THE REDUCTION OF POSTOPERATIVE ADHESIONS BY 2 DIFFERENT BARRIER METHODS VERSUS CONTROL IN CYNOMOLGUS MONKEYS - A PROSPECTIVE, RANDOMIZED, CROSSOVER STUDY

Objectives: To determine the effectiveness of two different surgical m embranes in preventing postoperative adhesions as compared with contro l and to evaluate the benefit as compared with ''second-look'' adhesio lysis. Design: A randomized, prospective, crossover study. Setting: A colony of individually caged non-human primates, Department of Obstetr ics and Gynecology, Eastern Virginia Medical School Norfolk, Virginia. Interventions: Hysterotomy or adhesiolysis at the time of exploratory laparotomy, with subsequent scoring of adhesions based on area, vascu larity, tenacity, and adhesion score. Results: The combined crossover data reveal that both surgical barriers are superior in adhesion preve ntion to microsurgical technique alone. Expanded polytetrafluoroethyle ne (Gore-Tex Surgical Membrane; WL Gore and Associates, Flagstaff, AZ) was better than oxidized regenerated cellulose (Interceed; Johnson an d Johnson Medical, Inc., Arlington, TX) with respect to adhesion area, tenacity, and vascularity, with a significant improvement in the tota l adhesion score. Second-look adhesiolysis resulted in significant adh esion reduction in the control group, making second-look adhesiolysis statistically similar to the use of either barrier alone (without subs equent adhesiolysis). Gore-Tex removal does not result in adhesion for mation as determined by third-look surgery. Conclusions: Both Intercee d and Gore-Tex show a reduction in the prevention of postsurgical adhe sions after hysterotomy incisions, as compared with microsurgical tech nique alone. Second-look adhesiolysis is as effective as either barrie r in the reduction of permanent pelvic adhesions.