orabase and Postoperative-Complications

This meta-analysis was performed to evaluate the effect of Seprafilm® on postoperative small bowel obstruction.. A literature search was conducted in the PubMed and EMBASE databases through August 2020. The pooled risk ratios as well as the corresponding 95% confidence intervals were calculated using RevMan 5.3 software.. A total of 9 clinical control trials involving 4,351 patients (2,123 in the Seprafilm® group and 2,228 in the control group) were included. The overall analysis showed that the pooled risk ratio was 0.45 (95% confidence interval = 0.34-0.60; P < .00001), indicating that the risk of postoperative small bowel obstruction can be significantly decreased by the application of Seprafilm®. Similarly, an obvious effect of Seprafilm® on reducing the rate of postoperative small bowel obstruction was also shown in the subgroup analyses by population (adult participants), study design (randomized control study or nonrandomized control study), region (Japan or Korea), follow-up duration (2 years or 5 years), and sheet number of Seprafilm® (1 sheet or >1 sheet).. In conclusion, the use of Seprafilm® is beneficial for decreasing the rate of postoperative small bowel obstruction.

Topics: Abdomen; Carboxymethylcellulose Sodium; Humans; Hyaluronic Acid; Intestinal Obstruction; Intestine, Small; Membranes, Artificial; Postoperative Complications; Risk Factors

Topics: Carboxymethylcellulose Sodium; Constriction, Pathologic; Endoscopic Mucosal Resection; Esophageal Neoplasms; Esophageal Stenosis; Female; Humans; Male; Postoperative Complications; Primary Prevention; Risk Assessment; Surgical Mesh; Treatment Outcome

Formation of adhesions after peritoneal surgery results in high morbidity. Barriers to prevent adhesion are seldom applied, despite their ability to reduce the severity of adhesion formation. We evaluated the benefits and harms of four adhesion barriers that have been approved for clinical use.. In this systematic review and meta-analysis, we searched PubMed, CENTRAL, and Embase for randomised clinical trials assessing use of oxidised regenerated cellulose, hyaluronate carboxymethylcellulose, icodextrin, or polyethylene glycol in abdominal surgery. Two researchers independently identified reports and extracted data. We compared use of a barrier with no barrier for nine predefined outcomes, graded for clinical relevance. The primary outcome was reoperation for adhesive small bowel obstruction. We assessed systematic error, random error, and design error with the error matrix approach. This study is registered with PROSPERO, number CRD42012003321.. Our search returned 1840 results, from which 28 trials (5191 patients) were included in our meta-analysis. The risks of systematic and random errors were low. No trials reported data for the effect of oxidised regenerated cellulose or polyethylene glycol on reoperations for adhesive small bowel obstruction. Oxidised regenerated cellulose reduced the incidence of adhesions (relative risk [RR] 0·51, 95% CI 0·31-0·86). Some evidence suggests that hyaluronate carboxymethylcellulose reduces the incidence of reoperations for adhesive small bowel obstruction (RR 0·49, 95% CI 0·28-0·88). For icodextrin, reoperation for adhesive small bowel obstruction did not differ significantly between groups (RR 0·33, 95% CI 0·03-3·11). No barriers were associated with an increase in serious adverse events.. Oxidised regenerated cellulose and hyaluronate carboxymethylcellulose can safely reduce clinically relevant consequences of adhesions.. None.

Topics: Abdomen; Carboxymethylcellulose Sodium; Cellulose, Oxidized; Glucans; Glucose; Humans; Icodextrin; Polyethylene Glycols; Postoperative Complications; Randomized Controlled Trials as Topic; Tissue Adhesions; Treatment Outcome

Postoperative tissue adhesion is a complex inflammatory disorder in which tissues that normally remain separated in the body grow into each other. Seroma is a common postoperative complication that arises when serous fluid collects in the space generated following surgeries that require extensive dissection and that create large empty spaces. Postsurgical tissue adhesion and seroma formation are two serious surgical complications that have received more attention recently from the biomaterials community. This paper provides a review of the pathogenesis and treatment of these surgical complications, with a thorough overview of biomaterial-based treatment and prevention methods.

Topics: Animals; Biocompatible Materials; Carboxymethylcellulose Sodium; Cellulose, Oxidized; Dextrans; Humans; Hyaluronic Acid; Inflammation; Models, Animal; Phospholipids; Polyethylene Glycols; Postoperative Complications; Seroma; Surgical Procedures, Operative; Tissue Adhesions

To study the prevention of postoperative adhesion using carboxymethylcellulose (CMC).. The literature was reviewed extensively, concerning the physical and chemical characters of CMC, the mechanism of preventing adhesion, the effect on healing of anastomoses, the experimental researches and the clinical application.. CMC was a polysaccharide with favorable biocompatibility, biodegradation, stable physical and chemical characters, and it can prevent postoperative adhesion.. CMC is with a wide outlook in prevention of postoperative adhesion.

Topics: Carboxymethylcellulose Sodium; Humans; Postoperative Complications; Tissue Adhesions; Wound Healing

This report describes a paradoxical inflammatory reaction to Seprafilm caused by extensive adhesion formation early in the postoperative period. A female patient had development of small bowel obstruction immediately after an uneventful low anterior resection for rectal carcinoma with placement of Seprafilm. The obstruction did not improve with nonoperative therapy. At laparotomy, extensive adhesions necessitating bowel resection and ileostomy were noted. Pathology results showed a giant cell foreign body reaction to Seprafilm. A literature search yielded only two other instances of adverse reactions to Seprafilm. The information provided by this and other atypical reports suggests that further studies aimed at identifying the incidence and pathophysiological mechanisms for such paradoxical reactions are needed.

Topics: Aged; Biocompatible Materials; Carboxymethylcellulose Sodium; Female; Gastric Outlet Obstruction; Humans; Hyaluronic Acid; Ileostomy; Inflammation; Laparotomy; Omentum; Postoperative Complications

We performed a prospective randomized study to assess whether the use of sodium hyaluronate-based bioresorbable membrane (Seprafilm. One hundred seven patients were assigned to the Seprafilm. The overall small bowel obstruction rate was 7.6% (N = 37/488 patients). Small bowel obstruction developed in 9 patients (5.8%) in the Guardix. The use of Seprafilm significantly reduces the incidence of postoperative small bowel obstruction in patients undergoing colorectal surgery. We observed no difference in the incidence of postoperative small bowel obstruction after the application of Seprafilm

Topics: Absorbable Implants; Adult; Aged; Carboxymethylcellulose Sodium; Colectomy; Drug Combinations; Female; Follow-Up Studies; Humans; Hyaluronic Acid; Incidence; Intestinal Obstruction; Intestine, Small; Male; Membranes, Artificial; Middle Aged; Postoperative Complications; Proctectomy; Prospective Studies; Treatment Outcome

Guardix-SG is a poloxamer-based antiadhesive agent. The aim of this study was to investigate its efficacy in preventing abdominal adhesions in gastric cancer patients undergoing gastrectomy. Few clinical studies have reported that antiadhesive agent reduces the incidence of adhesion after gastrectomy.. We conducted a multicenter trial from June 2013 and August 2015 in patients with gastric adenocarcinoma undergoing radical gastrectomy. Patients were randomly assigned to the Guardix treatment or control group. Postoperative adhesions were diagnosed based on postoperative symptoms, plain x-ray films, and computed tomography. The primary endpoint of the study was the incidence of small bowel obstruction in the first postoperative year. The secondary end-point was the safety of Guardix-SG.. The study included 109 patients in the Guardix group and 105 patients in the control group. The groups were similarly matched with pathological stage, operation type, anastomosis method, midline incision length, and the extent of lymph node dissection. Eight in the Guardix group and 21 in the control group experienced intestinal obstruction during the 1-year follow-up period. The cumulative incidence of small bowel obstruction was significantly lower in the Guardix group compared to that seen in the control group (4.7% vs 8.6% at 6 months and 7.3% vs 20% at 1 year; P = .007, log-rank test). There were no differences in postoperative complications and adverse events.. Guardix-SG significantly decreased the incidence of intestinal obstruction without affecting the incidence of postoperative complications.

Topics: Abdomen; Adenocarcinoma; Carboxymethylcellulose Sodium; Drug Combinations; Female; Gastrectomy; Humans; Hyaluronic Acid; Incidence; Intestinal Obstruction; Male; Middle Aged; Postoperative Complications; Protective Agents; Stomach Neoplasms; Tissue Adhesions

To identify the prevalence of corneal ulceration in dogs receiving prophylactic gel lubrication under general anesthesia (GA).. An ophthalmic examination was performed before premedication and 24 h after GA in 100 dogs (199 eyes) undergoing nonophthalmic procedures. Individuals with known pre-existing ocular surface conditions were excluded. An ocular lubricating gel containing carmellose sodium was applied by the anesthetist at induction and every 2-4 h until extubation. Logistic regression analysis was used to calculate risk factors for ulcerative disease, including signalment, length of GA, patient position, procedure performed, pre-, and post-GA ophthalmic examination findings and admitting service. A Wilcoxon rank sum test compared pre- and post-GA Schirmer tear test-1 (STT-1) values.. One dog (0.5% of total eyes) developed fluorescein stain uptake consistent with superficial corneal ulceration that resolved within 48 h with supportive treatment. Twenty-five (18.6% of total eyes) developed a faint, patchy corneal uptake of stain in the axial cornea that was consistent with epithelial erosion. All erosions resolved with lubrication 24 h later. The decrease in STT-1 readings at 24 h post-GA was statistically significant from those pre-GA (P < 0.001). No significant risk factors for corneal erosion/ulceration were identified.. The results of this study show that a basic protocol of prophylactic lubrication during GA was associated with a low prevalence of corneal ulceration but a higher prevalence of epithelial erosion. In addition, the study supports the need for post-GA corneal examination.

Topics: Anesthesia, General; Animals; Carboxymethylcellulose Sodium; Corneal Diseases; Dog Diseases; Dogs; Lubricant Eye Drops; Postoperative Complications; Prevalence; Prospective Studies; Risk Factors; Ulcer

To assess the anti-adhesive effect of treatment with hyaluronic acid-carboxymethylcellulose following laparoscopic radical prostatectomy.. This was a randomized, controlled, single-blind, parallel-group study using hyaluronic acid-carboxymethylcellulose in patients who underwent laparoscopic radical prostatectomy. Sixty patients were enrolled in the study. All patients were randomly assigned to either the hyaluronic acid-carboxymethylcellulose treatment group (n = 30) or the control group (n = 30). Viscera slide ultrasounds and plain X-rays were obtained at enrollment (V0), postoperative week 12 (V1), and 24 (V2). The primary end point was the difference in the excursion distance in the viscera slide ultrasound between V0 and V2.. A total of 50 patients completed this study. The average excursion distance at V2 in the experimental group (n = 25) was significantly longer than in the control group (n = 25, 2.7 ± 1.2 vs. 1.3 ± 1.0 cm, respectively; p < 0.001). The differences in the V0 and V2 excursion distances were significantly higher in the control group than in the experimental group (1.48 ± 1.5 vs. 2.9 ± 1.2 cm, respectively; p < 0.001). None of patients showed adverse events associated with the use of hyaluronic acid-carboxymethylcellulose.. This randomized study demonstrated that hyaluronic acid-carboxymethylcellulose treatment resulted in a reduction in bowel adhesion to the abdominal wall after laparoscopic pelvic surgery and had good clinical safety.. ClinicalTrials.gov Identifier: NCT02773251 Date: May 12, 2016.

