title: PVA gel as a potential adhesion barrier: a safety study in a large animal model of intestinal surgery.
abstract: BACKGROUND
  Intra-abdominal adhesions following surgery are a major source of morbidity and mortality including abdominal pain and small bowel obstruction. This study evaluated the safety of PVA gel (polyvinyl alcohol and carboxymethylated cellulose gel) on intestinal anastomoses and its potential effectiveness in preventing adhesions in a clinically relevant large animal model.
  
  
  METHODS
  Experiments were performed in a pig model with median laparotomy and intestinal anastomosis following small bowel resection. The primary endpoint was the safety of PVA on small intestinal anastomoses. We also measured the incidence of postoperative adhesions in PVA vs. control groups: group A (eight pigs): stapled anastomosis with PVA gel compared to group B (eight pigs), which had no PVA gel; group C (eight pigs): hand-sewn anastomosis with PVA gel compared to group B (eight pigs), which had no anti-adhesive barrier. Animals were sacrificed 14 days after surgery and analyzed.
  
  
  RESULTS
  All anastomoses had a patent lumen without any stenosis. No anastomoses leaked at an intraluminal pressure of 40 cmH2O. Thus, anastomoses healed very well in both groups, regardless of whether PVA was administered. PVA-treated animals, however, had significantly fewer adhesions in the area of stapled anastomoses. The hand-sewn PVA group also had weaker adhesions and trended towards fewer adhesions to adjacent organs.
  
  
  CONCLUSIONS
  These results suggest that PVA gel does not jeopardize the integrity of intestinal anastomoses. However, larger trials are needed to investigate the potential of PVA gel to prevent adhesions in gastrointestinal surgery.
authors.affiliation: Department of Surgery, University of Munich-Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: Bernhard W
authors.initials: BW
authors.lastname: Renz
authors.forename: Kurt
authors.initials: K
authors.lastname: Leitner
authors.forename: Erich
authors.initials: E
authors.lastname: Odermatt
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Worthley
authors.forename: Martin K
authors.initials: MK
authors.lastname: Angele
authors.forename: Karl-Walter
authors.initials: KW
authors.lastname: Jauch
authors.forename: Reinhold A
authors.initials: RA
authors.lastname: Lang
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects*; D000818:Animals; D002266:Carboxymethylcellulose Sodium / Q000627:therapeutic use*; D004195:Disease Models, Animal; D005260:Female; D005782:Gels; D007421:Intestine, Small / Q000601:surgery*; D007813:Laparotomy; D011142:Polyvinyl Alcohol / Q000627:therapeutic use*; D013536:Suture Techniques / Q000009:adverse effects*; D013552:Swine; D000267:Tissue Adhesions / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D014945:Wound Healing
chemical_list: D005782:Gels; D011142:Polyvinyl Alcohol; D002266:Carboxymethylcellulose Sodium