Postoperative Adhesion Prevention with a New Barrier: An Experimental Study

被引:23
作者
Ditzel, M. [1 ]
Deerenberg, E. B. [1 ]
Komen, N. [3 ]
Mulder, I. M. [1 ]
Jeekel, H. [2 ]
Lange, J. F. [1 ]
机构
[1] Univ Med Ctr Rotterdam, Dept Surg, Erasmus MC, Rotterdam, Netherlands
[2] Univ Med Ctr Rotterdam, Dept Neurosci, Erasmus MC, Rotterdam, Netherlands
[3] Univ Antwerp Hosp, Dept Surg, Edegem, Belgium
关键词
Abdominal adhesion prevention; Barrier; Experimental animal model; Side-wall defect model; A-Part (R) gel; Adept (R); SMALL-BOWEL OBSTRUCTION; TERM-FOLLOW-UP; CLINICAL-TRIAL; DOUBLE-BLIND; SURGERY; ICODEXTRIN; GEL; MULTICENTER; MEMBRANE; SAFETY;
D O I
10.1159/000337741
中图分类号
R61 [外科手术学];
学科分类号
摘要
Introduction: Postoperative adhesion formation remains a major clinical problem. The aim of this study was to test the effect of a new hydrogel on adhesion formation in a rat model. Materials and Methods: A reproducible rat model was used to induce standardized adhesion formation in three experiments. In experiment 1, a cross-linked polyvinyl alcohol (PVA) and carboxymethylcellulose (CMC) hydrogel (PVA/CMC, A-Part (R); B. Braun Aesculap, Germany) was tested in different dosages. In experiment 2, PVA/CMC gel was compared to icodextrin 4% (Adept (R); Baxter USA). In both groups, animals were sacrificed after 2 weeks. In experiment 3, histological examination after 4 and 6 weeks was performed. The percentage of adhesions to the defect was measured and the density was determined according to the Zuhlke scale. During histological examination of the abdominal wall, the formation of neoperitoneum and potential residues of the agents were assessed. Results: In experiment 1, a significant reduction in amount as well as density of the adhesions was visible with all dosages of PVA/CMC gel. In experiment 2, again quantity and density of the adhesions were diminished by PVA/CMC hydrogel compared to the control group. Icodextrin 4% showed no significant reduction in adhesion formation. In experiment 3, no residues of PVA/CMC gel or icodextrin 4% were found during histological examination after 4 and 6 weeks and neoperitoneum was present in all cases. Conclusion: PVA/CMC hydrogel appears to be a novel effective adhesion prevention agent. Together with an upcoming safety study, these data encourage to start clinical efficacy studies. Copyright (C) 2012 S. Karger AG, Basel
引用
收藏
页码:187 / 193
页数:7
相关论文
共 29 条
[1]   A prospective, randomized, multicenter, controlled study of the safety of Seprafilm® adhesion barrier in abdominopelvic surgery of the intestine [J].
Beck, DE ;
Cohen, Z ;
Fleshman, JW ;
Kaufman, HS ;
van Goor, H ;
Wolff, BG .
DISEASES OF THE COLON & RECTUM, 2003, 46 (10) :1310-1319
[2]   Impact of adhesions in colorectal surgery [J].
Bhardwaj, R. ;
Parker, M. C. .
COLORECTAL DISEASE, 2007, 9 :45-53
[3]   Adept (icodextrin 4% solution) reduces adhesions after laparoscopic surgery for adhesiolysis: a double-blind, randomized, controlled study [J].
Brown, Colin B. ;
Luciano, Anthony A. ;
Martin, Dan ;
Peers, Elizabeth ;
Scrimgeour, Alison ;
diZerega, Gere S. .
FERTILITY AND STERILITY, 2007, 88 (05) :1413-1426
[4]   Reduction in adhesive small-bowel obstruction by Seprafilm® stop adhesion barrier after intestinal resection [J].
Fazio, VW ;
Cohen, Z ;
Fleshman, JW ;
van Goor, H ;
Bauer, JJ ;
Wolff, BG ;
Corman, M ;
Beart, RW ;
Wexner, SD ;
Becker, JM ;
Monson, JRT ;
Kaufman, HS ;
Beck, DE ;
Bailey, HR ;
Ludwig, KA ;
Stamos, MJ ;
Darzi, A ;
Bleday, R ;
Dorazio, R ;
Madoff, RD ;
Smith, LE ;
Gearhart, S ;
Lillemoe, K ;
Göhl, J .
DISEASES OF THE COLON & RECTUM, 2006, 49 (01) :1-11
[5]  
Hooker GD, 1999, SURGERY, V125, P211, DOI 10.1067/msy.2099.94987
[6]   A prospective, randomised, controlled, double-blind phase I-II clinical trial on the safety of A-Part® Gel as adhesion prophylaxis after major abdominal surgery versus non-treated group [J].
Lang, Reinhold ;
Baumann, Petra ;
Jauch, Karl-Walter ;
Schmoor, Claudia ;
Weis, Christine ;
Odermatt, Erich ;
Knaebel, Hanns-Peter .
BMC SURGERY, 2010, 10
[7]   Polyvinyl alcohol gel prevents abdominal adhesion formation in a rabbit model [J].
Lang, Reinhold Andreas ;
Gruentzig, Patricia Mercedes ;
Weisgerber, Christiane ;
Weis, Christine ;
Odermatt, Erich Kurt ;
Kirschner, Martin Hartwig .
FERTILITY AND STERILITY, 2007, 88 :1180-1186
[8]   Foreign material in postoperative adhesions [J].
Luijendijk, RW ;
deLange, DCD ;
Wauters, CCAP ;
Hop, WCJ ;
Duron, JJ ;
Pailer, JL ;
Camprodon, BR ;
Holmdahl, L ;
vanGeldorp, HJ ;
Jeekel, J .
ANNALS OF SURGERY, 1996, 223 (03) :242-248
[9]  
Menzies D, 2001, ANN ROY COLL SURG, V83, P40
[10]  
Menzies D, 1992, Surg Annu, V24 Pt 1, P27