Topics: Aged; Carboxymethylcellulose Sodium; Drug Therapy, Combination; Humans; Hyaluronic Acid; Laparoscopy; Male; Middle Aged; Postoperative Complications; Prospective Studies; Prostatectomy; Single-Blind Method; Tissue Adhesions; Urologic Surgical Procedures

To evaluate the effect of hyaluronic acid (HA) and carboxymethylcellulose (CMC) instillation after transurethral resection of the prostate (TURP) on preventing urethral stricture.. A total of 180 patients underwent TURP for benign prostatic hyperplasia. Recruited patients were randomly divided into two groups: Groups A and B. Patients in group A (90 patients, experimental group) received HA/CMC instillation, and patients in the group B (90 patients, control group) received lubricant instillation after TURP. Each patient was evaluated at 4 weeks (V1), 12 weeks (V2), and 24 weeks (V3) after the surgery. The effectiveness of HA/CMC instillation was evaluated based on the International Prostate Symptom Score/Quality of Life, peak urine flow rate, voided volume, and postvoid residual volume. The visual analogue scale (VAS) pain score and degree of satisfaction were also determined for each participant.. Among 180 initial participants, 80 patients in group A and 81 patients in group B had completed the experiment. VAS pain scores were 0.75±0.75 and 1.75±1.37 (P<0.001), and degrees of satisfaction were 0.63±0.66 and 0.91±0.51 in group A and group B at 1 month after surgery (P=0.002). By retrograde urethrography, urethral stricture after TURP was seen in 1 of 80 subjects in group A and 7 of 81 subjects in group B.. HA/CMC instillation after TURP decreased the incidence of urethral stricture. In addition, HA/CMC was effective at reducing pain during the early postoperative period, with no adverse effects.

Topics: Carboxymethylcellulose Sodium; Catheterization; Humans; Hyaluronic Acid; Male; Postoperative Complications; Prostatic Hyperplasia; Single-Blind Method; Transurethral Resection of Prostate; Treatment Outcome; Urethral Stricture

To evaluate the anti-adhesive and anti-inflammatory effects of sodium hyaluronate-carboxymethylcellulose (HA-CMC) on postoperative hearing improvement and complications during tympanomastoid surgery.. Prospective controlled clinical trial.. We evaluated 287 patients who underwent type I tympanoplasty, with or without canal wall up mastoidectomy, between January 2007 and June 2010. Postoperative hearing and complications were compared in the 143 patients who received Gelfoam soaked with HA-CMC during myringoplasty and the 144 patients who received Gelfoam only.. There were no significant between-group differences in sex, age, and preoperative hearing status. However, average postoperative air-bone gap (13.7 ± 8.5 dB vs. 17.2 ± 9.9 dB) and the number of air-bone gaps smaller than 10 dB (40.6% vs. 24.3%) were significantly improved in the HA-CMC compared with the control group. In addition, the rates of re-otorrhea, reperforation of the tympanic membrane (TM), postoperative TM adhesion, and reoperation were lower in the HA-CMC than in the control group without significances.. These findings suggest that combined application of Gelfoam with HA-CMC may be beneficial in patients undergoing tympanomastoid surgery.

Topics: Carboxymethylcellulose Sodium; Drug Carriers; Female; Follow-Up Studies; Humans; Hyaluronic Acid; Male; Mastoid; Middle Aged; Otitis Media; Postoperative Complications; Prospective Studies; Single-Blind Method; Tissue Adhesions; Treatment Outcome; Tympanic Membrane; Tympanoplasty; Viscosupplements

To evaluate the efficacy of hyaluronate/carboxymethylcellulose (HA/CMC) membrane and melatonin separately and in combination in reducing adhesion reformation following adhesiolysis of surgically induced adhesions in a rat uterine horn adhesion model.. A randomized, prospective study was carried out in a university animal laboratory. Ninety-eight female Sprague-Dawley albino rats were operated on. Following infliction of standard lesions, all the animals underwent second operations after one week. In all the animals, there were dense and vascular adhesions only between the uterine horns. These adhesions were lysed. Following the completion of adhesiolysis, the animals were randomized before closure of the abdomen to one of four groups (melatonin, HA/CMC membrane, combination of melatonin and HA/CMC membrane, control group). Seven days after the second surgery, the third operations were carried out and adhesions were scored. The main outcome measures were type, tenacity, and extent of adhesions. Total adhesion scores were determined.. Adhesion scores in the melatonin and HA/CMC membrane groups were similar, and significantly lower than those in the control group (P < 0.001). Adhesion scores in the combination group were lower than those in the other three groups (P < 0.001).. Melatonin and HA/CMC membrane are both effective separately in preventing adhesion reformation following adhesiolysis, but in combination they are significantly more beneficial.

Topics: Administration, Topical; Animals; Carboxymethylcellulose Sodium; Combined Modality Therapy; Disease Models, Animal; Female; Free Radical Scavengers; Hyaluronic Acid; Melatonin; Membranes, Artificial; Peritoneal Diseases; Postoperative Complications; Prospective Studies; Random Allocation; Rats; Rats, Sprague-Dawley; Tissue Adhesions; Treatment Outcome; Uterine Diseases; Uterus

To assess the safety and efficacy of Sepraspray Adhesion Barrier (a modified hyaluronic acid and carboxymethylcellulose powder) after laparoscopic surgery, in view of both the high efficacy of Seprafilm Adhesion Barrier in reducing postoperative adhesions after open surgical procedures and the difficulty with laparoscopic delivery.. Multicenter, randomized, reviewer-blinded trial.. Reproductive endocrinology and infertility clinics.. Women undergoing laparoscopic myomectomy for indications including infertility.. Randomization to treatment with (n = 21) or without (n = 20) Sepraspray Adhesion Barrier.. Postoperative adhesions development was assessed at early second-look laparoscopy. Adhesions were scored using the modified American Fertility Society scoring system.. Surgical procedure duration length was 99 versus 102 minutes in the control versus Sepraspray Adhesion Barrier groups, respectively, with the median number of fibroids removed being two in each group and corresponding fibroid weights of 134 ± 103 versus 113 ± 161 g, respectively. Adhesions scores increased in both the control and Sepraspray Adhesion Barrier groups, with larger although nonstatistically significant increases noted in control subjects when evaluating for the anterior uterus, the posterior uterus, and the entire uterus.. Laparoscopic application of Sepraspray Adhesion Barrier after myomectomy in this pilot study was associated with a trend toward a reduction in postoperative adhesion development, as well as an encouraging safety profile. Further evaluation is warranted.. Sepraspray Adhesion Barrier #NCT00624930.

Topics: Adult; Carboxymethylcellulose Sodium; Female; Gynecologic Surgical Procedures; Humans; Hyaluronic Acid; Laparoscopy; Leiomyoma; Pilot Projects; Postoperative Complications; Powders; Prospective Studies; Second-Look Surgery; Time Factors; Tissue Adhesions; Treatment Outcome; United States; Uterine Neoplasms

Postoperative adhesions occur when fibrous strands of internal scar tissue bind anatomical structures to one another. The most common cause of intra-abdominal adhesions is previous intra-abdominal surgical intervention. Up to 74% of intestinal obstructions are caused by post surgical adhesions. Although a variety of methods and agents have been investigated to prevent post surgical adhesions, the problem of peritoneal adhesions remains largely unsolved. Materials serving as an adhesion barrier are much needed.. This is a prospective, randomised, controlled, patient blinded and observer blinded, single centre phase I-II trial, which evaluates the safety of A-Part Gel as an adhesion prophylaxis after major abdominal wall surgery, in comparison to an untreated control group. 60 patients undergoing an elective median laparotomy without prior abdominal surgery are randomly allocated into two groups of a 1:1- ratio. Safety parameter and primary endpoint of the study is the occurrence of wound healing impairment or peritonitis within 28 (+10) days after surgery. The frequency of anastomotic leakage within 28 days after operation, occurrence of adverse and serious adverse events during hospital stay up to 3 months and the rate of adhesions along the scar within 3 months are defined as secondary endpoints. After hospital discharge the investigator will examine the enrolled patients at 28 (+10) days and 3 months (+/-14 days) after surgery.. This trial aims to assess, whether the intra-peritoneal application of A-Part Gel is safe and efficacious in the prevention of post-surgical adhesions after median laparotomy, in comparison to untreated controls.

Topics: Abdomen; Abdominal Wound Closure Techniques; Adult; Biocompatible Materials; Carboxymethylcellulose Sodium; Clinical Protocols; Drug Combinations; Female; Gels; Humans; Male; Peritonitis; Polyvinyl Alcohol; Postoperative Complications; Prospective Studies; Tissue Adhesions; Wound Healing

Although Seprafilm has been demonstrated to reduce adhesion formation, it is not known whether its usage would translate into a reduction in adhesive small-bowel obstruction.. This was a prospective, randomized, multicenter, multinational, single-blind, controlled study. This report focuses on those patients who underwent intestinal resection (n = 1,701). Before closure of the abdomen, patients were randomized to receive Seprafilm or no treatment. Seprafilm was applied to adhesiogenic tissues throughout the abdomen. The incidence and type of bowel obstruction was compared between the two groups. Time to first adhesive small-bowel obstruction was compared during the course of the study by using survival analysis methods. The mean follow-up time for the occurrence of adhesive small-bowel obstruction was 3.5 years.. There was no difference between the treatment and control group in overall rate of bowel obstruction. The incidence of adhesive small-bowel obstruction requiring reoperation was significantly lower for Seprafilm patients compared with no-treatment patients: 1.8 vs. 3.4 percent (P < 0.05). This finding represents an absolute reduction in adhesive small-bowel obstruction requiring reoperation of 1.6 percent and a relative reduction of 47 percent. In addition, a stepwise multivariate analysis indicated that the use of Seprafilm was the only predictive factor for reducing adhesive small-bowel obstruction requiring reoperation. In both groups, 50 percent of first adhesive small-bowel obstruction episodes occurred within 6 months after the initial surgery with nearly 30 percent occurring within the first 30 days. Additionally no first adhesive small-bowel obstruction events were reported in Years 4 and 5 of follow-up.. The overall bowel obstruction rate was unchanged; however, adhesive small-bowel obstruction requiring reoperation was significantly reduced by the use of Seprafilm, which was the only factor that predicted this outcome.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carboxymethylcellulose Sodium; Digestive System Surgical Procedures; Female; Follow-Up Studies; Humans; Hyaluronic Acid; International Cooperation; Intestinal Obstruction; Intestine, Small; Intraoperative Period; Male; Middle Aged; Postoperative Complications; Prospective Studies; Time Factors; Tissue Adhesions; Treatment Outcome

To evaluate efficacy and safety of IP administration of high-molecular-weight carboxymethylcellulose (HMW CMC) for the prevention of postoperative intra-abdominal adhesions in ponies.. 10 ponies.. A 1% solution of HMW CMC was instilled intra-abdominally prior to surgery in 5 ponies, whereas 5 control ponies did not receive HMW CMC. Postoperative adhesions were induced by use of a bowel-abrasion method comprising laparotomy, typhlotomy, and abrasion of jejunal serosa at multiple sites with placement of 3 sutures at each site. Day of surgery was day 0. After surgery, ponies were monitored, and hematologic, serum biochemical, and peritoneal fluid analyses were performed on days 1, 2, 3, 5, 7, and 10. On day 10, ponies were euthanatized. Intra-abdominal adhesions were recorded, and tissue samples were collected for histologic examination.. A significantly greater number of adhesions, number of multiple adhesions, and mean incidence of adhesions were identified in control ponies, compared with CMC-treated ponies. Mean peritoneal fluid WBC count on day 7 and serum fibrinogen concentrations on days 5 and 7 were significantly higher in control ponies, compared with CMC-treated ponies. Results of serum biochemical analyses did not differ significantly between the 2 groups.. Intra-abdominal use of 1% HMW CMC during surgery was effective for preventing postoperative adhesions in ponies. Use of HMW CMC did not have detrimental effects on wound healing, intra-abdominal defenses, or patient health. A 1% solution of HMW CMC may be used routinely during abdominal surgery of horses for prevention of postoperative adhesions.

