Prevention of postsurgical adhesions with an autocrosslinked hyaluronan derivative gel

Background. ACP gel is a new crosslinked derivative of hyaluronic acid (RA) that displays the biocompatibility properties of its original polymer but has a higher viscosity. It has been demonstrated in an animal model that th e gel reduces adhesions after gynecological surgery. The aim of the present study was therefore to investigate the efficacy of ACP gel in increasing v iscosity for the prevention of adhesions after abdominal surgery. Methods. The antiadhesive effect of ACP gel was tested in a controlled rand omized study using a standardized animal model of abdominal surgery involvi ng the creation of defects in the parietal peritoneum and muscular fascia a nd cecal abrasion. The animals (100 female New Zealand white rabbits) were randomly allocated into five treatment groups to receive: ACP gel (1,2,4, a nd 6%) on the injured area or no ACP gel (control). The incidence of adhesi ons and their grade (score 0-11) were blindly evaluated 10 weeks after surg ery. Results. The percentages of adhesion-free animals were 60, 84, 90, and 84% in the 1, 2, 4, and 6% ACP gel concentration groups, respectively, versus 1 5% in the control group (P = 0.001). The mean adhesion scores were 3.00 +/- 0.91, 1.37 +/- 0.75, 0.65 +/- 0.45, and 1.16 +/- 0.64 in the 1, 2, 4, and 6% ACP gel groups, respectively, versus 7.70 +/- 0.83 in the control group (P < 0.001). Conclusion. ACP gel prevents postsurgical abdominal adhesions even at a 1% concentration. This finding may be of clinical importance in situations in which large volumes of antiadhesive solution are required. (C) 2001 Academi c Press.