Comparison of antiadhesive treatments using an objective rat model

Intraperitoneal adhesions are a significant problem (increased morbidity, m ortality, and cost) for patients undergoing abdominal procedures. Although a variety of approaches (e.g., fibrinolytic agents, anti-inflammatory drugs , or barrier/separation methods) have been used with some success in preven ting adhesions, a comparison of these different modalities has yet to be pe rformed in a model that objectively measures intraperitoneal adhesion forma tion. Our objectives were to establish an objective, reproducible model of intraperitoneal adhesion formation and to establish efficacy of different t reatment modalities in decreasing the strength and extent of intraperitonea l adhesions. In this two-part study, a rat model establishing an objective measure of both the strength and extent of intraperitoneal adhesions was us ed to compare different treatment modalities. Fibrinolytic agents [recombin ant tissue plasminogen activator (rtPA), streptokinase, and urokinase], ant i-inflammatory drugs (dexamethasone and tolmetin sodium), and barrier metho ds [sodium carboxymethylcellulose (CMC), and sodium hyaluronate] and a cont rol group were compared in the first phase. In the second phase, the two mo st successful agents (rtPA, CMC) were compared both alone and in combinatio n against a commercially available barrier agent (Seprafilm(TM)) and a cont rol group. In the first phase of the study, rtPA was the only agent that ha d a statistically significant effect in decreasing the strength of adhesion s. CMC was the only agent that demonstrated a decrease in the extent of adh esions, and the difference tended toward significance. In the second phase, the combination of rtFA and CMC showed a significant decrease in both the strength and extent of adhesions when compared with those of the control gr oup. This decrease was also observed in the group treated with Seprafilm(TM ), which showed no difference from the rtPA + CMC group. We conclude that, in this reproducible adhesion model, only the combination of rtPA + CMC and Seprafilm(TM) significantly reduced both the strength and the extent of in traperitoneal adhesions.