Topics: Abdomen; Animals; Carboxymethylcellulose Sodium; Female; Horse Diseases; Horses; Male; Molecular Weight; Peritoneal Diseases; Postoperative Complications; Solutions; Tissue Adhesions

To evaluate, the safety and efficacy of Seprafilm, a novel bioresorbable membrane of chemically modified hyaluronic acid and carboxymethylcellulose, in preventing and reducing postoperative adhesion formation.. Randomized, controlled, blinded, prospective multicenter study.. Major academic surgical centers.. 183 (treatment, n = 91; control, n = 92) patients with ulcerative colitis or familial polyposis.. Restorative proctocolectomy and ileal J-pouch anastomosis with diverting ileostomy followed by second-stage laparoscopy for ileostomy closure and direct visual assessment of the peritoneal cavity. Before abdominal closure in treated patients, Seprafilm, averaging 406.9 cm2 per patient, was applied without suturing between the midline incision and underlying tissues and organs.. Determination of the incidence, extent (mean percentage of midline incision associated with adhesions), severity (grade 1, least severe; grade 2, moderately severe; grade 3, very severe), and distribution of adhesions.. In 175 (treatment, n = 90) evaluable patients, Seprafilm significantly reduced the incidence (49% and 94%, respectively, p < 0.0001), extent (23% and 63%, respectively, p < 0.0001), and severity (15% versus 58% grade 3 severity, respectively, p < 0.0001) of postoperative adhesions. Seprafilm decreased the rate of adhesion formation by nearly 50%. More than half (51%) of Seprafilm recipients were adhesion-free, versus only 6% of untreated patients. Thus treated patients were eight times more likely to be free of adhesions than untreated controls. The incidence of incisional adhesions associated with the omentum, small bowel, left sidewall, bladder, ileostomy, and stomach was significantly reduced in the Seprafilm patients. Effects on vital signs and laboratory parameters were comparable in the two groups and were attributable to the operative procedure, concomitant therapy, or comorbid disease. All reported adverse events were associated with the surgical procedure and/or comorbid disease and did not differ significantly between the two groups (p > 0.05).. Seprafilm is safe and significantly reduces the incidence, extent, and severity of postoperative adhesions to the midline incision compared with no treatment, the current standard of surgical care.

Topics: Absorption; Adolescent; Adult; Aged; Anastomosis, Surgical; Biocompatible Materials; Carboxymethylcellulose Sodium; Evaluation Studies as Topic; Female; Humans; Hyaluronic Acid; Male; Membranes, Artificial; Middle Aged; Postoperative Complications; Proctocolectomy, Restorative; Prospective Studies; Prostheses and Implants; Tissue Adhesions

Postoperative abdominal adhesions are associated with numerous complications, including small bowel obstruction, difficult and dangerous reoperations, and infertility. A sodium hyaluronate and carboxymethylcellulose bioresorbable membrane (HA membrane) was developed to reduce formation of postoperative adhesions. The objectives of our prospective study were to assess the incidence of adhesions that recurred after a standardized major abdominal operation using direct laparoscopic peritoneal imaging and to determine the safety and effectiveness of HA membrane in preventing postoperative adhesions.. Eleven centers enrolled 183 patients with ulcerative colitis or familial polyposis who were scheduled for colectomy and ileal pouch-anal anastomosis with diverting-loop ileostomy. Before abdominal closure, patients were randomly assigned to receive or not receive HA membrane placed under the midline incision. At ileostomy closure eight to 12 weeks later, laparoscopy was used to evaluate the incidence, extent, and severity of adhesion formation to the midline incision.. Data were analyzed for 175 assessable patients. While only five (6 percent) of 90 control patients had no adhesions, 43 (51 percent) of 85 patients receiving HA membrane were free of adhesions (p < 0.00000000001). The mean percent of the incision length involved was 63 percent in the control group, significantly greater than the 23 percent observed in patients who received HA membrane (p < 0.001). Dense adhesions were observed in 52 (58 percent) of the 90 control patients, but in only 13 (15 percent) of the 85 receiving HA membrane (P < 0.0001). Comparison of the incidence of specific adverse events between the groups did not identify a difference (P > 0.05).. This study represents the first controlled, prospective evaluation of postoperative abdominal adhesion formation and prevention after general abdominal surgery using standardized, direct peritoneal visualization. In this study, HA membrane was safe and significantly reduced the incidence, extent, and severity of postoperative abdominal adhesions.

Topics: Adenomatous Polyposis Coli; Adult; Biocompatible Materials; Carboxymethylcellulose Sodium; Colectomy; Colitis, Ulcerative; Double-Blind Method; Female; Humans; Hyaluronic Acid; Ileostomy; Incidence; Male; Membranes, Artificial; Postoperative Complications; Proctocolectomy, Restorative; Prospective Studies; Time Factors; Tissue Adhesions

In 80% to 90% of the patients intra-abdominal adhesions occur after abdominal surgery, which can cause small-bowel obstruction, chronic abdominal pain, female infertility and difficulty during reoperation. A novel crosslinked hyaluronic acid gel is evaluated regarding its anti-adhesive capacities in an ischemic button model in rats.. 51 adult, male Wistar rats from a registered breeder, received eight ischemic buttons each and were treated with hyaluronic acid gel (HA, HyaRegen. Macroscopic evaluation of adhesion formation did not differ between the groups. The number of organs involved in adhesions in the HA gel group was significantly lower compared to HA-CMC (p = .041) and the control group (p = .012). A significantly, 1.36-fold higher. HA gel application reduces the number of organs involved in adhesions in an ischemic button model, but no overall reduction in adhesion formation was encountered. Macrophage subtype 2 polarization and high

Topics: Animals; Carboxymethylcellulose Sodium; Cross-Linking Reagents; Disease Models, Animal; Gels; Hyaluronic Acid; Ischemia; Macrophages; Male; Matrix Metalloproteinase 1; Membranes, Artificial; Postoperative Complications; Rats; Rats, Wistar; Tissue Adhesions

There has been no solid evidence regarding the actual efficacy of adhesion barriers in liver surgery.. Difficulty grade of lysis of adhesion was evaluated in 122 patients who underwent repeat hepatectomy (ReHx) using the TORAD score. Technical difficulty of lysis of adhesion and incidence of complication were then compared between the group of patients who received a sheet-type adhesion barrier (Seprafilm®) in the previous hepatectomy (n = 70) and those who did not (n = 52) using the inverse probability weighting method.. Use of Seprafilm was significantly associated with lower grade of difficulty of lysis of adhesion according to the TORAD score (P < 0.001). Postoperative morbidity rate was lower and postoperative stay was shorter in the Seprafilm group in the propensity-score adjusted population (37% vs. 74%, P < 0.001 and 12 days vs. 14 days in median, P = 0.048). Multivariate analysis confirmed that use of Seprafilm was independent predictor for severity of adhesion (odds ratio [OR] 0.24, 95% CI, 0.09-0.65, P = 0.005) and decreased incidence of postoperative morbidity at ReHx (OR, 0.34; 95% CI, 0.14-0.84, P = 0.020).. Use of Seprafilm may be associated with decreased technical difficulty of lysis of adhesion and may correlate with lower risk of postoperative morbidity in patients undergoing ReHx.

Topics: Carboxymethylcellulose Sodium; Hepatectomy; Humans; Hyaluronic Acid; Postoperative Complications; Tissue Adhesions

Pharmacological-based treatment approaches have been used over time to prevent postlaparotomy adhesion. However, the rapid elimination of therapeutics from the peritoneum, and their unwanted side effects, easy flow from the wound site by gravity, and low therapeutic efficacy increase the urgent need for the next generation of antiadhesion agents. This article represents the development of biocompatible and biodegradable antiadhesion agents that consist of carboxymethyl cellulose (CMC) and pullulan with three different types of physical characteristics such as the solution type (ST), film type (FT), and thermosensitive type (TST). These antiadhesion agents that contain no drugs exhibit excellent physical characteristics and superior stability over 30 days in the operative sites without any toxicity and side effects that make the compositions strong candidates as novel antiadhesion agents. Also, the proposed samples reveal superior antiadhesion and tissue regeneration properties in Sprague-Dawley (SD) rats after surgery over Medicurtain. Medicurtain effectively prevented postlaparotomy adhesion in ∼42% of experimental animals, whereas ST 2.25-10, ST 2.5-5, ST 2.5-10, FT 20, and TST 1.5 were effective in 100% of animals. Thus, we believe these antiadhesion agents could be promising to reduce adhesion-related complications during and post-surgical operations and deserve consideration for further study for clinical purposes.

Topics: Animals; Carboxymethylcellulose Sodium; Female; Glucans; Poloxamer; Postoperative Complications; Rats; Rats, Sprague-Dawley; Regeneration; Tissue Adhesions

Two-staged pancreatoduodenectomy with exteriorization of pancreatic juice is a safe procedure for high-risk patients. However, two-staged pancreatoduodenectomy requires complex re-laparotomy and adhesion removal. We analyzed whether using hyaluronate carboxymethylcellulose-based bioresorbable membrane (HCM) reduced the time required for the second operation and facilitated good fistula formation in two-staged pancreatoduodenectomy.. Between April 2011 and December 2018, data were collected from 206 consecutive patients who underwent two-staged pancreatoduodenectomy. HCM has been used for all patients since 2015. Patients for whom HCM was used (HCM group; n = 61) were compared to historical controls (before 2015) without HCM (control group; n = 145) in terms of feasibility of the second operation (operation time, adhesion grade, and complications) and optimal granulation around the external tube at the second laparotomy.. The HCM group showed significantly shorter median operation time [105 min (30-228 min) vs. 151 min (30-331 min); p < 0.001] and smaller median blood loss [36 mL (8-118 mL) vs. 58 mL (12-355 mL); p < 0.001] for the second operation. Neither overall postoperative complication rate (p = 0.811) nor severe-grade complication rate (p = 0.857) differed significantly. Both groups showed good fistula formation, with no significant difference in rate of optimal fistula formation (HCM group, 95.1% vs. control, 95.9%; p = 0.867).. HCM placement significantly improved safety and duration for the second operation, while preserving good fistula formation.

Topics: Absorbable Implants; Aged; Aged, 80 and over; Blood Loss, Surgical; Carboxymethylcellulose Sodium; Feasibility Studies; Female; Humans; Hyaluronic Acid; Laparotomy; Male; Middle Aged; Operative Time; Pancreaticoduodenectomy; Pancreaticojejunostomy; Postoperative Complications; Tissue Adhesions

Postoperative bowel adhesions may lead to various disorders, including abdominal pain, bowel obstruction, ischemia, and necrosis. In previous reports, a dose-dependent increase in bowel adhesions was observed in talc-treated animals in comparison with control animals. Although various methods have been devised to prevent peritoneal adhesions, each of these methods has advantages and disadvantages. In this study, we have attempted to reassess the effect of a carboxymethylcellulose (CMC) solution in the reduction of peritoneal adhesions induced by an intraperitoneal injection of a talc suspension in mice.. Mice received an intraperitoneal injection of a talc suspension, followed by an injection of a CMC solution or vehicle. Two weeks after the injection, any adherent bowel mass was removed en bloc, weighed, and histologically observed.. The administration of talc induced severe bowel adhesions. CMC treatment was unable to completely inhibit the development of bowel adhesions, but treatment did reduce their weight in a dose-dependent manner. According to a histopathologic analysis, the bowel adhesions were composed of a conglomerate of talc aggregate and granulation tissue. The conglomerate was divided into two zones: the cell-rich marginal zone and the cell-scarce central zone. The injection of CMC specifically reduced the width of the marginal zone and the number of infiltrated cells.. This study demonstrated that CMC inhibited bowel adhesions induced by talc in mice. In addition, this is the first report on the effect of CMC on talc peritonitis accompanied by a detailed histologic examination. Our experimental model is very simple and easy to use. Therefore, it may help in the discovery of new antiadhesive agents and in the analysis of the kinetics of bowel adhesion.

