Skip to main content
SpringerLink
Log in

All the commercially available adhesion barriers have the same effect on adhesion prophylaxis?; A comparison of barrier agents using a newly developed, severe intra-abdominal adhesion model

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Various types of adhesion barriers are widely used to prevent intra-abdominal adhesion. However, few studies have compared the efficacy of adhesion barriers using the same animal model. The aim of this study was to compare the anti-adhesive effects of various barrier agents using a newly developed, severe adhesion model.

Methods

A severe adhesion model was established by excision of a 1-cm2 intra-abdominal wall and application of cyanoacrylate in rat. Eighty male Sprague–Dawley rats (10 weeks old; 370 ± 50 g) were divided randomly into four groups (n = 20 each): the untreated control group, G-group using a hyaluronic acid and sodium carboxymethyl cellulose gel (Guardix-sol®), A-group using 4 % icodextrin (Adept®), and S-group using a hyaluronate–carboxymethyl cellulose membrane (Seprafilm®). The effect of each adhesion barrier was evaluated by means of the extent and severity of adhesion, difficulty of adhesiolysis scoring systems, and microscopic grade of fibrosis.

Results

The G-group showed no difference in adhesion score and fibrosis, the A-group demonstrated only a significantly lower fibrosis, and the S-group exhibited a significantly lower adhesion score and lower fibrosis compared with the control group. The S-group had a significantly lower adhesion score and reduced fibrosis compared with the G-group; however, no significant difference in adhesion score and fibrosis was noted with the A-group.

Conclusions

The membranous barrier Seprafilm® may be effective in the prevention of adhesion in the condition of peritoneal injury combined with foreign material. Adept® showed a tendency of decreasing the severity of adhesion and was effective in the prevention of fibrosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Liakakos T, Thomakos N, Fine PM, Dervenis C, Young RL (2001) Peritoneal adhesions: etiology, pathophysiology, and clinical significance. Recent advances in prevention and management. Dig Surg 18(4):260–273

    Article  PubMed  CAS  Google Scholar 

  2. Van Der Krabben AA, Dijkstra FR, Nieuwenhuijzen M, Reijnen MM, Schaapveld M, Van Goor H (2000) Morbidity and mortality of inadvertent enterotomy during adhesiotomy. Br J Surg 87:467–471

    Article  Google Scholar 

  3. Hellebrekers BW, Kooistra T (2011) Pathogenesis of postoperative adhesion formation. Br J Surg 98(11):1503–1516

    Article  PubMed  CAS  Google Scholar 

  4. Kumar S, Wong PF, Leaper DJ (2009) Intra-peritoneal prophylactic agents for preventing adhesions and adhesive intestinal obstruction after non-gynaecological abdominal surgery. Cochrane Database Syst Rev 21;(1):CD005080

    Google Scholar 

  5. Harris ES, Morgan RF, Rodeheaver GT (1995) Analysis of the kinetics of peritoneal adhesion formation in the rat and evaluation of potential antiadhesive agents. Surgery 117(6):663–669

    Article  PubMed  CAS  Google Scholar 

  6. Burns JW, Colt MJ, Burgees LS, Skinner KC (1997) Preclinical evaluation of Seprafilm bioresorbable membrane. Eur J Surg Suppl 577:40–48

    PubMed  Google Scholar 

  7. Kim JH, Lee JH, Yoon JH, Chang JH, Bae JH, Kim KS (2007) Antiadhesive effect of the mixed solution of sodium hyaluronate and sodium carboxymethyl cellulose after endoscopic sinus surgery. Am J Rhinol 21:95

    Article  PubMed  Google Scholar 

  8. Park JS, Cha SJ, Kim BG, Choi YS, Kwon GY, Kang H et al (2011) An assessment of the effects of a hyaluronan-based solution on reduction of postsurgical adhesion formation in rats: a comparative study of hyaluronan-based solution and two film barriers. J Surg Res 168(1):49–55

    Article  PubMed  CAS  Google Scholar 

  9. Utian WH (1980) Prevention of adhesions after tubal surgery by use of dextran 70. S Afr Med J 58:204–206

    PubMed  CAS  Google Scholar 

  10. Brown CB, Luciano AA, Martin D, Peers E, Scrimgeour A, diZerega GS, Adept Adhesion Reduction Study Group (2007) Adept (icodextrin 4 % solution) reduces adhesions after laparoscopic surgery for adhesiolysis: a double-blind, randomized, controlled study. Fertil Steril 88(5):1413–1426

    Article  PubMed  Google Scholar 

  11. Leach RE, Burns JW, Dawe EJ, SmithBarbour MD, Diamond MP (1998) Reduction of postsurgical adhesion formation in the rabbit uterine horn model with use of hyaluronate/carboxymethlcellulose gel. Fertil Steril 69:415–418

    Article  PubMed  CAS  Google Scholar 

  12. Knightly JJ, Agostino D, Cliffton EE (1962) The effect of fibrinolysin and heparin on the formation of peritoneal adhesions. Surgery 52:250–258

    PubMed  CAS  Google Scholar 

  13. Oncel M, Remzi FH, Senagore AJ, Connor JT, Fazio VW (2003) Liquid antiadhesive product (Adcon-p) prevents post-operative adhesions within the intra-abdominal organs in a rat model. Int J Colorectal Dis 18(6):514–517

    Article  PubMed  Google Scholar 

  14. Kössi J, Salminen P, Rantala A, Laato M (2003) Population-based study of the surgical workload and economic impact of bowel obstruction caused by postoperative adhesions. Br J Surg 90:1441–1444

