Polyvinyl alcohol hydrogel decreases formation of adhesions in a rat model of peritonitis.
BACKGROUND
Adhesion formation after surgery for peritonitis-related conditions, with such associated complications as intestinal obstruction, pain, and infertility, remains an important problem. Applying a liquid barrier intra-peritoneally might reduce initial adhesion formation.


METHODS
A combination of the cecal ligation and puncture model of peritonitis with the side-wall defect (SWD) model of adhesion formation was performed. Forty rats were assigned randomly to receive no barrier or 1 mL or 2 mL of the cross-linked polyvinyl alcohol and carboxymethylcellulose (PVA/CMC) hydrogel A-Part(®) Gel (B. Braun Aesculap AG, Tuttlingen, Germany). After 14 days, the animals were sacrificed, and adhesion formation and abscess formation were scored.


RESULTS
Thirty animals survived, distributed equally among the groups. There were significantly fewer adhesions to the SWD in the PVA/CMC groups (median 0) than in the control group (median 26%-50%) (p<0.05). The median tenacity of the adhesions was significantly higher in the control group (Zühlke score 2) than in the PVA/CMC groups (Zühlke score 0) (p<0.05). The amount and size of intra-abdominal abscesses were not significantly different in the three groups.


CONCLUSIONS
In this experiment, PVA/CMC hydrogel reduced the amount of adhesions to the SWD and between viscera significantly with equal risk of abscess formation.
Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. e.deerenberg@erasmusmc.nl
Eva B
EB
Deerenberg
Irene M
IM
Mulder
Max
M
Ditzel
Juliette C
JC
Slieker
Willem A
WA
Bemelman
Johannes
J
Jeekel
Johan F
JF
Lange
D018784:Abdominal Abscess / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D000818:Animals; D002266:Carboxymethylcellulose Sodium / Q000494:pharmacology; D004195:Disease Models, Animal; D008297:Male; D010538:Peritonitis / Q000601:surgery*; D011142:Polyvinyl Alcohol / Q000494:pharmacology*; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D051381:Rats; D017208:Rats, Wistar; D000267:Tissue Adhesions / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*
C062364:polyvinyl alcohol hydrogel; D011142:Polyvinyl Alcohol; D002266:Carboxymethylcellulose Sodium