Topics: Animals; Carboxymethylcellulose Sodium; Dose-Response Relationship, Drug; Injections, Intraperitoneal; Male; Mice; Mice, Inbred ICR; Peritonitis; Postoperative Complications; Protective Agents; Random Allocation; Talc; Tissue Adhesions; Treatment Outcome

Perihepatic adhesions induced by hepatectomy make the subsequent repeat hepatectomy technically demanding. The aim of this study was to verify the effect of hyaluronic acid/carboxymethyl cellulose-based bioresorbable membrane (HA membrane) in preventing posthepatectomy adhesion formation by focusing on the ease of the adhesiolysis in subsequent hepatectomy for recurrent tumors.. A total of 201 patients who underwent hepatectomy using HA membrane were prospectively followed-up for 3 years. Thirty of the 201 patients underwent a repeat hepatectomy for recurrence. The operative data of 85 cases of repeat hepatectomy, the primary hepatectomy of which had been performed without the use of HA membrane, served as the historical control data. The primary endpoint was the time interval between the skin incision and the start of hepatic parenchymal transection (the preparation time) including adhesiolysis. Secondary endpoints were blood loss during the operation, incidence of postoperative complications, and the biochemical data.. The median preparation time (183 vs. 228 min; p = 0.027) and total operation time (374 vs. 439 min; p = 0.041) were significantly shorter in the HA membrane group than in the control group.. Use of HA membranes during hepatectomy enabled significant shortening of the adhesiolysis time during the sequential hepatectomy performed for recurrent tumors.

Topics: Absorbable Implants; Adult; Aged; Aged, 80 and over; Biocompatible Materials; Carboxymethylcellulose Sodium; Cohort Studies; Hepatectomy; Hospitals, University; Humans; Hyaluronic Acid; Liver Neoplasms; Membranes, Artificial; Middle Aged; Postoperative Complications; Prognosis; Prospective Studies; Reference Values; Statistics, Nonparametric; Tissue Adhesions; Treatment Outcome

A total of 48 females, Sprague Dawley rats, were divided into three groups according to the applied materials. A uterine horn adhesion model was created. The control group (group CO; n = 16) received no special materials except saline infusion. The experimental groups were treated with 1.0 mL HA-CMC solution (group HA-CMC; n = 16) or 1.0 mL PACM solution/gel (group PACM; n = 16). Adhesion scores were evaluated with macroscopic, microscopic, and immunohistochemistry grading 14 days postoperatively.. Macroscopic adhesion scores, including extent, severity, and total scores in group HA-CMC and group PACM, were significantly lower than those in group CO (P < .001). Among these three categories of scoring, group PACM had a significantly lower score than did group HA-CMC in adhesion severity (P = .025). In the microscopic adhesion score analysis, the fibrosis scores in group HA-CMC and group PACM were also significantly lower than that of group CO. In group PACM, the fibrosis score was significantly lower than that of group HA-CMC. There were no statistical differences across all three groups in the microscopic inflammation and immunohistochemistry staining.. Both HA-CMC solution and PACM solution/gel effectively reduced adhesion formation. PACM solution/gel was superior to HA-CMC solution in preventing pelvic adhesion, especially in adhesion severity and microscopic fibrosis.

Topics: Alginates; Animals; Carboxymethylcellulose Sodium; Female; Glucuronic Acid; Hexuronic Acids; Hyaluronic Acid; Immunohistochemistry; Pelvis; Poloxamer; Postoperative Complications; Rats; Rats, Sprague-Dawley; Temperature; Tissue Adhesions; Uterine Diseases; Uterus

To determine the influence of hyaluronate-carboxymethylcellulose (HA-CMC) membranes applied to intestinal anastomoses or enterotomies on postoperative complications after emergency exploratory celiotomy.. Multicenter retrospective case-controlled series.. Adult horses (59 in the HA-CMC group and 91 controls).. Medical records from 4 referral hospitals were searched for horses ≥1 year of age, treated between 2008 and 2014 with emergency exploratory celiotomy, and surviving at least 24 hours postoperatively. Horses receiving repeat celiotomy during the same hospitalization were excluded. Horses who received HA-CMC were matched with controls who did not receive HA-CMC but had similar intestinal lesions and procedures at the same referral hospital. Postoperative complications (colic, nasogastric reflux, fever, incisional infection, and septic peritonitis), duration of hospitalization, and survival were compared between groups. Data were compared between horses by t test, Wilcoxon signed rank test, and χ. The volume of nasogastric reflux at admission (P = .02) and the duration of administration of lidocaine after surgery (P = .02) were greater in horses with HA-CMC membranes than in controls. No difference in postoperative complications or survival was detected between groups: 48 of 59 (81%) horses treated with HA-CMC survived until discharge from the hospital compared with 80 of 91 (88%) horses in the control group (P = .27). Fifteen of 21 horses treated with HA-CMC and 30 of 43 horses in the control group survived >12 months after hospital discharge.. Application of HA-CMC membranes to anastomoses or intestinal incisions did not influence postoperative complications or survival after emergency celiotomy compared with controls.. The safety and efficacy of HA-CMC membrane application to intestinal sites during colic surgery in horses is equivocal.

Topics: Animals; Carboxymethylcellulose Sodium; Case-Control Studies; Colic; Female; Horse Diseases; Horses; Hyaluronic Acid; Laparotomy; Male; Membranes, Artificial; Postoperative Complications; Retrospective Studies; Surgical Wound Infection; Survival Analysis; United States

Adhesions are a major clinical problem after abdominal surgery. Despite decades of research, therapies to prevent adhesion formation are suboptimal.. We have investigated combinations of carboxymethylcellulose (CMC) and heparin at preventing surgical adhesions in two rat models of adhesion formation. The first was the well-established cecal abrasion model, and the second was a model developed in our laboratory, the avascular mesenteric knot model. This model consistently produced adhesions at the knot in 90% of experiments and causes little or no tissue injury.. Topical administration of CMC 4% gave optimal results in the avascular knot model, but was less effective in the cecal abrasion model. This concentration of CMC was combined with a range of heparin doses between 0.5 and 160 IU/mL in the cecal abrasion model. These heparin doses, apart from the lowest (0.5 IU/mL), were effective in preventing adhesion formation in combination with CMC, as was the commercially available topical product Lipactin. The optimal dose was 30 IU/mL, that abolished adhesions, but there was little difference at doses between 2 and 160 IU. Heparin was effective in doses as low as 2 IU/mL when in combination with CMC. Heparin 160 IU/mL, but not heparin 30 IU/mL or Lipactin, significantly increased the degree of bleeding post cecal abrasion surgery.. Topical application of tiny doses of heparin, in combination with CMC 4% gel, significantly reduces adhesion formation in experimental models. We suggest that this cheap and, as far as we know, safe intervention should be evaluated in human clinical trials.

Topics: Administration, Topical; Animals; Carboxymethylcellulose Sodium; Dose-Response Relationship, Drug; Drug Combinations; Heparin; Male; Postoperative Complications; Protective Agents; Rats; Rats, Wistar; Single-Blind Method; Tissue Adhesions; Treatment Outcome

An injectable adhesive hydrogel composed of carboxymethyl cellulose (CMC) and pullulan is developed and evaluated as a postoperative anti-adhesion barrier. CMC was modified with tyramine to introduce crosslinking site via an EDC-NHS reaction. The in situ hydrogel was prepared by an enzyme-mediated reaction of tyramine-immobilized CMC with horseradish peroxidase (HRP) and hydrogen peroxide (H

Topics: Animals; Carboxymethylcellulose Sodium; Cell Proliferation; Gels; Glucans; Hydrogels; Injections; Male; Mice; NIH 3T3 Cells; Postoperative Complications; Rats; Rats, Sprague-Dawley; Rheology; Tissue Adhesions

Vocal fold movement impairment (VFMI) due to neuronal injury occurs in 20% to 30% of surgeries in the region of the aortic arch. Early injection laryngoplasty can aid with postoperative pulmonary toilet in these high-risk cardiovascular patients. The purpose of this study is to determine whether continuing antiplatelet and anticoagulation therapy during awake transcervical injection laryngoplasty surgery is safe, and if there is any increase in bleeding complications in these patients.. This is a retrospective review of patients undergoing awake injection laryngoplasty surgery for VFMI between 2013 and 2016 at a tertiary academic center specializing in aortic and mediastinal diseases. Records were reviewed for patients regarding baseline antiplatelet or anticoagulation therapy, and whether these medications were stopped or continued preoperatively. The primary outcome was bleeding complications.. Of the 95 surgeries reviewed, 44 (46%) were performed for patients on antiplatelet therapy, and 71 (75%) for patients on anticoagulation therapy. None of the patients on antiplatelet therapy had their treatment discontinued. Of the patients on anticoagulation, 13 (16.4%) had their therapy held prior to surgery. There was no observed difference in bleeding complications between patients who were continued on antiplatelet or anticoagulation treatment versus those whose therapy was withheld.. These results suggest that patients undergoing awake transcervical injection laryngoplasty for VFMI can be maintained on antiplatelet or anticoagulation therapy without increased risk of bleeding. Further larger studies are needed to confirm these findings.. 4. Laryngoscope, 127:1850-1854, 2017.

Topics: Anticoagulants; Carboxymethylcellulose Sodium; Female; Humans; Injections; Intraoperative Care; Laryngoplasty; Male; Middle Aged; Neck; Platelet Aggregation Inhibitors; Postoperative Complications; Retrospective Studies; Vocal Cord Paralysis

Abdominal operations are followed by adhesions, a prevalent cause of abdominal pain, and the most frequent cause for bowel obstruction and secondary female infertility. This rat study addresses adhesion prevention capability of Adept(®), Interceed(®), Seprafilm(®), and a novel device, 4DryField(®) PH which is provided as powder and generates its effect as gel.. Sixty-eight male Lewis rats had cecal abrasion and creation of an equally sized abdominal wall defect, and were grouped randomly: A control group without treatment (n=10); two groups treated with 4DryField(®) PH using premixed gel (n=15) or in-situ gel technique (n=16); one group each was treated with Seprafilm(®) (n=8), Interceed(®) (n=9), or Adept(®) (n=10). Sacrifice was on day 7 to evaluate incidence, quality, and quantity of adhesions, as expressed via adhesion reduction rate (AR). Histologic specimens were evaluated. Statistical analyses used ANOVA and unpaired t-tests.. 4DryField(®) PH significantly reduced incidence and severity of adhesions both as premixed gel (AR: 85.2%) and as in-situ made gel (AR: 100%), a comparison between these two application techniques showed no differences in efficacy. Seprafilm(®) did not reduce incidence but severity of adhesions significantly (AR: 53.5%). With Interceed(®) (AR: 3.7%) and Adept(®) (AR: 16.1%) no significant adhesion-reduction was achieved. Except for inflammatory response with Interceed(®), histopathology showed good tissue compatibility of all other devices.. 4DryField(®) PH and Seprafilm(®) showed significant adhesion prevention capabilities. 4DryField(®) PH achieved the highest adhesion prevention effectiveness without restrictions concerning mode of application and compatibility and, thus, is a promising strategy to prevent abdominal adhesions.

