Effects of hyaluronic acid-carboxymethylcellulose antiadhesion barrier on ischemic colonic anastomosis - An experimental study

Purpose: Intraperitoneal adhesions may help the healing of marginally viable bowel ends. If adhesion formation is prevented by various methods, the integrity of ischemic bowel anastomosis may be compromised. Thus, we decided to study the effects of hyaluronic acid-carboxymethylcellulose, an antiadhesion barrier, on ischemic bowel anastomosis. Methods: Thirty Wistar-Albino rats were divided into three groups. In Group A (control), a well-perfused distal colonic segment was transected, and free ends were anastomosed. In Group B, an ischemic colonic segment was prepared, then divided and anastomosed. In Group C, after completion of ischemic colonic anastomosis, hyaluronic acid-carboxymethylcellulose film was wrapped around the anastomosis. In all groups, rats were killed on the seventh day. Intraperitoneal adhesions were graded by adhesion score, and healing of the anastomosis was assessed by measurement of bursting pressure and hydroxyproline levels in the anastomotic tissue. Results: A statistically significant difference was found between hydroxyproline levels of the control group and the ischemic group (P=0.02). HP level was also significantly higher in the hyaluronic acid-carboxymethylcellulose group than in the ischemic group (P=0.01). There was no difference in hydroxyproline levels between the control and hyaluronic acid-carboxymethylcellulose groups. Compared with the control group, bursting pressure was lower in the ischemic group (P=0.02). Hyaluronic acid-carboxymethylcellulose wrapping increased the bursting pressure significantly (P<0.001). However, there was no difference in bursting pressure between the control group and the hyaluronic acid-carboxymethylcellulose group (P=0.13). A marked increase in the adhesion score was observed in the ischemic group (P=0.01). The difference between adhesion scores of the hyaluronic acid-carboxymethylcellulose and ischemic groups was not found to be significant, although the adhesion score in the hyaluronic acid-carboxymethylcellulose group was lower (P=0.16). There was no difference in adhesion score between the control and hyaluronic acid-carboxymethylcellulose groups. Conclusions: Application of hyaluronic acid-carboxymethylcellulose in ischemic colonic anastomosis did not compromise anastomotic integrity. The adverse effect of ischemia on healing of colonic anastomosis was counteracted by hyaluronic acid-carboxymethylcellulose.