title: Sutures impregnated with carbazate-activated polyvinyl alcohol reduce intraperitoneal adhesions.
abstract: BACKGROUND
  Intraperitoneal adhesions cause significant morbidity. They occur after peritoneal trauma, which induces oxidative stress with production of inflammatory cytokines, peroxidized proteins (carbonyls) and lipids (aldehydes). This study aimed to investigate if carbazate-activated polyvinyl alcohol (PVAC), an aldehyde-carbonyl inhibitor, can reduce intraperitoneal adhesions in an experimental model.
  
  
  METHODS
  Male Sprague-Dawley rats (n=110) underwent laparotomy, cecal abrasion and construction of a small bowel anastomosis. They either were treated with intraperitoneal instillation of PVAC or were sutured with PVAC-impregnated sutures. Thromboelastography analysis was performed using human blood and PVAC. The lipid peroxidation product malondialdehyde (MDA) and inflammatory cytokines IL-1β and IL-6 were quantified in peritoneal fluid. At day 7, bursting pressure of the anastomosis was measured and adhesions were blindly scored.
  
  
  RESULTS
  PVAC in human blood decreased the production of the fibrin-thrombocyte mesh without affecting the coagulation cascade. MDA, IL-1β and IL-6 were increased after 6h without significant difference between the groups. PVAC-impregnated sutures reduced intraperitoneal adhesions compared to controls (p=0.0406) while intraperitoneal instillation of PVAC had no effect. Anastomotic bursting pressure was unchanged.
  
  
  CONCLUSIONS
  Intervention with an aldehyde-carbonyl inhibitor locally in the wound by PVAC-impregnated sutures might be a new strategy to reduce intraperitoneal adhesions.
authors.affiliation: Department of Women's and Children's Health, Section of Pediatric Surgery, Uppsala University, SE-751 85 Uppsala, Sweden. Electronic address: fanny.fredriksson@kbh.uu.se.
authors.forename: F
authors.initials: F
authors.lastname: Fredriksson
authors.affiliation: Department of Immunology, Genetics and Pathology, Uppsala University, SE-751 85 Uppsala, Sweden.
authors.forename: F
authors.initials: F
authors.lastname: Sellberg
authors.affiliation: Department of Materials Chemistry, Uppsala University, SE-751 21 Uppsala, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Bowden
authors.affiliation: Department of Reconstructive Plastic Surgery, Karolinska University Hospital and Karolinska Institute, SE-171 76 Stockholm, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Engstrand
authors.affiliation: Department of Immunology, Genetics and Pathology, Uppsala University, SE-751 85 Uppsala, Sweden.
authors.forename: D
authors.initials: D
authors.lastname: Berglund
authors.affiliation: Department of Women's and Children's Health, Section of Pediatric Surgery, Uppsala University, SE-751 85 Uppsala, Sweden.
authors.forename: H E
authors.initials: HE
authors.lastname: Lilja
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D000818:Animals; D002432:Cecum / Q000601:surgery; D016207:Cytokines / Q000378:metabolism; D004195:Disease Models, Animal; D006834:Hydrazines / Q000494:pharmacology*; D007813:Laparotomy / Q000009:adverse effects; D008297:Male; D010537:Peritoneum / Q000187:drug effects / Q000601:surgery; D011142:Polyvinyl Alcohol / Q000494:pharmacology*; D051381:Rats; D017207:Rats, Sprague-Dawley; D013537:Sutures / Q000009:adverse effects; D000267:Tissue Adhesions / Q000517:prevention & control*
chemical_list: D016207:Cytokines; D006834:Hydrazines; C010877:carbazic acid; D011142:Polyvinyl Alcohol
keywords: Experimental adhesion model; Intraperitoneal adhesion prevention; Peroxidation products