Topics: Animals; Carboxymethylcellulose Sodium; Hyaluronic Acid; Male; Membranes, Artificial; Peritoneal Diseases; Postoperative Complications; Random Allocation; Rats; Rats, Inbred Lew; Tissue Adhesions

Collagen exhibits ideal multifactorial action for preventing tissue adhesions. This study examined the efficacy of ionized collagen in preventing tissue adhesion after surgical procedures.. Ionized collagen was prepared using the esterification technique of natural collagen. Three forms of collagen materials (membrane, film, and gel) were compared with three commercialized materials (oxidized regenerated cellulose membrane [OC membrane], hyaluronic acid and carboxymethylcellulose film, and gel [HC film and HC gel]) in a rat cecum abrasion model. Antiadhesive activity and histologic findings were assessed.. The incidence of adhesion was reduced significantly in all test groups compared to the sham-operated control group (100% in control, 14.3% in collagen membrane, 63.6% in collagen film, 25.0% in collagen gel, 55.6% in OC membrane, 75% in HC film, and 83.3% in HC gel). All collagen materials of the three forms exhibited a significant reduction in adhesion grade compared with the sham operation, whereas no significant difference was found among these three different forms. The collagen membrane showed significantly less adhesion grade, less inflammation and more regenerative features compared to widely used conventional materials.. This preclinical investigation indicated that ionized collagen materials readily formed clinically suitable shapes for easy handling without the need for any complex processing and effectively reduced postoperative tissue adhesion profiles compared to conventional antiadhesive agents.

Topics: Animals; Biocompatible Materials; Carboxymethylcellulose Sodium; Cecum; Cellulose, Oxidized; Collagen; Hyaluronic Acid; Incidence; Male; Postoperative Complications; Random Allocation; Rats; Rats, Sprague-Dawley; Tissue Adhesions; Treatment Outcome

The aim of this study is to investigate the expected adhesion-modifying effect of clinoquinol which has metal-chelating feature that limits the inflammation and fibroblastic activity.. A total of 40 Wistar Albino rats were included, which were divided into 5 groups. Group-1 constituted the sham group. Other groups, adhesions were induced by performing cecal abrasion on the rats. For treatment, saline solution was added to Group-2, carboxymethylcellulose was added to Group-3, methylene blue was added to Group-4, and clioquinol was added to Group-5. Blood samples were obtained from the heart to measure IL-10 and TNF α-levels. Adhesions were evaluated both macroscopically and histopathologically.. Clioquinol reduced adhesions at significant level via decreasing the inflammation and fibroblastic activity in the adhesion-induced rats. At macroscopic level, carboxymethylcellulose and clioquinol were the most potent agents in reducing adhesions. Nonetheless, significant foreign body-reaction was observed in the carboxymethylcellulose-treated group.. Clioquinol could reduce the formation of intra-abdominal adhesions. It exerts this activity by limiting the inflammation and fibroblastic activity between the intestines and serous surfaces. Furthermore, it does not induce a foreign body reaction. Due to these properties, we conclude that clioquinol can be used as an alternative agent to prevent adhesions.

Topics: Animals; Carboxymethylcellulose Sodium; Cecum; Clioquinol; Inflammation; Interleukin-10; Male; Postoperative Complications; Rats; Rats, Wistar; Tissue Adhesions; Tumor Necrosis Factor-alpha

We aimed to evaluate the effects of the barrier agent sodium carboxymethyl cellulose (SCMC) with and without dexamethasone for the prevention of postoperative adhesion formation in a rat model of postoperative peritoneal adhesion. A total of 160 three-month old male and female Wistar rats underwent a laparotomy, and adhesions were induced by ileocecal abrasion. Rats were randomly assigned to 4 groups (n=40 each): group A, untreated; group B, treated with SCMC only; group C1, treated with SCMC + 3 mg dexamethasone, and group C2, treated with SCMC + 8 mg dexamethasone. After 12 days, adhesion formation and histopathological changes were compared. In groups A, B, C1, and C2, the mortality rates were 10, 5, 5, and 5%, respectively. In groups C1 and C2, the adhesions were filmy and easy to dissect and were milder compared with those in groups A and B. The total adhesion score in group C1 (3.38±0.49) was significantly lower than that of group B (6.01±0.57; P<0.01) or group A (8.01±0.67; P<0.05). There was no significant difference in adhesion formation between groups C1 and C2. Compared with groups A and B, groups C1 and C2 exhibited milder histopathological changes. SCMC in combination with dexamethasone can prevent adhesion formation and is a better barrier agent than SCMC alone. The safety and feasibility of SCMC in combination with dexamethasone to prevent adhesion formation after abdominal surgery warrants further clinical study.

Topics: Animals; Carboxymethylcellulose Sodium; Dexamethasone; Disease Models, Animal; Drug Therapy, Combination; Female; Laparotomy; Male; Peritoneal Diseases; Peritoneum; Postoperative Complications; Random Allocation; Rats, Wistar; Tissue Adhesions

We aimed to compare the effectiveness of linezolid in preventing intraperitoneal adhesions with hyaluronic acid + carboxymethylcellulose (Seprafilm).. Thirty rats were divided randomly into 3 groups: Group I (control), untreated; Group II (Seprafilm); and Group III (linezolid). All rats were sacrificed on the 14th day after surgery. Macroscopic adhesion, inflammation, and fibrosis were evaluated.. The multiple comparisons between groups showed a statistically significant difference for adhesion. There were statistically significant differences between Group I and II and I and III, but no statistically significant difference between Group II and III. The multiple comparisons between the groups showed a statistically significant difference for inflammation and fibrosis. For inflammation and fibrosis, there was a statistically significant difference between Group I and II and I and III, but no statistically significant difference between Group II and III.. The efficiency of linezolid in reducing the formation of intraperitoneal adhesions was statistically significant compared with the control group.

Topics: Acetamides; Animals; Anti-Infective Agents; Biocompatible Materials; Carboxymethylcellulose Sodium; Cecum; Female; Hyaluronic Acid; Injections, Intraperitoneal; Linezolid; Oxazolidinones; Peritoneal Diseases; Postoperative Complications; Random Allocation; Rats; Rats, Wistar; Tissue Adhesions; Treatment Outcome

An analysis of complex examination and results of treatment was made in 290 patients with diffuse peritonitis. The patients were divided into two groups according to way of sanation of the abdominal cavity. The sanation with 0.03% aqueous solution of sodium hypochlorite was used for the first group of 155 patients. The immobilized forms of sodium hypochlorite in carboxymethyl cellulose gel were applied in the second group. The rate of postoperative complications was decreased on 15.4%, the lethality--on 8.2% in the case of application of the immobilized forms of sodium hypochlorite. The developed technology allowed increasing of physical component of life quality of the patients in 1.3 times, though it didn't influence on psychical component.

Topics: Abdominal Cavity; Carboxymethylcellulose Sodium; Comparative Effectiveness Research; Disinfectants; Drainage; Drug Carriers; Female; Gels; Humans; Male; Middle Aged; Peritoneal Lavage; Peritonitis; Postoperative Complications; Quality of Life; Severity of Illness Index; Sodium Hypochlorite; Survival Analysis; Tissue Adhesions; Treatment Outcome

In this study, we aimed at investigating the effect of placing hyaluronate- carboxymethyl-cellulose membrane (HCMC) on the formation of adhesion postoperatively in a damaged area in the peritoneum of the anterior stomach wall.. The study was conducted on 30 rabbits. A transverse peritoneal damage was inflicted on the stomach anterior walls of all rabbits. In the first treatment group, HCMC was placed on the sutured anterior wall of stomach of 15 rabbits. In the second control group, on the other hand, no treatment was conducted on 15 rabbits. On the 30th day after the operation, relaparatomy was performed on the rabbits and adhesions were evaluated by an independent surgeon according to seriousness and prevalence scores.. There were postoperative adhesions (POA) in 12 (80 %) rabbits in the control group. On the other hand, there were POA in 5 rabbits (33.3 %) in the treatment group. In the treatment group, adhesion was totally prevalent in 2 rabbits (13.3 %), whereas this ratio was 7 (46.6 %) in the control group (p < 0.01).. The study suggested that the use of hyaluronate-carboxymethyl-cellulose could be beneficial on damaged peritoneum surfaces following abdominal surgery in order to reduce POA development to a minimum (Tab. 3, Fig. 3, Ref. 22).

Topics: Animals; Carboxymethylcellulose Sodium; Female; Hyaluronic Acid; Membranes, Artificial; Peritoneum; Postoperative Complications; Rabbits; Stomach; Tissue Adhesions

We aimed to evaluate whether using sodium hyaluronate carboxymethylcellulose membrane (Seprafilm™) can facilitate assessment of hepatic microcirculation via orthogonal polarization spectroscopy (OPS) by preventing intra-abdominal adhesions and whether Seprafilm™ as a foreign material can evoke local or systemic inflammatory reactions. After the right median hepatic vein was ligated, rats received either placement of Seprafilm™ or untreated with observation of 1 or 4 weeks (n = 6/group). Hepatic microcirculation was visualized. Systemic and local inflammatory reactions were evaluated by blood count, histology and immunohistochemical staining for CD68. Seprafilm™ significantly (P < 0.05) prevented intra-abdominal adhesion formation compared to non-Seprafilm™ groups (adhesion score: 0 vs 1.3 ± 0.5 at POW1 and 0.3 ± 0.5 vs 3.5 ± 1.4 at POW4). Placement of Seprafilm™ provided sufficient liver surface for acquisition of OPS videos during the harvest procedure. Adhesiolysis in non-Seprafilm™ groups prevented visualization of hepatic microcirculation. A severe local foreign body reaction with formation of a "fibrin-like" membrane containing CD68-positive inflammatory histiocytic cells and mesothelial cells was observed in Seprafilm™ groups even at POW4. Use of Seprafilm™ conferred visualization of hepatic microcirculation after long term observation in experimental setting. In clinical situation, we would suggest being very cautious in immuno-compromised patients because of an ongoing local foreign body reaction caused by Seprafilm™.

Topics: Animals; Carboxymethylcellulose Sodium; Hyaluronic Acid; Inflammation; Liver; Male; Membranes, Artificial; Microcirculation; Microscopy, Video; Postoperative Complications; Rats; Rats, Inbred Lew; Tissue Adhesions

To investigate the efficacy of hyaluronic acid-carboxymethylcellulose (HACM) in facilitating early recovery of erectile function (EF) after radical prostatectomy, we report our initial experience of HACM use on the neurovascular bundle (NVB) after robot-assisted radical prostatectomy (RARP).. Between 2008 and 2010, 459 consecutive patients who underwent RARP with bilateral nerve-sparing technique were included in this study. Patients were classified into two groups: HACM (group 1; n=162) and non-HACM (group 2; n=287). HACM was delivered to the anatomic location of the NVB after prostate removal. We retrospectively analyzed the surgical outcomes including EF, continence, and perioperative complications.. At 6 months after surgery, EF recovery rate was 28.5% in group 1 and 17.4% in group 2 (P=0.006). In a subgroup analysis consisting of 225 patients with a preoperative International Index of Erectile Function Short Survey (IIEF)-5 score ≥20, the difference in EF recovery at 6 months was significant with 62.8% in group 1 and 27.0% in group 2 (P=0.002), respectively. HACM use was an independent predictor for EF recovery at 6 months after surgery (odds ratio, 2.735; 95% confidence interval, 1.613-4.638; P<0.001). Age and preoperative IIEF-5 were also independent predictors. No differences in continence at 6 months or perioperative complications were found between the two groups. EF recovery was not different between the two groups after 18 months.. HACM use around the NVBs is safe and facilitates early recovery of EF after nerve-sparing RARP. HACM use is more effective in patients with normal preoperative sexual function.

