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Effects of hyaluronic acid/Carboxymethylcellulose gel on bowel anastomoses in the New Zealand white rabbit

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Journal of Gastrointestinal Surgery

Abstract

Intra-abdominal adhesions form in more than 90% of patients undergoing major abdominal surgery and can lead to significant complications. Application of a bioresorbable gel consisting of chemically modified hyaluronic acid (HA) and carboxymethylcellulose (CMC) has shown promise as a means of preventing intra-abdominal adhesions, but there have been concerns that the presence of the gel might interfere with the integrity and healing of bowel anastomoses. We tested the effects of HA/CMC gel on adhesion formation and anastomotic healing in 60 New Zealand white rabbits after transection and complete (100%) or incomplete (90%) anastomosis of the ileum. Half of the animals underwent application of HA/CMC gel and half served as control subjects. Animals were killed at 4, 7, or 14 days after surgery. Anastomotic adhesions were scored in a blinded fashion. Integrity of the anastomosis was tested by measuring bursting pressure at the anastomotic site and in an adjacent section of intact bowel. With complete anastomosis, HA/CMC gel significantly reduced adhesion formation at 7 and 14 days after surgery (P<0.05), but gel application did not inhibit adhesion formation when the anastomosis was incomplete. Anastomosed segments of bowel burst at a lower pressure than intact bowel 4 days after surgery, but bursting pressures were normal at 7 and 14 days. Burst pressures of anastomoses receiving an application of HA/CMC gel were nearly identical to control anastomoses at all three time points. HA/CMC gel did not interfere with the normal healing process of bowel anastomoses. Furthermore, HA/CMC gel decreased adhesion formation after complete anastomoses, yet it did not affect adhesion formation in the presence of anastomotic disruption.

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Authors and Affiliations

  1. Division of Surgery, Boston Univesity School of Medicine, 88 E. Newton St., 02118, Boston, MA

    Anoushirvan Hadaegh M.D., Wayne W. LaMorte M.D., Ph.D., M.P.H. & James M. Becker M.D., F.A.C.S.

  2. Genzyme, Cambridge, Mass

    James Burns Ph.D., Laurette Burgess B.M., Rosalind Rose B.S. & Eric Rowe B.S.

Authors
  1. Anoushirvan Hadaegh M.D.
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  2. James Burns Ph.D.
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  3. Laurette Burgess B.M.
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  4. Rosalind Rose B.S.
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  5. Eric Rowe B.S.
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  6. Wayne W. LaMorte M.D., Ph.D., M.P.H.
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  7. James M. Becker M.D., F.A.C.S.
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Hadaegh, A., Burns, J., Burgess, L. et al. Effects of hyaluronic acid/Carboxymethylcellulose gel on bowel anastomoses in the New Zealand white rabbit. J Gastrointest Surg 1, 569–575 (1997). https://doi.org/10.1016/S1091-255X(97)80074-1

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  • DOI: https://doi.org/10.1016/S1091-255X(97)80074-1

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