EFFECTS OF PHYSICAL BARRIERS IN PREVENTION OF ADHESIONS - AN INCISIONAL HERNIA MODEL IN RATS

Background: Adhesion formation between viscera and mesh is almost inev itable following incisional hernia repair with prosthetic mesh. Such a dhesions may lead to intestinal obstruction and enterocutaneous fistul ae formation and make further laparotomies extremely difficult. Sodium carboxymethylcellulose (SCMC) and Interceed TC? (oxidized regenerated cellulose) as physical barriers have been shown to be effective in re ducing postoperative adhesions, Materials and methods: To evaluate the effects of SCMC and Interceed TC7, we used an incisional hernia model in rats. A ventral abdominal defect (15 x 25 mm) was created in each of 36 male rats which were then divided into three equal groups. In Gr oup I (control) the defect was repaired with polypropylene mesh (PPM) only; in Group II the defect was repaired after a layer of Interceed T C7 was laid over the viscera with Interceed TC7-covered PPM; in Group III the defect was repaired after a layer of SCMC was laid over the vi scera with SCMC-coated PPM. Six of the animals from each group were sa crificed at Postoperative Day 7 and the adhesions were scored. The rem aining 6 were sacrificed at Day 30 and histological evaluation was mad e in addition to the adhesion score, Results: Animals in the SCMC-trea ted group developed significantly less adhesions (P = 0.0002) compared with control and Interceed TC7-treated groups. However, histological analysis revealed poor fibroblast proliferation with impaired wound he aling in the SCMC group. Conclusion: SCMC prevented adhesion formation but seriously impaired wound healing, and Interceed TC7 was ineffecti ve in preventing adhesion in this model. (C) 1997 Academic Press.