Preventing intra-abdominal adhesions with a sodium hyaluronate carboxymethylcellulose membrane enabled visualization of hepatic microcirculation

We aimed to evaluate whether using sodium hyaluronate carboxymethylcellulose membrane (Seprafilm (TM)) can facilitate assessment of hepatic microcirculation via orthogonal polarization spectroscopy (OPS) by preventing intra-abdominal adhesions and whether Seprafilm (TM) as a foreign material can evoke local or systemic inflammatory reactions. After the right median hepatic vein was ligated, rats received either placement of Seprafilm (TM) or untreated with observation of 1 or 4 weeks (n = 6/group). Hepatic microcirculation was visualized. Systemic and local inflammatory reactions were evaluated by blood count, histology and immunohistochemical staining for CD68. Seprafilm (TM) significantly (P < 0.05) prevented intra-abdominal adhesion formation compared to non-Seprafilm (TM) groups (adhesion score: 0 vs 1.3 +/- 0.5 at POW1 and 0.3 +/- 0.5 vs 3.5 +/- 1.4 at POW4). Placement of Seprafilm (TM) provided sufficient liver surface for acquisition of OPS videos during the harvest procedure. Adhesiolysis in non-Seprafilm (TM) groups prevented visualization of hepatic microcirculation. A severe local foreign body reaction with formation of a "fibrin-like" membrane containing CD68-positive inflammatory histiocytic cells and mesothelial cells was observed in Seprafilm (TM) groups even at POW4. Use of Seprafilm (TM) conferred visualization of hepatic microcirculation after long term observation in experimental setting. In clinical situation, we would suggest being very cautious in immuno-compromised patients because of an ongoing local foreign body reaction caused by Seprafilm (TM). (C) 2013 Published by Elsevier Ltd on behalf of Surgical Associates Ltd.