John Kuckelman, Morgan Barron, Kevin Kniery, Jeffrey Kay, Joseph Kononchik, Zachary Hoffer, Vance Sohn. Madigan Army Medical Center
INTRODUCTION: Adhesion formation after laparotomy remains a major cause of post-operative morbidity. Hyaluronate/carboxymethylcellulose membranes (HAC) are costly bioresorbable membranes that represent current anti-adhesion therapy. Alternatively, hydro-flotation using saline theoretically provides a transient barrier during adhesion formation. We sought to evaluate the efficacy of saline hydro-flotation compared HAC in adhesion generation after surgery.
METHODS: In this double-blinded study, forty-six Sprague-Dawley rats were randomized to sham (N=5), HAC (N=20) or saline (N=21) after undergoing laparotomy with injury to the cecum and abdominal wall. HAC was placed between the injury sites and abdominal wall closure or 5cc of saline was instilled into the abdominal cavity. Necropsies at 14 days were performed to compare histological and adhesion formation analysis.
RESULTS: Adhesions were observed in all animals (100%) with no complications. Adhesion burden was worse in the HAC group with total overall scores significantly higher with HAC (10/15) vs the saline group (8.1/15, p=0.02). Gross adhesion scores were lower in the saline group at 5.6/9 versus 7.1/9 in the HAC group (p=0.01). Neovascularity of adhesions were higher with HAC at 2.6/3 versus 1.9/3 in the saline group (p=0.01). Percent of the cecum involved was also higher in the HAC when compared to saline alone with 42% and 31% respectively (p=0.05). Histologic examination revealed decreased incidence of both inflammation and fibrosis for HAC versus for saline (p=0.3)
CONCLUSION: Saline hydro-flotation is superior to hyaluronate/carboxymethylcellulose bioresorable membrane in preventing abdominal adhesions. This use of saline offers a cost efficient and efficacious tool in mitigating adhesions with no apparent short term complications.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87123
Program Number: MSS01
Presentation Session: Full-Day Military Surgical Symposium – Basic Science Presentations
Presentation Type: MSSPodium