Abstract
The effects of hyaluronic acid/carboxymethylcellulose membrane on adhesions and anastomotic healing after Hartmann colostomy closure Background: Adhesion formation is one of the leading causes of morbidity after abdominal surgery. In this study, it is aimed to investigate effects of anti-adhesive hyaluronic acid/carboxymethylcellulose membrane on adhesions and anastomotic healing after Hartmann colostomy closure in a rat model. Materials and Methods: Thirty male Wistar-Albino rats are randomised into 3 groups: Standard colostomy (Grup A), standart colostomy + hyaluronic acid/carboxymethylcellulose (Grup B), and control group (Grup C). Adhesions were evaluated by means of a scoring system. Bursting pressure values, and hydroxyproline levels were detected. Results: Adhesion score of group A (1.7±0.6) was statistically higher compared to group B (1.1±0.3), and to control group C (1.2±0.4) (p<0.05). There was no statistical difference between bursting pressure values, and hydroxyproline levels. Conclusions: Although hyaluronic acid/carboxymethylcellulose membrane decreased adhesion formation, there was no obvious effect on anastomotic strength and healing. On the other hand, further clinical studies are needed to draw major conclusions.
Keywords: Hyaluronic acid/carboxymethylcellulose, adhesion, colostomy closure
References
Vrijland WW, Jeekel J, Van Geldorp HJ, et al. Abdominal adhesions: intestinal obstruction, pain, and infertility. Surg Endosc 2003; 17: 1017-1022.
Liakakos T, Thomakos N, Fine PM, et al. Peritoneal adhesions: etiology, pathophysiology, and clinical significance. Recent advances in prevention and management. Dig Surg 2001; 18:260-273.
Ellis H, Moran BJ, Thompson JN, et al. Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet 1999; 353: 1476-1480.
diZerega GS, Campeau JD. Peritoneal repair and post-surgical adhesion formation. Hum Reprod Update 2001; 7: 547- 555.
Ivarsson ML, Falk P, Holmdahl L. Response of visceral peritoneum to abdominal surgery. Br J Surg 2001; 88:148-151.
Thompson J. Pathogenesis and prevention of adhesion formation. Dig Surg 1998; 15: 153-157.
Chegini N, Rong H. Postoperative exposure to glove powders modulates production of peritoneal eicosanoids during peritoneal wound healing. Eur J Surg 1999; 165: 698-704.
Buckenmaier CC III, Pusateri AE, Harris RA, et al. Comparison of antiadhesive treatments using an objective rat model. Am Surg 1999; 65:274-282.
Muller SA, Treutner KH, Haase G, et al. Effect of intraperitoneal antiadhesive fluids in a rat peritonitis model. Arch Surg 2003; 138:286-290.
Verco SJ, Peers EM, Brown CB, et al. Development of a novel glucose polymer solution (icodextrin) for adhesion prevention: pre-clinical studies. Hum Reprod 2000; 15:1764-1772.
Buckenmaier CC, III, Summers MA, Hetz SP. Effect of the antiadhesive treatments, carboxymethylcellulose combined with recombinant tissue plasminogen activator and Seprafilm, on bowel anastomosis in the rat. Am Surg 2000; 66:1041-1045.
Falk K, Bjorquist P, Stromqvist M, et al. Reduction of experimental adhesion formation by inhibition of plasminogen activator inhibitor type 1. Br J Surg 2001; 88:286-289.
Erturk S, Yuceyar S, Temiz M, et al. Effects of hyaluronic acid-carboxymethylcellulose antiadhesion barrier on ischemic colonic anastomosis: an experimental study. Dis Colon Rectum 2003; 46:529-534.
Reijnen MM, Meis JF, Postma VA, van Goor H. Prevention of intra-abdominal abscesses and adhesions using a hyaluronic acid solution in a rat peritonitis model. Arch Surg 1999; 134: 997-1001.
Rodgers KE, Johns DB, Girgis W, et al. Prevention of adhesion formation with intraperitoneal administration of tolmetin and hyaluronic acid. J Invest Surg 1997; 10:367-373.
Gago LA, Saed GM, Chauhan S, et al. Seprafilm (modified hyaluronic acid and carboxymethylcellulose) acts as a physical barrier. Fertil Steril 2003; 80: 612-616.
DeCherney AH, diZerega GS. Clinical problem of intraperitoneal postsurgical adhesion formation following general surgery and the use of adhesion prevention barriers. Surg Clin North Am 1997; 77: 671-688.
Beck DE, Cohen Z, Fleshman JW, et al. A prospective, randomized, multicenter, controlled study of the safety of Seprafilm adhesion barrier in abdominopelvic surgery of the intestine. Dis Colon Rectum 2003; 46:1310-1319.
Bane CL, Jennings C. Adhesion reduction as a new treatment innovation. AORN J 1998; 67: 774-778, 781-782.
Uzunkoy A, Akinci OF, Coskun A, et al. Effects of antiadhesive agents on the healing of intestinal anastomosis. Dis Colon Rectum 2000; 43:370-375.
Reddy GK, Enwemeka CS. A simplified method for the analysis of hydroxyproline in biological tissues. Clin Biochem1996; 29; 225-229.
Hemadeh O, Chilukuri S, Bonet V, et al. Prevention of peritoneal adhesions by administration of sodium carboxymethyl cellulose and oral vitamin E. Surgery 1993; 114:907-910.
Medina M, Paddock HN, Connolly RJ, et al. Novel antiadhesion barrier does not prevent anastomotic healing in a rabbit model. J Invest Surg 1995; 8: 179-186.
Bowers D, Raybon RB, Wheeless CR, Jr. Hyaluronic acid-carboxymethylcellulose film and perianastomotic adhesions in previously irradiated rats. Am J Obstet Gynecol 1999; 181:1335-1337.
van Oosterom FJ, van Lanschot JJ, Oosting J, et al. Hyaluronic acid/ carboxymethylcellulose membrane surrounding an intraperitoneal or subcutaneous jejunojejunostomy in rats. Eur J Surg 2000; 166: 654-658.
