title: Adhesions and Healing of Intestinal Anastomoses: The Effect of Anti-Adhesion Barriers.
abstract: Background Postoperative adhesions are the result of aberrant peritoneal healing. As they are the leading cause of postoperative bowel obstruction, anti-adherence barriers are advocated for their prevention. This study looks into the effect of these biomaterials on the healing of intestinal anastomoses. Materials and Methods Thirty-three New Zealand White rabbits underwent laparotomy, transection of the terminal ileum, and creation of an end-to-end anastomosis. Animals were randomized into 3 groups: the Control group (n = 11); the Icodextrin group, receiving icodextrin 4% intraperitonealy (n = 11); and the HA/CMC group, having the anastomosis wrapped with a hyaluronic acid/carboxymethylcellulose film (n = 11). All animals were sacrificed on the seventh postoperative day. Macroscopic adhesions were graded and anastomotic strength was tested by the burst pressure. Histological healing was assessed in a semiquantitative way for the presence of ulceration, reepithelization, granulation tissue, inflammation, eosinophilic infiltration, serosal inflammation, and microscopic adhesions. Univariate and multivariate analysis was used. Results are given as medians with interquartile range. Results The median adhesion scores were the following: Control 1 (0-3), Icodextrin 0 (0-1), HA/CMC 0 (0-0), P = .017. The burst pressure did not differ between the groups; however, all except one bowel segments tested burst away from the anastomosis. The macroscopic and histological anastomotic healing was comparable in all 3 groups. A poor histological anastomotic healing score was associated with a higher adhesion grade (odds ratio = 1.92; 95% confidence interval = 1.06-3.47; P = .032). Conclusion Adhesion formation was inhibited by the materials tested without direct detrimental effects on anastomotic healing. Poor anastomotic healing provokes adhesions even in the presence of anti-adhesion barriers.
authors.affiliation: Foundation of Biomedical Research, Academy of Athens, Athens, Greece Hellenic Red Cross Hospital, Athens, Greece dntourakis@hotmail.com.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Ntourakis
authors.affiliation: Foundation of Biomedical Research, Academy of Athens, Athens, Greece.
authors.forename: Michail
authors.initials: M
authors.lastname: Katsimpoulas
authors.affiliation: Third surgical department, Attiko Hospital, Faculty of Medicine, University of Athens, Athens, Greece.
authors.forename: Anna
authors.initials: A
authors.lastname: Tanoglidi
authors.affiliation: Third surgical department, Attiko Hospital, Faculty of Medicine, University of Athens, Athens, Greece.
authors.forename: Calypso
authors.initials: C
authors.lastname: Barbatis
authors.affiliation: Foundation of Biomedical Research, Academy of Athens, Athens, Greece.
authors.forename: Panayotis E
authors.initials: PE
authors.lastname: Karayannacos
authors.affiliation: Hellenic Red Cross Hospital, Athens, Greece.
authors.forename: Theodoros N
authors.initials: TN
authors.lastname: Sergentanis
authors.affiliation: Foundation of Biomedical Research, Academy of Athens, Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Kostomitsopoulos
authors.affiliation: Hellenic Red Cross Hospital, Athens, Greece.
authors.forename: Anastasios
authors.initials: A
authors.lastname: Machairas
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D000818:Animals; D001672:Biocompatible Materials / Q000494:pharmacology; D002266:Carboxymethylcellulose Sodium / Q000494:pharmacology*; D004195:Disease Models, Animal; D005936:Glucans / Q000494:pharmacology*; D005947:Glucose / Q000494:pharmacology*; D006820:Hyaluronic Acid / Q000494:pharmacology*; D000077607:Icodextrin; D007082:Ileum / Q000601:surgery*; D015552:Injections, Intralesional; D007274:Injections, Intraperitoneal; D007813:Laparotomy / Q000379:methods; D011817:Rabbits; D011897:Random Allocation; D012016:Reference Values; D000267:Tissue Adhesions / Q000517:prevention & control*; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects / Q000502:physiology
chemical_list: D001672:Biocompatible Materials; D005936:Glucans; D000077607:Icodextrin; D006820:Hyaluronic Acid; D005947:Glucose; D002266:Carboxymethylcellulose Sodium
keywords: adhesions; anastomosis; burst pressure; healing; histology; intestinal; rabbit