M. Medina et al., NOVEL ANTIADHESION BARRIER DOES NOT PREVENT ANASTOMOTIC HEALING IN A RABBIT MODEL, Journal of investigative surgery, 8(3), 1995, pp. 179-186
Intraperitoneal adhesions following surgical procedures cause consider
able morbidity. Hyaluronic acid-carboxymethylcellulose (HA/CMC)films h
ave been shown to be effective agents ill decreasing adhesion formatio
n. However, when there is art inadvertent leak of bowel contents into
the peritoneum due to incomplete anastomosis, adhesion. formation abou
t a defect in order to prevent further leakage and to promote healing
of the wound is important for the prevention of morbidity and mortalit
y. The purpose of this study was to determine if an antiadhesion film
(HA/CMC) impairs these potentially beneficial adhesions to bowel anast
omoses, thus predisposing them to enteric leaks with subsequent perito
nitis. Sixty-four rabbits were divided in two groups, each undergoing
a complete or partial (90% anastomosis to simulate anastomotic leak) l
arge bowel anastomosis. Half of each of the above groups were treated
by wrapping a HA/CMC film over the anastomosis and the other half were
untreated controls. These two subgroups were then further divided equ
ally and sacrificed at either 7 or 14 days for evaluation of anastomos
is integrity and strength. The average anastomotic bursting pressures
did not change significantly between those groups treated with HA/CMC
when compared to untreated controls at 7 or 14 days or in the complete
or partial anastomosis group (Student's t rest). Adhesion formation t
o the anastomosis was not impaired in either group independent of HA/C
MC film application. ir;tris study suggests that while HA/CMC film has
been shown to decrease adhesions in other models, healing of a rabbit
colonic anastomosis even in the presence of an anastomotic defect tak
es place, further suggesting that the stimulus for adhesion formation
can overcome the antiadhesion properties of HA/CMC. Therefore, HA/CMC
is a potentially safe adjuvant for preventing postoperative intraabdom
inal adhesions.