Topics: Adult; Aged; Carboxymethylcellulose Sodium; Erectile Dysfunction; Humans; Hyaluronic Acid; Male; Middle Aged; Penile Erection; Postoperative Complications; Prostate; Prostatectomy; Prostatic Neoplasms; Recovery of Function; Retrospective Studies; Robotics; Tissue Adhesives; Urinary Incontinence

While bioresorbable solid barriers such as Seprafilm® prevent adhesions, their efficacy is limited to sites of application. The aim of this study was to assess the effectiveness of the sprayable adhesion barrier Sepraspray® in preventing adhesions to sites of direct application and to remote sites.. Intraabdominal adhesions were induced in 30 rats by creating three ischemic buttons on each side of a midline incision. To assess efficacy, Sepraspray (5 mg/button) or Seprafilm (1 cm(2)/button) was applied over three buttons on one side of the peritoneum. Operated control animals received no treatment. On day 7, adhesions were scored as percent of buttons with adhesions. To assess safety, 81 rats underwent a colonic transection repaired with an end-to-end anastomosis. Both barriers were applied circumferentially to anastomoses. Controls received no product. The integrity of healing anastomosed colonic wounds was assessed by burst pressure and tensile strength at days 3, 5, and 7 postoperatively.. The direct application of both Sepraspray and Seprafilm significantly (p < 0.001) reduced adhesion formation compared to controls. While Seprafilm had no remote effect on adhesion formation, Sepraspray significantly (p < 0.001) reduced adhesion formation to contralateral ischemic buttons. Neither barrier affected anastomotic integrity at any time point.. Sepraspray has widespread efficacy throughout the peritoneum in reducing adhesions without compromising intestinal healing. Furthermore, this sprayable alternative offers the potential for easier intraabdominal application.

Topics: Anastomosis, Surgical; Animals; Biocompatible Materials; Carboxymethylcellulose Sodium; Colon; Colonic Diseases; Drug Carriers; Hyaluronic Acid; Male; Membranes, Artificial; Peritoneal Diseases; Postoperative Complications; Powders; Rats; Rats, Wistar; Tissue Adhesions; Treatment Outcome; Wound Healing

Postoperative adhesion formation remains a major clinical problem. The aim of this study was to test the effect of a new hydrogel on adhesion formation in a rat model.. A reproducible rat model was used to induce standardized adhesion formation in three experiments. In experiment 1, a cross-linked polyvinyl alcohol (PVA) and carboxymethylcellulose (CMC) hydrogel (PVA/CMC, A-Part®; B. Braun Aesculap, Germany) was tested in different dosages. In experiment 2, PVA/CMC gel was compared to icodextrin 4% (Adept®; Baxter USA). In both groups, animals were sacrificed after 2 weeks. In experiment 3, histological examination after 4 and 6 weeks was performed. The percentage of adhesions to the defect was measured and the density was determined according to the Zühlke scale. During histological examination of the abdominal wall, the formation of neoperitoneum and potential residues of the agents were assessed.. In experiment 1, a significant reduction in amount as well as density of the adhesions was visible with all dosages of PVA/CMC gel. In experiment 2, again quantity and density of the adhesions were diminished by PVA/CMC hydrogel compared to the control group. Icodextrin 4% showed no significant reduction in adhesion formation. In experiment 3, no residues of PVA/CMC gel or icodextrin 4% were found during histological examination after 4 and 6 weeks and neoperitoneum was present in all cases.. PVA/CMC hydrogel appears to be a novel effective adhesion prevention agent. Together with an upcoming safety study, these data encourage to start clinical efficacy studies.

Topics: Animals; Carboxymethylcellulose Sodium; Female; Hydrogels; Models, Animal; Polyvinyl Alcohol; Postoperative Complications; Rats; Tissue Adhesions

Adhesion formation after surgery for peritonitis-related conditions, with such associated complications as intestinal obstruction, pain, and infertility, remains an important problem. Applying a liquid barrier intra-peritoneally might reduce initial adhesion formation.. A combination of the cecal ligation and puncture model of peritonitis with the side-wall defect (SWD) model of adhesion formation was performed. Forty rats were assigned randomly to receive no barrier or 1 mL or 2 mL of the cross-linked polyvinyl alcohol and carboxymethylcellulose (PVA/CMC) hydrogel A-Part(®) Gel (B. Braun Aesculap AG, Tuttlingen, Germany). After 14 days, the animals were sacrificed, and adhesion formation and abscess formation were scored.. Thirty animals survived, distributed equally among the groups. There were significantly fewer adhesions to the SWD in the PVA/CMC groups (median 0) than in the control group (median 26%-50%) (p<0.05). The median tenacity of the adhesions was significantly higher in the control group (Zühlke score 2) than in the PVA/CMC groups (Zühlke score 0) (p<0.05). The amount and size of intra-abdominal abscesses were not significantly different in the three groups.. In this experiment, PVA/CMC hydrogel reduced the amount of adhesions to the SWD and between viscera significantly with equal risk of abscess formation.

Topics: Abdominal Abscess; Animals; Carboxymethylcellulose Sodium; Disease Models, Animal; Male; Peritonitis; Polyvinyl Alcohol; Postoperative Complications; Rats; Rats, Wistar; Tissue Adhesions

Intraperitoneal adhesion is a serious surgical postoperative complication. Using a rat model, we compared the effectiveness of intraperitoneally administered zinc-modified sodium carboxymethyl cellulose (Zn(2+)-SCMC) and hyaluronic acid (HA) in preventing postoperative intraperitoneal adhesions.. Peritoneal adhesions were induced in 120 Wistar rats by scraping the cecal mucosa. The rats were randomized into a no treatment group (n = 40) or into a treatment group in which 3 ml of HA (n = 40) or Zn(2+)-SCMC (n = 40) was administered intraperitoneally before the abdominal wall was closed. Following sacrifice two weeks later, the intraperitoneal adhesions were scored and tissues were examined histologically using HE staining.. Eight animals died, five in the untreated group (mortality rate, 12.5%), two in the HA group (mortality rate, 5.0%) and one in the Zn(2+)-SCMC group (mortality rate, 2.5%). Relative to the untreated group, the incidence of intraperitoneal adhesions was 77.5% in the HA and 48.7% in the Zn(2+)-SCMC group, with the incidence significantly lower in the Zn(2+)-SCMC group (P < 0.001). Both agents prevented intraperitoneal adhesions by promoting the repair of the abdominal serosa.. Administration of Zn(2+)-SCMC was more effective in preventing intraperitoneal adhesions than HA.

Topics: Animals; Carboxymethylcellulose Sodium; Disease Models, Animal; Female; Hyaluronic Acid; Male; Peritoneal Diseases; Postoperative Complications; Rats; Rats, Wistar; Tissue Adhesions

Treatment of blow-out fractures is aimed at the prevention of permanent diplopia and cosmetically unacceptable enophthalmos. Porous polyethylene sheets are one of the most common alloplastic implants for blow-out fracture repair. Because adhesion between the porous polyethylene and the orbital soft tissue can result in restrictions of ocular motility, prevention of postoperative adhesion is important in the reconstruction of blow-out fractures. The purpose of this study was to find out the effect of the mixed solution of sodium hyaluronate and sodium carboxymethylcellulose (HACMC) on postoperative adhesion in blow-out fracture repair in an animal model.Twenty-four New Zealand white rabbits were used. An 8-mm defect was made in the maxillary sinuses including the bone and mucosa. A 10-mm porous polyethylene sheet (Medpor; Porex Surgical Inc., Newnan, GA) was inserted in to the defect. The rabbits were divided into a control group and a HACMC group. In the HACMC group, HACMC solution was instilled onto the surface of the implant and then the implant was inserted. The implants were harvested at 1, 2, 4, and 8 weeks after surgery (3 implants each period). Hematoxylin and eosin, Masson trichrome, and CD31 (platelet endothelial cell adhesion molecule-1) stains were performed for evaluation of inflammation, fibrosis, and vascularization.Inflammation appeared less severe in the HACMC group, but the difference between the 2 groups was not statistically significant. The degree of fibrosis was more severe in the control group. There were significant differences in the degree of fibrosis between the 2 groups 4 and 8 weeks after surgery (P = 0.046). The amount of vascularization was similar in both groups.The HACMC solution seemed to be effective for reducing postoperative adhesion in reconstruction of blow-out fractures in a rabbit model. Our results suggest that the application of HACMC solution could be an effective adjunct for the repair of trap-door fractures or revision of blow-out fractures.

Topics: Animals; Carboxymethylcellulose Sodium; Hyaluronic Acid; Orbital Fractures; Polyethylenes; Postoperative Complications; Prostheses and Implants; Rabbits; Tissue Adhesions

Intra-abdominal application of anti-adhesive barriers may reduce the extent and severity of postoperative adhesions. This study was designed to compare the effectiveness of a sprayable liquid barrier (a mixed solution of sodium hyaluronate and carboxymethylcellulose) with two conventional sheets.. Eighty male Sprague Dawley rats underwent laparotomy with subsequent multiple intestinal wall abrasions and abdominal wall injury. Afterwards, sodium hyaluronate and carboxymethylcellulose (HA-CMC) solutions were intraperitoneally sprayed or a film barrier of either oxidized regenerated cellulose (ORC) or polylactic acid (PA) was placed under the incision. At postoperative d 21, the rats underwent relaparotomy and complete adhesiolysis. Three investigators, who were blind to the group assignment, scored the extent of adhesion formation and resected specimens for histologic examination of fibrosis and inflammation. Expression profiles of parameters as mediators (macrophages [CD68]) in cellular inflammation response were analyzed.. Mean adhesion scores in rats that received HA-CMC solution (7.6±2.3) and ORC membrane (8.1±2.2) were lower than in rats that received PA film (10.7±2.5) and the control group (11.2±2.6) (P<0.05 for each comparison). In addition, there were significantly fewer adhesions located between large and small intestine in the HA-CMC solution group than in the control and each of the film barrier groups (P<0.05 for each comparison).. This study suggests that both HA-CMC solution and ORC membrane decrease the overall incidence of postoperative adhesions. However, the mixed solution of HA-CMC appeared to be superior to ORC membrane because this sprayable solution is easy to use and suitable for site-specific adhesion prevention after multifocal bowel trauma.

Topics: Animals; Carboxymethylcellulose Sodium; Cellulose; Hyaluronic Acid; Incidence; Lactic Acid; Laparotomy; Male; Models, Animal; Polyesters; Polymers; Postoperative Complications; Rats; Rats, Sprague-Dawley; Tissue Adhesions

Sodium hyaluronate and carboxymethylcellulose (HA-CMC) membrane is an effective barrier material for limiting postoperative adhesions, but can be difficult to apply in certain situations due to its physical properties. We tested whether HA-CMC membrane hydrated in saline (slurry) is an effective alternative to HA-CMC membrane for preventing surgical adhesions in rat models of abdominal surgery.. All studies were performed in rat cecal abrasion or sidewall defect models of adhesion formation. Adhesions were examined 7 d after surgery. In separate studies, the effects of variations in slurry composition, volume, and site of application on anti-adhesive properties were studied and compared with untreated controls. Finally, the effectiveness of HA-CMC membrane slurry for preventing adhesions was compared with that of conventional HA-CMC membrane.. Application of HA-CMC membrane slurry to traumatized tissue resulted in a significant reduction in the incidence of adhesions compared with untreated controls in both rat surgery models. Slurry was equally effective when applied in low and high film-to-volume formulations, but had minimal effect when applied in a small volume or at a location distal to the injury. Comparison of HA-CMC membrane slurry and conventional HA-CMC membrane indicated similar efficacy for reducing postoperative adhesions.. In rat models of abdominal surgery, HA-CMC membrane slurry reduced postoperative adhesion formation and may be an effective alternative for HA-CMC membrane in situations where its use is limited by its physical properties.