    Article  PubMed  Google Scholar 

  15. Menzies D, Ellis H (1990) Intestinal obstruction from adhesions; how big is the problem. Ann R Coll Surg Engl 72:60–63

    PubMed  CAS  Google Scholar 

  16. Ellis H, Moran BJ, Thompson JN, Parker MC, Wilson MS, Menzies D et al (1999) Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet 353:1476–1480

    Article  PubMed  CAS  Google Scholar 

  17. Ivarsson ML, Holmdahl L, Franzén G, Risberg B (1997) Cost of bowel obstruction resulting from adhesions. Eur J Surg 163:679–684

    PubMed  CAS  Google Scholar 

  18. Ray NF, Denton WG, Thamer M, Henderson SC, Perry S (1998) Abdominal adhesiolysis: inpatient care and expenditures in the United States in 1994. J Am Coll Surg 186:1–9

    Article  PubMed  CAS  Google Scholar 

  19. Heuer GJ, Miller RT, Matas R (1925) In memoriam William Steward Halsted: 1852–1922. Arch Surg 10:293–305

    Article  Google Scholar 

  20. Arung W, Meurisse M, Detry O (2011) Pathophysiology and prevention of postoperative peritoneal adhesions. World J Gastroenterol 17(41):4545–4553

    Article  PubMed  Google Scholar 

  21. Oncel M, Remzi FH, Connor J, Fazio VW (2005) Comparison of cecal abrasion and multiple-abrasion models in generating intra-abdominal adhesions for animal studies. Tech Coloproctol 9:29–33

    Article  PubMed  CAS  Google Scholar 

  22. Tebala GD, Ceriati F, Ceriati E, Vecchioli A, Noris S (1995) The use of cyanoacrylate tissue adhesive in high-risk intestinal anastomoses. Surg Today 25:1069–1072

    Article  PubMed  CAS  Google Scholar 

  23. Bae KB, Kim SH, Jung SJ, Hong KH (2010) Cyanoacrylate for colonic anastomosis; is it safe. Int J Colorectal Dis 25:601–606

    Article  PubMed  Google Scholar 

  24. Becker JM, Dayton MT, Fazio VW et al (1996) Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study. J Am Coll Surg 183:297–306

    PubMed  CAS  Google Scholar 

  25. Beck DE, Cohen Z, Fleshman JW et al (2003) A prospective, randomized, multicenter, controlled study of the safety of Seprafilm adhesion barrier in abdominopelvic surgery of the intestine. Dis Colon Rectum 46:1310–1319

    Article  PubMed  Google Scholar 

  26. Yeo Y, Bellas E, Highley CB, Langer R, Kohane DS (2007) Peritoneal adhesion prevention with an in situ cross-linkable hyaluronan gel containing tissue-type plasminogen activator in a rabbit repeated-injury model. Biomaterials 28(25):3704–3713

    Article  PubMed  CAS  Google Scholar 

  27. Hong JH, Choe JW, Kwon GY, Cho DY, Sohn DS, Kim SW et al (2011) The effects of barrier materials on reduction of pericardial adhesion formation in rabbits: a comparative study of a hyaluronan-based solution and a temperature sensitive poloxamer solution/gel material. J Surg Res 166(2):206–213

    Article  PubMed  CAS  Google Scholar 

  28. Rajab TK, Wallwiener M, Planck C, Brochhausen C, Kraemer B, Wallwiener CW (2010) A direct comparison of seprafilm, adept, intercoat, and spraygel for adhesion prophylaxis. J Surg Res 161(2):246–249

    Article  PubMed  CAS  Google Scholar 

  29. Hirasaki Y, Fukunaga M, Kidokoro A, Hashimoto A, Nakamura T, Tsujimoto H et al (2011) Development of a novel antiadhesive material, alginate flakes, ex vivo and in vivo. A Surg Today 41(7):970–977

    Article  CAS  Google Scholar 

  30. Zeng Q, Yu Z, You J, Zhang Q (2007) Efficacy and safety of Seprafilm for preventing postoperative abdominal adhesion: systematic review and meta-analysis. World J Surg 31(11):2125–2131, discussion 2132

    Article  PubMed  Google Scholar 

  31. Tang CL, Jayne DG, Seow-Choen F, Ng YY, Eu KW, Mustapha N (2006) A randomized controlled trial of 0.5% ferric hyaluronate gel (Intergel) in the prevention of adhesions following abdominal surgery. Ann Surg 243(4):449–455

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

This work was supported by Grant from Inje University, 2012

Author information

Authors and Affiliations

  1. Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, 633-165 Gaegum-dong, Jin-gu, Busan, 614-735, Republic of Korea

    Hyo Jun Hwang, Min Sung An, Tae Kwun Ha, Kwang Hee Kim, Tae Hyeon Kim, Chang Soo Choi, Kwan Hee Hong & Ki Beom Bae

  2. Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea

    Soo Jin Jung

  3. Paik Institute for Clinical Research, Busan, Republic of Korea

    Sun-Hee Kim, Kuk Hwan Rho & Ki Beom Bae

Authors
  1. Hyo Jun Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Min Sung An
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tae Kwun Ha
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kwang Hee Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tae Hyeon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chang Soo Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kwan Hee Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Soo Jin Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sun-Hee Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kuk Hwan Rho
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Ki Beom Bae
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ki Beom Bae.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hwang, H.J., An, M.S., Ha, T.K. et al. All the commercially available adhesion barriers have the same effect on adhesion prophylaxis?; A comparison of barrier agents using a newly developed, severe intra-abdominal adhesion model. Int J Colorectal Dis 28, 1117–1125 (2013). https://doi.org/10.1007/s00384-013-1679-8

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-013-1679-8

Keywords

Search

Navigation