Development of a novel glucose polymer solution (icodextrin) for adhesion prevention: pre-clinical studies

Intra-abdominal adhesion formation causes significant post-operative morbid ity, Controlled studies using animal models have been carried out to assess the tolerability and preventive efficacy of icodextrin solution (a biodegr adable, biocompatible, glucose polymer). Reduction of adhesion formation wa s first evaluated in a rabbit double uterine horn model, applying 10-75 ml of 7.5 and 20%, or 50 ml of 2.5-20% icodextrin solution post-operatively. S ignificant increases in adhesion free sites (P < 0.005) were observed with volumes greater than or equal to 25 mi, and at concentrations greater than or equal to 4%. Efficacy of 50 mi 4 and 20% icodextrin was then evaluated b oth during and after surgery, demonstrating significant reductions in adhes ion formation (P < 0.002), In one study, intraplus post-operative use of 4% icodextrin produced the greatest reduction of non-surgical site adhesions; in others, the post-operative effect was predominant. Post-surgical admini stration of 50 mi 4% icodextrin in a rabbit sidewall model also resulted in more adhesion-free animals, and a significant reduction (P < 0.001) in are as of adhesion formation and reformation. In a rat infection potentiation m odel, 4% icodextrin produced no difference in mortality, abscess formation or overall abscess score. These data suggest that 4% icodextrin offers a we ll-tolerated and effective means of reducing post-surgical adhesion formati on.