Hemostatic agents are frequently used during abdominal surgery and some are linked to adhesion formation. We sought to evaluate the impact of several commonly used hemostatic agents on adhesion formation in a rat peritoneal model.
  
  
  METHODS
  In our study, Wister outbred rats underwent laparotomy and excision of a portion of their peritoneum to initiate adhesion formation process. One of six different hemostatic agents, namely, activated starch microspheres (Arista AH; Medafor Inc., Minneapolis, MN), glutaraldehyde activated collagen (BioGlue; Cryolife Inc., Kennesaw, GA), thrombin coated collagen microspheres (FloSeal; Baxter Inc., Deerfield, IL), thrombin activated fibrin polymer (Tisseel, Baxter), polyethylene glycol polymer (CoSeal, Baxter), or oxidized cellulose (Surgicel; Ethicon Inc., Somerville, NJ), was placed in the area of peritoneal defect. All animals were sacrificed on post-op day 7 and strength and extent of adhesion formation was determined. Histopathological examination of rat caecum was also performed.
  
  
  RESULTS
  Arista and CoSeal showed significantly lower adhesion formation than controls (P < 0.05). Higher adhesion scores were seen in BioGlue (P < 0.05) treated rats. Additionally, histopathologic examination showed that BioGlue caused statistically more inflammation and necrosis than controls (P < 0.05). Total adhesion score increased with residual amount of agent present at 7 d.
  
  
  CONCLUSIONS
  Use of Arista and CoSeal may help in reducing peritoneal adhesions after intra-abdominal surgeries. Furthermore, there appears to be a relationship between the creation of inflammation and necrosis in tissues and the eventual formation of adhesions. This could aid in improving the design of these agents in the future.
authors.affiliation: Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
authors.forename: Nathan E
authors.initials: NE
authors.lastname: Hoffmann
authors.forename: Sameer A
authors.initials: SA
authors.lastname: Siddiqui
authors.forename: Shvetank
authors.initials: S
authors.lastname: Agarwal
authors.forename: Stephen H
authors.initials: SH
authors.lastname: McKellar
authors.forename: Harold J
authors.initials: HJ
authors.lastname: Kurtz
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Gettman
authors.forename: Mark H
authors.initials: MH
authors.lastname: Ereth
mesh_terms: D000818:Animals; D002429:Cecal Diseases / Q000139:chemically induced* / Q000473:pathology; D006490:Hemostatics / Q000009:adverse effects*; D007249:Inflammation / Q000139:chemically induced / Q000473:pathology; D008863:Microspheres; D009336:Necrosis / Q000139:chemically induced / Q000473:pathology; D010532:Peritoneal Diseases / Q000139:chemically induced* / Q000473:pathology; D011092:Polyethylene Glycols / Q000009:adverse effects; D011506:Proteins / Q000009:adverse effects; D051381:Rats; D017208:Rats, Wistar; D013213:Starch / Q000009:adverse effects*; D000267:Tissue Adhesions / Q000139:chemically induced* / Q000473:pathology
chemical_list: C527600:Arista; C472676:Bio-glue; C513322:CoSeal; D006490:Hemostatics; D011506:Proteins; D011092:Polyethylene Glycols; D013213:Starch