Topics: Abdomen; Animals; Carboxymethylcellulose Sodium; Hyaluronic Acid; Membranes, Artificial; Models, Animal; Postoperative Complications; Postoperative Period; Rats; Rats, Sprague-Dawley; Tissue Adhesions; Treatment Outcome

Postoperative intra-abdominal adhesion sometimes causes significant morbidity. The aim of this study was to compare the efficacy of our newly developed antiadhesive material, alginate flakes, to the most commonly used combination of hyaluronic acid and carboxymethyl cellulose film.. Sodium alginate was formed into a gel, powder, or flakes. In the ex vivo study, these different alginate forms were attached onto pig skin and their antisolubility properties in saline and attachment stability were compared. In the in vivo study, a rat surgical adhesion model was used to study the properties of the alginates, and the rats were euthanized on day 14 after surgery. The efficacy of the antiadhesive materials was evaluated using an adhesion scoring system, and the locations that were treated with the antiadhesives were histologically examined.. In the alginate groups, the alginate flakes were superior with respect to the antisolubility and the attachment stability ex vivo as well as with respect to the antiadhesive efficacy in vivo. The adhesion score was almost the same as that observed in the alginate flake and cellulose film groups.. We developed an alginate flake material and demonstrated its antiadhesive effects both ex vivo and in vivo. This is the first reported study using this flake-like material, which has a unique characteristic in that it can be applied by spraying in compressed air. Alginate flakes may therefore be especially useful in the field of laparoscopic surgery.

Topics: Alginates; Animals; Biocompatible Materials; Carboxymethylcellulose Sodium; Dermatologic Surgical Procedures; Female; Glucuronic Acid; Hexuronic Acids; Hyaluronic Acid; Laparoscopy; Models, Animal; Postoperative Complications; Rats; Rats, Wistar; Swine

The primary objective of this study was to evaluate the effectiveness and safety of injection laryngoplasty using a temporary injectable agent in the acute setting for patients with unilateral vocal cord paralysis following thoracic surgical procedures.. Retrospective consecutive case series in an academic institution.. Inclusion criteria included patients acutely treated with injection laryngoplasty from January 1, 2006, to March 31, 2010, for a unilateral vocal cord paralysis that occurred after a thoracic surgical procedure (N = 20). All patients were injected with Radiesse Voice Gel using microlaryngoscopy technique.. The mean time to vocal cord injection from the time of thoracic surgery was 4.5 days. There was one operative-related complication of intraoperative bile reflux that caused a pneumonitis. Ninety percent of patients were recommended for strict nothing by mouth prior to injection. Of these, 94% were allowed an oral diet following injection, and 67% tolerated a regular diet. None of the patients required subsequent procedures for aspiration or dysphagia, and 25% required further intervention after discharge for persistent dysphonia. Patients with a known nerve transection had a higher rate of dysphonia requiring further surgical procedures than those who did not have a known nerve transection.. Acute treatment of thoracic surgery-related unilateral vocal cord paralysis with injection laryngoplasty appears safe and effective at preventing postoperative aspiration pneumonia and improves swallowing function to allow resumption of an oral diet. A single injection is often the only required treatment.

Topics: Adult; Aged; Carboxymethylcellulose Sodium; Esophagectomy; Female; Humans; Injections; Laryngoplasty; Male; Microsurgery; Middle Aged; Pneumonectomy; Postoperative Complications; Retrospective Studies; Thoracic Surgical Procedures; Treatment Outcome; Vocal Cord Paralysis; Young Adult

Adhesion formation is a well-known complication of abdominal surgery. Although one third of all deliveries in the United States are by cesarean delivery (CD), little is known about adhesions in the obstetric setting. Various surgical techniques for reducing adhesion formation following CD have been investigated. The relative benefits of peritoneal closure and single-layer uterine closure are areas of continued research and debate. Adhesion prevention products are also becoming more commonplace in gynecologic surgery. Two membrane/adhesion barriers have been approved in the United States. A barrier consisting of oxidized regenerated cellulose (Interceed absorbable adhesion barrier) has been shown to reduce adhesions during microsurgery. Its use may be limited following CD because complete hemostasis is crucial to its efficacy. Seprafilm adhesion barrier, composed of hyaluronic acid and carboxymethylcellulose, is approved for use in abdominal or pelvic laparotomy. Preliminary data suggest that it may be effective for reducing adhesions following CD. This article discusses what is currently known about adhesion prevention in the obstetric population and highlights the paucity of level I evidence available to clinicians in this setting.

Topics: Carboxymethylcellulose Sodium; Cellulose; Cellulose, Oxidized; Cesarean Section; Cesarean Section, Repeat; Female; Humans; Hyaluronic Acid; Membranes, Artificial; Peritoneum; Postoperative Complications; Pregnancy; Risk Factors; Tissue Adhesions

Scar tissue formation is the major cause of failure in peripheral nerve surgery. Use of a hyaluronic acid-carboxymethylcellulose (HA-CMC) membrane (Seprafilm) as a solid anti-adhesion barrier agent is one of the therapeutic approaches to reduce postoperative scar tissue formation. However, a solid membrane may not be suitable for repair of a weak peripheral nerve site. This study examined the effect of HA-CMC solution on perineural scar formation after peripheral nerve repair in rats.. The sciatic nerves of 40 rats were transected and then immediately repaired using 10-0 nylon. The nerves were divided randomly into two groups. Saline and HA-CMC solution were applied topically to the nerve repair sites in the control and experimental groups, respectively. Reoperation was performed at 3, 6, 9, and 12 weeks to assess scar tissue formation. The assessment included the quality of wound healing, presence of perinueral adhesion, cellular components of the scar tissue, thickness of the scar tissue and histomorphological organization of the repair site.. Topical application of the HA-CMC solution significantly decreased the macroscopic nerve adherence score and the numbers of the cellular components such as fibroblasts and inflammatory cells (p < 0.05, Mann-Whitney U-test). The scar tissue formation index was significantly lower in the experimental group at 12 weeks than that in the control group (p < 0.05, Mann-Whitney U-test). The grading scores of the histomorphological axonal organization at the repair site were significantly higher in the experimental group than those in the control group at 12 weeks (p < 0.05, Mann-Whitney U-test). No evidence of wound dehiscence or inflammatory reactions against the HA-CMC solution was noted.. Topical application of a HA-CMC solution is effective in reducing the perineural scar formation and adhesion after sciatic nerve repair in rats, and is effective in promoting peripheral nerve regeneration at the repair site.

Topics: Animals; Carboxymethylcellulose Sodium; Cicatrix; Drug Combinations; Hyaluronic Acid; Membranes, Artificial; Postoperative Complications; Rats; Rats, Sprague-Dawley; Sciatic Nerve; Solutions

Complex examination and the following treatment of 380 patients with diffuse purulent peritonitis were analyzed. The patients were divided into 2 groups. The first group included 245 patients to whom the sanitization of the abdominal cavity used traditional antiseptics. The main group included 135 patients to whom the immobilized form of sodium hypochlorite in the carboxymethyl cellulose was introduced instead of aqueous solution. An original method of sanitization of the abdominal cavity allows 1.2-1.5 times decreased degree of endotoxicosis, 2-2.5 times improved the motor-evacuatory function of the intestine in different forms of treatment of peritonitis. In the main group of patients the number of postoperative complications was 10% less, lethality was 8.2% less.

Topics: Abdominal Cavity; Anti-Infective Agents, Local; APACHE; Carboxymethylcellulose Sodium; Combined Modality Therapy; Drug Carriers; Drug Delivery Systems; Female; Gastrointestinal Motility; Humans; Male; Peritonitis; Postoperative Complications; Sodium Hypochlorite; Suppuration; Surgical Procedures, Operative; Treatment Outcome

Bioresorbable membranes composed of hyaluronic acid and carboxymethylcellulose (HA/CMC) are the most effective method to prevent intra-abdominal adhesions; however, their efficacy may be limited to the site of application. Previous studies in our laboratory have shown that the intraperitoneal administration of a neurokinin-1 receptor antagonist (NK-1RA) reduces adhesions; however, the co-administration of HA/CMC plus an NK-1RA has not been studied.. Adhesions were induced in rats by creating ischemic buttons on the peritoneum. Rats received NK-1RA, HA/CMC, HA/CMC+NK-1RA or saline intraperitoneally at surgery. The HA/CMC was applied either bilaterally over all ischemic buttons or unilaterally over half the ischemic buttons. Animals were sacrificed and adhesions quantified at 7 days. Peritoneal fluid was collected at 24 hours to measure peritoneal tissue plasminogen activator (tPA) activity using a bioassay.. The bilateral placement of HA/CMC alone reduced adhesions by 62% (P < .05) while the NK-1RA when administered alone reduced adhesions by 45% (P < .05), both groups compared with saline controls. The bilateral placement of HA/CMC+ NK-1RA decreased adhesions by 86% (P < .05) compared with saline controls and by 70% (P < .05) compared with either HA/CMC or NK-1RA alone. Unilateral application of HA/CMC resulted in a 41% decrease (P < .05) in adhesions where placed compared with the distal unprotected buttons in the same animal. However, the unilateral placement of HA/CMC+NK-1RA reduced adhesions by nearly 75% (P < .05) at the site of HA/CMC application compared with HA/CMC + saline, and by 45% (P < .05) at the distal unprotected buttons compared with saline controls. HA/CMC and the NK-1RA alone as well as HA/CMC+NK-1RA increased peritoneal tPA activity by 124%, 432%, and 192%, respectively (P < .05) compared with saline controls.. The co-administration of HA/CMC plus NK-1RA not only increases the efficacy of the membrane at the site of application, but significantly reduces adhesions formation at distal unprotected sites. This combination may represent an emerging concept in more effective adhesion prevention throughout the peritoneum.

Topics: Animals; Bridged Bicyclo Compounds, Heterocyclic; Carboxymethylcellulose Sodium; Hyaluronic Acid; Male; Membranes, Artificial; Neurokinin-1 Receptor Antagonists; Postoperative Complications; Rats; Rats, Wistar; Tissue Adhesions; Tissue Plasminogen Activator

Topics: Carboxymethylcellulose Sodium; Cost-Benefit Analysis; Humans; Laser Therapy; Microsurgery; Mouth; Pharyngeal Neoplasms; Postoperative Complications; Tooth Injuries

Formation of postoperative intra-abdominal adhesions is a severe problem in surgery. Apart from standard surgical procedures, a variety of different substances is available to prevent adhesions, but no universal method has been developed so far. A membrane consisting of polyvinyl alcohol (PVA) and carboxymethylcellulose (CMC) has been demonstrated to be antiadhesive. Here, the in vitro testing and first in vivo results in a rabbit sidewall model are reported.. A-part membrane contains a PVA/CMC mixture in a thickness of 40 microm. The composition, dissolution, tensile strength, and elasticity were examined to characterize the membrane in vitro. Experiments in vivo were carried out using a 'rabbit sidewall model' in which a standardized peritoneal trauma was covered with a 5 x 6 cm A-part membrane. Adhesion formation in A-part-treated animals was compared with that in Adept (15 mL/kg body weight) and untreated controls.. An 80/20 PVA/CMC mixture forms a stable, elastic, transparent membrane, which can easily be placed intraoperatively. The dissolution shows a half-life of about 2 weeks [day 15: (45.1 +/- 4.9)% SD], which affords good adhesion protection during the initial critical phase of adhesion formation. In wet conditions, the membrane follows abdominal movements without tearing (tensile strength 5.0 +/- 4.2 N/cm SD; elasticity 29.5%). In a rabbit sidewall model, A-part membrane significantly reduced adhesion development by (83.1 +/- 31.5)% SD compared with the control and the Adept group (p < 0.001).. The properties of the A-part membrane suggest that it may be useful as an antiadhesive in surgery. A-part is effective in in vivo testing as determined in a rabbit sidewall model.

