title: Ultrapure alginate anti-adhesion gel does not impair colon anastomotic strength.
abstract: BACKGROUND
  Ultrapure alginate gel is promising in terms of adhesion prevention. Because anti-adhesive barriers have been shown to disturb healing of bowel anastomoses, the effect of ultrapure alginate gel on the repair of colon anastomoses was studied.
  
  
  METHODS
  In 102 male Wistar rats, a 0.5-cm segment was resected from the descending colon and continuity was restored by an inverted single-layer end-to-end anastomosis. Animals were randomized into a control, an alginate gel, and a sodium hyaluronate carboxymethyl cellulose film group, each n = 34. Half of each group was sacrificed at day 3 and 7 postoperatively. Anastomotic strength was assessed by measuring both bursting pressure and breaking strength. Hydroxyproline content was measured and histologic analysis was performed. The incidence of adhesion and abscess formation was scored at sacrifice.
  
  
  RESULTS
  No difference in either anastomotic-bursting pressure or breaking strength was found between experimental groups and the controls at any time point. Both the incidence of adhesion formation (35% versus 71%, P = 0.007) and the adhesion score (0.38 versus 0.79, P = 0.009) were significantly lower in the alginate gel group than in the controls. The abscess rate was higher (46% versus 18%, P = 0.030) in the hyaluronate carboxymethyl cellulose group than in the controls and unchanged in the alginate gel group.
  
  
  CONCLUSIONS
  While reducing adhesion formation, ultrapure alginate gel does not interfere with the development of colonic anastomotic strength during the crucial early healing period.
authors: Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; European Medical Contract Manufacturing B.V, Nijmegen, The Netherlands. Electronic address: A.chaturvedi@chir.umcn.nl.
authors: Ankit A
authors: AA
authors: Chaturvedi
authors: Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors: Roger M L M
authors: RM
authors: Lomme
authors: Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors: Thijs
authors: T
authors: Hendriks
authors: Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors: Harry
authors: H
authors: van Goor
mesh_terms: D018784:Abdominal Abscess / Q000517:prevention & control; D000464:Alginates / Q000494:pharmacology*; D000714:Anastomosis, Surgical; D000818:Animals; D001672:Biocompatible Materials / Q000494:pharmacology*; D003094:Collagen / Q000378:metabolism; D003106:Colon / Q000378:metabolism / Q000601:surgery*; D004195:Disease Models, Animal; D005782:Gels; D020723:Glucuronic Acid / Q000494:pharmacology; D006603:Hexuronic Acids / Q000494:pharmacology; D006909:Hydroxyproline / Q000378:metabolism; D008297:Male; D011184:Postoperative Period; D011312:Pressure; D011897:Random Allocation; D017208:Rats, Wistar; D000267:Tissue Adhesions / Q000517:prevention & control*; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D000464:Alginates; D001672:Biocompatible Materials; D005782:Gels; D006603:Hexuronic Acids; D020723:Glucuronic Acid; D003094:Collagen; D006909:Hydroxyproline
keywords: Abdominal adhesion; Colon anastomosis; HA/CMC; Ultrapure alginate gel