Role of a hyaluronate-based membrane in the prevention of peritonitis-induced adhesions

Adhesions remain a significant postoperative complication of abdominal surg ery; however, recent evidence suggests that physical barriers may reduce th eir incidence. Although these adhesion prevention barriers are efficacious when used under aseptic conditions, little is known about their use ill the presence of peritonitis, which is associated with an increased incidence o f abdominal adhesions. A sodium hyaluronate and carboxymethylcellulose bior esorbable membrane (HA membrane) has been shown recently to reduce postoper ative adhesions in several animal models and in two clinical trials. To inv estigate the efficacy of HA membrane in the presence of peritonitis, genera lized peritonitis was induced in rats by either cecal ligation and puncture (CLP) or cecal ligation (CL) alone. The ceca were resected after 12 hours, and animals were randomly assigned to receive or not receive HA membrane a pplied to the cecum. At day 7, abdominal adhesions and abscesses were score d. In the presence of peritonitis, HA membrane did not significantly reduce the number or tenacity of adhesions. A trend toward increased abscess form ation was associated with HA membrane in the CL group. Although HA membrane has been shown to reduce the incidence and severity of abdominal adhesions under aseptic conditions, this study demonstrates that it is not efficacio us in preventing abdominal adhesions in the presence of peritonitis. The as sociation between HA membrane and abscess formation in the presence of expe rimental peritonitis requires further investigation.