An assessment of the effects of a hyaluronan-based solution on reduction of postsurgical adhesion formation in rats: a comparative study of hyaluronan-based solution and two film barriers.
BACKGROUND
Intra-abdominal application of anti-adhesive barriers may reduce the extent and severity of postoperative adhesions. This study was designed to compare the effectiveness of a sprayable liquid barrier (a mixed solution of sodium hyaluronate and carboxymethylcellulose) with two conventional sheets.


METHODS
Eighty male Sprague Dawley rats underwent laparotomy with subsequent multiple intestinal wall abrasions and abdominal wall injury. Afterwards, sodium hyaluronate and carboxymethylcellulose (HA-CMC) solutions were intraperitoneally sprayed or a film barrier of either oxidized regenerated cellulose (ORC) or polylactic acid (PA) was placed under the incision. At postoperative d 21, the rats underwent relaparotomy and complete adhesiolysis. Three investigators, who were blind to the group assignment, scored the extent of adhesion formation and resected specimens for histologic examination of fibrosis and inflammation. Expression profiles of parameters as mediators (macrophages [CD68]) in cellular inflammation response were analyzed.


RESULTS
Mean adhesion scores in rats that received HA-CMC solution (7.6±2.3) and ORC membrane (8.1±2.2) were lower than in rats that received PA film (10.7±2.5) and the control group (11.2±2.6) (P<0.05 for each comparison). In addition, there were significantly fewer adhesions located between large and small intestine in the HA-CMC solution group than in the control and each of the film barrier groups (P<0.05 for each comparison).


CONCLUSIONS
This study suggests that both HA-CMC solution and ORC membrane decrease the overall incidence of postoperative adhesions. However, the mixed solution of HA-CMC appeared to be superior to ORC membrane because this sprayable solution is easy to use and suitable for site-specific adhesion prevention after multifocal bowel trauma.
Park
Jun Seok
JS
Department of Surgery, Division of Colorectal Surgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Dae-gu, Korea.
Cha
Seong Jae
SJ
Kim
Beom Gyu
BG
Choi
Yoo Shin
YS
Kwon
Gui Young
GY
Kang
Hyun
H
An
Seong Soo
SS
D000818:Animals; D002266:Carboxymethylcellulose Sodium / Q000627:therapeutic use; D002482:Cellulose / Q000627:therapeutic use*; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D015994:Incidence; D019344:Lactic Acid / Q000627:therapeutic use*; D007813:Laparotomy / Q000009:adverse effects*; D008297:Male; D023421:Models, Animal; D011091:Polyesters; D011108:Polymers / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D051381:Rats; D017207:Rats, Sprague-Dawley; D000267:Tissue Adhesions / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
D011091:Polyesters; D011108:Polymers; D019344:Lactic Acid; C033616:poly(lactide); D002482:Cellulose; D006820:Hyaluronic Acid; D002266:Carboxymethylcellulose Sodium