title: A new poly(1,3-trimethylene carbonate) film provides effective adhesion reduction after major abdominal surgery in a rat model.
abstract: BACKGROUND
  Postoperative adhesions remain a major clinical problem after abdominal surgery. We evaluated the efficacy of a new poly(trimethylene carbonate) (PTMC) film as an antiadhesive material. In many abdominal operations, there is an increased risk of fecal contamination; the risk of (increased) infection in presence of PTMC film was studied in 2 additional animal models.
  
  
  METHODS
  A validated rat adhesion model with peritoneal ischemic buttons was used to compare the new PTMC film with a hyaluronate carboxymethylcellulose (HA-CMC) sheet, icodextrin solution, and a control group. Primary endpoint was occurrence of adhesions at the ischemic buttons after 14 days in 44 rats (n = 11 per group). To evaluate potential risks associated with the film, both an anastomotic leakage model and a cecal ligation and puncture model were used. Kruskal-Wallis tests with subsequent Mann-Whitney tests were used to detect differences between groups.
  
  
  RESULTS
  PTMC film showed a significant reduction in the amount of adhesions (median, 0.5 buttons) compared with control group (median, 4 buttons; P < .001) and icodextrin group (median, 4.5; P < .001). The amount of adhesions was similar to the HA-CMC group (median, 2; P = .04). The presence of the film did not increase the risk of anastomotic leakage or bacterial growth in a contaminated environment.
  
  
  CONCLUSIONS
  The presence of a PTMC film leads to a significant reduction in the amount of adhesions after 14 days in an ischemic button rat model. Furthermore, this film was found to be safe in an animal model, even in complex abdominal operations with an increased risk of fecal contamination.
authors.affiliation: Department of General Surgery, Maastricht University, Maastricht, The Netherlands; NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands. Electronic address: r.vogels@maastrichtuniversity.nl.
authors.forename: Ruben R M
authors.initials: RR
authors.lastname: Vogels
authors.affiliation: Department of General Surgery, Maastricht University, Maastricht, The Netherlands; NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands.
authors.forename: Joanna W A M
authors.initials: JW
authors.lastname: Bosmans
authors.affiliation: Department of General Surgery, Maastricht University, Maastricht, The Netherlands; NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands.
authors.forename: Kevin W Y
authors.initials: KW
authors.lastname: van Barneveld
authors.affiliation: MIRA Institute for Biomedical Technology and Technical Medicine, and Department of Biomaterials Science and Technology, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands; Medisse BV, Ede, The Netherlands.
authors.forename: Vincent
authors.initials: V
authors.lastname: Verdoold
authors.affiliation: Department of General Surgery, Maastricht University, Maastricht, The Netherlands; NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands.
authors.forename: Selwyn
authors.initials: S
authors.lastname: van Rijn
authors.affiliation: Department of Pathology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Marion J J
authors.initials: MJ
authors.lastname: Gijbels
authors.affiliation: Department of Medical Microbiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: John
authors.initials: J
authors.lastname: Penders
authors.affiliation: Department of General Surgery, Maastricht University, Maastricht, The Netherlands.
authors.forename: Stephanie O
authors.initials: SO
authors.lastname: Breukink
authors.affiliation: MIRA Institute for Biomedical Technology and Technical Medicine, and Department of Biomaterials Science and Technology, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands; Department of Biomedical Engineering, W.J. Kolff Institute, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Dirk W
authors.initials: DW
authors.lastname: Grijpma
authors.affiliation: Department of General Surgery, Maastricht University, Maastricht, The Netherlands; NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands.
authors.forename: Nicole D
authors.initials: ND
authors.lastname: Bouvy
mesh_terms: D034841:Abdominal Cavity / Q000601:surgery*; D057868:Anastomotic Leak / Q000517:prevention & control; D000818:Animals; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D004146:Dioxanes / Q000494:pharmacology*; D004195:Disease Models, Animal; D008297:Male; D008567:Membranes, Artificial; D011183:Postoperative Complications / Q000517:prevention & control; D011897:Random Allocation; D051381:Rats; D017208:Rats, Wistar; D012016:Reference Values; D018709:Statistics, Nonparametric; D000267:Tissue Adhesions / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D004146:Dioxanes; D008567:Membranes, Artificial; C443643:trimethylene carbonate