Prevention of intestinal adhesions as a result of intraperitoneal mesh with the addition of hyaluronic acid/carboxymethylcellulose gel. Experimental model in rats.
BACKGROUND
Intraperitoneal meshes produce adhesions and intestinal fistula. Composite materials with an antiadherent barrier prevent that complication. There are no studies using gel products in intraperitoneal meshes to keep in contact with viscera.


METHODS
Two groups of 20 rats each were used. Polypropylene mesh was placed intraperitoneally in both groups adding hyaluronic acid/carboxymethylcellulose gel to the mesh in the study group. At 28 days, rats were sacrificed and evaluated using the Diamond adhesions scale.


RESULTS
There were 20 rats in the study group and 19 rats in the control group (one postoperative death). Control group all had adhesions: six (32%) >50% of the mesh surface. In the study group one rat (5%) showed no adhesions, and in 14 (70%) <25% of the mesh surface. Severity showed strong and cohesive adhesions in 11 (58%) control group rats and thin, avascular adhesions in 11 (55%) study group rats. For density, in the study group there were two rats (10%) where adhesions were released spontaneously by separating the flap. There was mild to moderate traction in 16 (80%) study group rats and six (32%) control group rats. Adhesiolysis with scissors was used in the study group (5%) and in 13 (68%) control group rats (p <0.05).


CONCLUSIONS
Hyaluronic acid/carboxymethylcellulose gel appears to be effective in reducing the percentage of adhesions to segments of intraperitoneal mesh implants.
Centro Especializado en el Tratamiento de Hernias. Hospital Médica Campestre. León, Guanajuato, Mexico. drmayagoitia@hotmail.com
Juan Carlos
JC
Mayagoitia-González
Luis Manuel
LM
Gudiño-Amezcua
Virgilio
V
Rivera-Barragán
Arturo Vázquez
AV
Mellado-Díaz
Emilio Prieto
EP
Díaz-Chávez
D000818:Animals; D002266:Carboxymethylcellulose Sodium / Q000627:therapeutic use*; D004195:Disease Models, Animal; D005260:Female; D005782:Gels; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D007410:Intestinal Diseases / Q000517:prevention & control*; D010537:Peritoneum; D051381:Rats; D017208:Rats, Wistar; D013526:Surgical Mesh / Q000009:adverse effects*; D000267:Tissue Adhesions / Q000517:prevention & control
D005782:Gels; D006820:Hyaluronic Acid; D002266:Carboxymethylcellulose Sodium