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PVA gel as a potential adhesion barrier: a safety study in a large animal model of intestinal surgery

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Abstract

Background

Intra-abdominal adhesions following surgery are a major source of morbidity and mortality including abdominal pain and small bowel obstruction. This study evaluated the safety of PVA gel (polyvinyl alcohol and carboxymethylated cellulose gel) on intestinal anastomoses and its potential effectiveness in preventing adhesions in a clinically relevant large animal model.

Methods

Experiments were performed in a pig model with median laparotomy and intestinal anastomosis following small bowel resection. The primary endpoint was the safety of PVA on small intestinal anastomoses. We also measured the incidence of postoperative adhesions in PVA vs. control groups: group A (eight pigs): stapled anastomosis with PVA gel compared to group B (eight pigs), which had no PVA gel; group C (eight pigs): hand-sewn anastomosis with PVA gel compared to group B (eight pigs), which had no anti-adhesive barrier. Animals were sacrificed 14 days after surgery and analyzed.

Results

All anastomoses had a patent lumen without any stenosis. No anastomoses leaked at an intraluminal pressure of 40 cmH2O. Thus, anastomoses healed very well in both groups, regardless of whether PVA was administered. PVA-treated animals, however, had significantly fewer adhesions in the area of stapled anastomoses. The hand-sewn PVA group also had weaker adhesions and trended towards fewer adhesions to adjacent organs.

Conclusion

These results suggest that PVA gel does not jeopardize the integrity of intestinal anastomoses. However, larger trials are needed to investigate the potential of PVA gel to prevent adhesions in gastrointestinal surgery.

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References

  1. Ellis H (1998) The magnitude of adhesion-related problems. Ann Chir Gynaecol 87(1):9–11

    CAS  PubMed  Google Scholar 

  2. Diamond MP, Freeman ML (2001) Clinical implications of postsurgical adhesions. Hum Reprod Update 7(6):567–576

    Article  CAS  PubMed  Google Scholar 

  3. Lang RA, Gruntzig PM, Weisgerber C, Weis C, Odermatt EK, Kirschner MH (2007) Polyvinyl alcohol gel prevents abdominal adhesion formation in a rabbit model. Fertil Steril 88(4 Suppl):1180–1186

    Article  PubMed  Google Scholar 

  4. Lang RA, Weisgerber C, Gruntzig PM, Weis C, Odermatt EK, Kirschner MH (2009) Polyvinyl alcohol gel prevents adhesion re-formation after adhesiolysis in a rabbit model. J Surg Res 153(1):12–16

    Article  CAS  PubMed  Google Scholar 

  5. Beck DE, Cohen Z, Fleshman JW, Kaufman HS, van Goor H, Wolff BG et al (2003) A prospective, randomized, multicenter, controlled study of the safety of Seprafilm adhesion barrier in abdominopelvic surgery of the intestine. Diseases of the Colon & Rectum 46(10):1310–1319

    Article  Google Scholar 

  6. Bessler M, Whelan RL, Halverson A, Allendorf JD, Nowygrod R, Treat MR (1996) Controlled trial of laparoscopic-assisted vs open colon resection in a porcine model. Surg Endosc 10(7):732–735

    Article  CAS  PubMed  Google Scholar 

  7. Allardyce RA, Morreau P, Bagshaw PF (1997) Operative factors affecting tumor cell distribution following laparoscopic colectomy in a porcine model. Diseases of the Colon & Rectum 40(8):939–945

    Article  CAS  Google Scholar 

  8. Chun J, Lee D, Stewart D, Talcott M, Fleshman J (2011) Comparison of the compression anastomosis ring (EndoCAR) with a circular stapled anastomosis in a porcine model. Surg Innov 18(3):235–240

    Article  PubMed  Google Scholar 

  9. Karges HE, Funk KA, Ronneberger H (1994) Activity of coagulation and fibrinolysis parameters in animals. Arzneimittelforschung 44(6):793–797

    CAS  PubMed  Google Scholar 

  10. Roussi J, Andre P, Samama M, Pignaud G, Bonneau M, Laporte A et al (1996) Platelet functions and haemostasis parameters in pigs: absence of side effects of a procedure of general anaesthesia. Thromb Res 81(3):297–305

    Article  CAS  PubMed  Google Scholar 

  11. Böhm B, Milsom JW, Kitago K, Brand M, Fazio VW (1994) Laparoscopic oncologic total abdominal colectomy with intraperitoneal stapled anastomosis in a canine model. J Laparoendosc Surg 4(1):23–30

    Article  PubMed  Google Scholar 

  12. Hanson RR, Nixon AJ, Calderwood-Mays M, Gronwall R, Pendergast JF (1988) Comparison of staple and suture techniques for end-to-end anastomosis of the small colon in horses. Am J Vet Res 49(9):1621–1628

    CAS  PubMed  Google Scholar 

  13. Dubcenco E, Grantcharov T, Streutker CJ, Jiang D, Baxter NN, Baker JP (2011) Feasibility and safety of adhesiolysis using transgastric NOTES approach: a pilot survival study in a porcine model. Surg Innov 18(2):106–113

    Article  PubMed  Google Scholar 

  14. Zuhlke HV, Lorenz EM, Straub EM, Savvas V (1990) [Pathophysiology and classification of adhesions]. Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir 1990:1009–1016

    Google Scholar 

  15. Müller SA, Treutner KH, Tietze L, Anurov M, Titkova S, Polivoda M et al (2001) Efficacy of adhesion prevention and impact on wound healing of intraperitoneal phospholipids. J Surg Res 96(1):68–74

    Article  PubMed  Google Scholar 

  16. Mall JW, Schwenk W, Philipp AW, Büttemeyer R, Pollmann C (2003) Intraperitoneal administration of the angiogenesis inhibitor thalidomide does not impair anastomotic healing following large bowel resection in a rabbit model. World J Surg 27(10):1119–1123

    Article  PubMed  Google Scholar 

  17. Hansen H, Sommer HJ, Eichelkraut W (1987) The blood supply of manually sutured and stapled colonic anastomoses. Langenbecks Arch Chir 370(2):141–151

    Article  CAS  PubMed  Google Scholar 

  18. Van Gieson I (1889) Laboratory notes of technical methods for the nervous system. New York Med J 50:57–60

    Google Scholar 

  19. Tintillier M, Pochet JM, Christophe JL, Scheiff JM, Goffin E (2002) Transient sterile chemical peritonitis with icodextrin: clinical presentation, prevalence, and literature review. Perit Dial Int 22(4):534–537

    PubMed  Google Scholar 

  20. Mruk JS, Zoldhelyi P, Webster MW, Heras M, Grill DE, Holmes DRJ et al (1996) Does antithrombotic therapy influence residual thrombus after thrombolysis of platelet-rich thrombus? Effects of recombinant hirudin, heparin, or aspirin. Circulation 93(4):792–799

    Article  CAS  PubMed  Google Scholar 

  21. Heering P, Brause M, Plum J, Grabensee B (2001) Peritoneal reaction to icodextrin in a female patient on CAPD. Perit Dial Int 21(3):321–322

    CAS  PubMed  Google Scholar 

  22. Reichel W, Schulze B, Dietze J, Mende W (2001) A case of sterile peritonitis associated with icodextrin solution. Perit Dial Int 21(4):414–415

    CAS  PubMed  Google Scholar 

  23. Williams PF, Foggensteiner L (2002) Transient sterile chemical peritonitis in a CAPD patient using icodextrin. Perit Dial Int 22(1):90–91

    Google Scholar 

  24. Catena F, Ansaloni L, Di Saverio S, Pinna AD, World Society of Emergency Surgery (2012) P.O.P.A. study: prevention of postoperative abdominal adhesions by icodextrin 4% solution after laparotomy for adhesive small bowel obstruction. A prospective randomized controlled trial. J Gastrointest Surg 16(2):382–388

    Article  PubMed  Google Scholar 

  25. Trew G, Pistofidis G, Pados G, Lower A, Mettler L, Wallwiener D et al (2011) Gynaecological endoscopic evaluation of 4% icodextrin solution: a European, multicentre, double-blind, randomized study of the efficacy and safety in the reduction of de novo adhesions after laparoscopic gynaecological surgery. Hum Reprod 26(8):2015–2027

    Article  CAS  PubMed  Google Scholar 

  26. Menzies D, Pascual MH, Walz MK, Duron JJ, Tonelli F, Crowe A et al (2006) Use of icodextrin 4% solution in the prevention of adhesion formation following general surgery: from the multicentre ARIEL Registry. Ann R Coll Surg Engl 88(4):375–382

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Greenawalt KE, Colt MJ, Corazzini RL, Syrkina OL, Jozefiak TH (2012) Remote efficacy for two different forms of hyaluronate-based adhesion barriers. J Invest Surg 25(3):174–180

    Article  PubMed  Google Scholar 

  28. Lalountas MA, Ballas KD, Skouras C, Asteriou C, Kontoulis T, Pissas D et al (2010) Preventing intraperitoneal adhesions with atorvastatin and sodium hyaluronate/carboxymethylcellulose: a comparative study in rats. Am J Surg 200(1):118–123

    Article  CAS  PubMed  Google Scholar 

  29. Holmdahl L, Risberg B, Beck DE, Burns JW, Chegini N, diZerega GS et al (1997) Adhesions: pathogenesis and prevention—panel discussion and summary. Eur J Surg Suppl 1997(577):56–62

    Google Scholar 

  30. Chaturvedi AA, Lomme RMLM, Hendriks T, van Goor H (2013) Prevention of postsurgical adhesions using an ultrapure alginate-based gel. Br J Surg 100(7):904–910

    Article  CAS  PubMed  Google Scholar 

  31. Lim R, Morrill JM, Lynch RC, Reed KL, Gower AC, Leeman SE et al (2009) Practical limitations of bioresorbable membranes in the prevention of intra-abdominal adhesions. J Gastrointest Surg 13(1):35–41, discussion41–2

    Article  PubMed  Google Scholar 

  32. Greenawalt KE, Corazzini RL, Colt MJ, Holmdahl L (2012) Adhesion formation to hemostatic agents and its reduction with a sodium hyaluronate/carboxymethylcellulose adhesion barrier. J Biomed Mater Res A 100(7):1777–1782

    Article  PubMed  Google Scholar 

  33. Baxter GM, Hunt RJ, Tyler DE, Parks AH, Jackman BR (1992) Sutured end-to-end and stapled side-to-side jejunal anastomoses in the horse. Vet Surg 21(1):47–55

    Article  CAS  PubMed  Google Scholar 

  34. McAdams AJ, Meikle AG, Taylor JO (1970) One layer or two layer colonic anastomoses? Am J Surg 120(4):546–550

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This study was supported by a grant from the Aesculap AG, which manufactures PVA gel.

Conflicts of interest

The authors declare that they have no competing financial interests.

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Authors and Affiliations

  1. Department of Surgery, University of Munich—Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany

    Bernhard W. Renz, Kurt Leitner, Martin K. Angele, Karl-Walter Jauch & Reinhold A. Lang

  2. Aesculap AG & Co. KG, Aesculap-Platz, Tuttlingen, Germany

    Erich Odermatt

  3. Division of Digestive and Liver Diseases, Irving Cancer Research Center, Columbia University Medical Center, New York, NY, USA

    Bernhard W. Renz & Daniel L. Worthley

  4. Klinik Weilheim, Johann-Baur-Str. 4, 82362, Weilheim, Germany

    Reinhold A. Lang

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  1. Bernhard W. Renz
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Correspondence to Reinhold A. Lang.

Additional information

Bernhard W. Renz and Kurt Leitner equally contributed to this work.

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Renz, B.W., Leitner, K., Odermatt, E. et al. PVA gel as a potential adhesion barrier: a safety study in a large animal model of intestinal surgery. Langenbecks Arch Surg 399, 349–357 (2014). https://doi.org/10.1007/s00423-013-1159-1

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  • DOI: https://doi.org/10.1007/s00423-013-1159-1

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