Topics: Abdomen; Animals; Biocompatible Materials; Carboxymethylcellulose Sodium; Elasticity; Female; Humans; Materials Testing; Membranes, Artificial; Polyvinyl Alcohol; Postoperative Complications; Rabbits; Tensile Strength; Tissue Adhesions

To investigate the inhibitory effect of solid hyaluronic acid-carboxymethyl cellulose film (hyaluronic acid film) on the formation of postoperative wound adhesion on rabbit eyes.. We first created a conjunctival flap under which hyaluronic acid film was inserted. Then, we performed trabeculectomy on other rabbit eyes with hyaluronic acid film applied under and above the scleral flaps. Expression of proliferative cell nuclear antigen and alpha-smooth muscle actin (alpha-SMA) were histologically and immunohistochemically examined.. Hyaluronic acid film significantly prevented adhesions after both kinds of surgery. Particularly, subconjunctival scar formation was significantly inhibited when the film was simply inserted under the wound. Furthermore, the adhesion around the scleral flap of trabeculectomy was less formed in eyes treated with hyaluronic acid film than in control eyes. Immunoreactivity to proliferative cell nuclear antigen almost disappeared after 28 days postoperatively in both treated and control groups. The alpha-SMA-positive cells appeared much less around the film-treated wound than the control eye.. The present results indicate that hyaluronic acid film can inhibit the formation of postoperative adhesion around the conjunctiva and sclera.. The results of this study indicate that this substance has potential benefits for improving ophthalmic surgery, such as filtering surgery for glaucoma.

Topics: Actins; Animals; Carboxymethylcellulose Sodium; Cell Count; Cicatrix; Conjunctiva; Fibrosis; Hyaluronic Acid; Immunoenzyme Techniques; Membranes, Artificial; Postoperative Complications; Proliferating Cell Nuclear Antigen; Rabbits; Sclera; Surgical Flaps; Trabeculectomy

Topics: Animals; Carboxymethylcellulose Sodium; Colic; Horse Diseases; Horses; Hospital Mortality; Kaplan-Meier Estimate; Postoperative Complications; Tissue Adhesions

Seprafilm (Genzyme Corp., Cambridge, MA) is safe and effective for reducing adhesion formation in abdominal and pelvic surgery. However, the relationships between Seprafilm and postoperative complications, including intra-abdominal abscess formation and intra-abdominal inflammation, remain controversial. Polymorphonuclear neutrophils (PMNs) play crucial roles in the processes of intra-abdominal inflammation, infection, and abscess formation, and PMNs act as the first line in nonspecific host defense against a wide range of pathogens. The present study evaluates the effect of Seprafilm itself on human PMNs in experimental models in vitro.. Human PMNs were isolated from blood samples obtained from 14 healthy volunteers. The functions of the isolated cells were assessed by examining their phagocytosis, apoptosis/necrosis rates, cytokine production, and PMN-elastase release with and without Seprafilm in an in vitro experimental model of inflammation and endotoxin-stimulation.. There were no significant differences in the PMN phagocytosis, apoptosis/necrosis rates, cytokine production, or PMN-elastase release into the supernatant after coculture with bacteria between assays with and without Seprafilm. In the PMN stimulation models involving tumor necrosis factor-alpha and lipopolysaccharide, there were no significant differences in cytokine production between assays with and without Seprafilm. Furthermore, a similar experiment measuring cytokine production in the presence of well-dissolved Seprafilm produced corresponding results.. Our results suggest Seprafilm itself does not affect the functions of isolated human PMNs in in vitro experimental models of inflammation and endotoxin-stimulation.

Topics: Adult; Carboxymethylcellulose Sodium; Cell Death; Cells, Cultured; Coculture Techniques; Cytokines; Escherichia coli; Humans; Hyaluronic Acid; Leukocyte Elastase; Membranes, Artificial; Neutrophils; Phagocytosis; Postoperative Complications; Staphylococcus aureus

Topics: Carboxymethylcellulose Sodium; Humans; Hyaluronic Acid; Laparoscopy; Postoperative Complications; Tissue Adhesions

To analyze the effect of the intraoperative use of sodium carboxymethylcellulose (CBMC) and related perioperative factors on postoperative colic and survival in horses that had abdominal surgery for colic.. Retrospective study.. Horses (n=203) that had surgery for small intestinal disease; 33 horses had intraoperative administration of CBMC.. Information was obtained from medical records for 170 horses that had surgery for colic before use of CBMC and 33 horses that had intraoperative CBMC. Kaplan-Meier survival curves were used to estimate median survival time and a Cox proportional hazards model was used to estimate the hazard ratio for the effect of CBMC and other perioperative variables on survival.. Seventy-five percent of horses administered CBMC survived to 180 days, whereas 75% of untreated horses survived 8 days (median survival time=18 days). Horses not administered CBMC were twice as likely to die compared with horses administered CBMC. Horses that had postoperative ileus (POI) were 1.4 times more likely to die than horses without ileus. Similarly, horses with signs of colic after surgery were 1.3 times more likely to die than horses without postoperative signs of colic.. CBMC administration is seemingly protective against death and prolongs survival when used intraoperatively in horses with small intestine disease, particularly horses with postoperative colic or POI. Both POI and colic increased risk of death after surgery.. Intraoperative administration of CBMC in horses that have surgery for small intestinal disease may improve survival, possibly by reducing early adhesion formation.

Topics: Animals; Carboxymethylcellulose Sodium; Colic; Female; Horse Diseases; Horses; Kaplan-Meier Estimate; Male; Postoperative Complications; Proportional Hazards Models; Retrospective Studies; Risk Factors; Time Factors; Tissue Adhesions

To investigate the effectiveness of human amniotic membrane (HAM) in the prevention of postoperative adhesion formation and to compare it with the efficacy of hyaluronate/carboxymethylcellulose (HA/CMC) membrane in a rat model.. Following pilot studies and computer-generated randomization, 23 female Wistar albino rats were operated on in the full study. One of the uterine horns with standard lesions was treated with either HAM (n = 13) or HA/CMC (n = 10) and the other uterine horn served as the control. Second look laparotomies were performed 2 weeks after the operations. Main outcome measures were extent, severity, degree, total adhesion scores and histopathologic characteristics of adhesions.. Uterine horns treated with HAM had significantly lower total adhesion scores than the controls (5.15 +/- 2.67 vs. 7.92 +/- 1.50, P < 0.05). Total adhesion scores of uterine horns treated with HA/CMC membrane were significantly lower than those of the controls (4.30 +/- 1.95 vs. 7.50 +/- 1.84, P < 0.01). There were no significant differences between the HAM and HA/CMC groups regarding any adhesion scores.. HAM and HA/CMC membrane are both effective for prevention of adhesion formation in a rat uterine horn model; however, one does not seem to be more effective than the other.

Topics: Amnion; Animals; Biocompatible Materials; Carboxymethylcellulose Sodium; Female; Gynecologic Surgical Procedures; Humans; Hyaluronic Acid; Membranes, Artificial; Models, Animal; Postoperative Complications; Rats; Rats, Wistar; Tissue Adhesions; Uterus

The purpose of this study was to compare the effects of anti-adhesion materials in postoperative adhesions.. Rats were assigned to five groups: Group 1: Control. Group 2: chitin layers were used. Group 3: Na-hyaluronate / carboxymethylcellulose layers were used. Group 4: Na-hyaluronate gel was poured into the abdomen. Group 5: methylprednisolone was injected. The adhesion frequency and grade were scored according to Granat. Blood was taken for Hb, AST, BUN and albumin levels determination.. The adhesion frequencies (right and left) and grades were as follow in Groups; I: 82%, 91%, 2.63 +/- 1.22; II: 8.3%, 25%, 0.58 +/- 0.66; III: 17%, 33%, 1.08 +/- 1.08; IV: 50%, 58%, 1.41 +/- 1.44; V: 50%, 42%, 1.41 +/- 1.50. The adhesion phase in all study groups was found significantly low compared to control group, p < 0.05. No difference was observed among serologic and hematological parameters in all groups.. All the materials used significantly lowered the adhesion frequency and grade.

Topics: Abdominal Cavity; Animals; Anti-Inflammatory Agents; Biocompatible Materials; Carboxymethylcellulose Sodium; Chitin; Disease Models, Animal; Female; Hyaluronic Acid; Membranes, Artificial; Methylprednisolone; Peritoneal Diseases; Postoperative Complications; Rats; Rats, Wistar; Severity of Illness Index; Tissue Adhesions; Wound Healing

Topics: Carboxymethylcellulose Sodium; Digestive System Surgical Procedures; Humans; Hyaluronic Acid; Intestinal Obstruction; Intestine, Small; Intraoperative Period; Membranes, Artificial; Postoperative Complications; Time Factors; Tissue Adhesions; Treatment Outcome

Topics: Carboxymethylcellulose Sodium; Digestive System Surgical Procedures; Humans; Hyaluronic Acid; Intestinal Obstruction; Intestine, Small; Intraoperative Period; Postoperative Complications; Time Factors; Tissue Adhesions; Treatment Outcome

A hyaluronic acid/carboxymethylcellulose (HA/CMC) membrane is an effective measure to prevent polypropylene mesh induced adhesions. We hypothesized that taurolidine 2% solution might be a cost-effective alternative to decrease adhesion formation.. Twenty-four rats were randomized into three groups: mesh alone (group 1), mesh + taurolidine 2% (group 2), and mesh + HA/CMC (group 3). Polypropylene mesh (4 cm2) was used to repair surgically induced anterior abdominal wall defects. Taurolidine 2%or a HA/CMC membrane was used as an antiadhesive measure. The animals were sacrificed 6 weeks after the operation, and adhesions to the prosthetic material were evaluated with digital image analysis.. Group 1 (mesh alone) had the highest adhesion ratio (58.5 +/- 4.8%) compared with groups 2 and 3 (p < 0.05). The differences between groups 2 (mesh + taurolidine 2%; adhesion ratio 42.9 +/- 1.6%) and 3 (mesh + HA/CMC; adhesion ratio 40.3 +/- 3.0%) were not significant (p > 0.05).. The animals of both treatment groups (2 and 3) had lower adhesion ratios compared with the controls (group 1). In particular, the HA/CMC membrane did not present with a superior antiadhesive effect compared with taurolidine. Therefore, taurolidine is a cost-effective alternative to HA/CMC membranes when a polypropylene mesh is used in direct contact with the abdominal viscera.

Topics: Animals; Antineoplastic Agents; Carboxymethylcellulose Sodium; Male; Membranes, Artificial; Polypropylenes; Postoperative Complications; Rats; Rats, Wistar; Surgical Mesh; Taurine; Thiadiazines; Tissue Adhesions

To investigate the effectiveness of melatonin in preventing post-operative adhesion formation and to compare it with the efficacy of hyaluronate/carboxymethylcellulose membrane in a rat model.. Following pilot studies, 35 rats were operated on in the full study. In 15 animals (group one), 10 standard lesions were inflicted in each uterine horn (total 30 horns) and melatonin was applied before closure of the abdomen. In the second group, 20 animals were operated on and one of the uterine horns (total 20 horns) with standard lesions was treated with hyaluronate/carboxymethylcellulose membrane and the other uterine horn served as a control. Second-look operations were performed 1 week later and adhesion scores were compared.. The adhesion scores of uterine horns treated with melatonin and of uterine horns treated with hyaluronate/carboxymethylcellulose membrane were significantly lower than the scores of the controls (P < 0.001). There was no statistically significant difference between the adhesion scores of uterine horns treated with melatonin and of uterine horns treated with hyaluronate/carboxymethylcellulose membrane (P > 0.05).. Both melatonin and hyaluronate/carboxymethylcellulose membrane were effective in prevention of adhesion formation in a rat uterine horn model.

Topics: Animals; Carboxymethylcellulose Sodium; Disease Models, Animal; Female; Free Radical Scavengers; Hyaluronic Acid; Melatonin; Membranes, Artificial; Peritoneal Diseases; Postoperative Complications; Rats; Rats, Wistar; Tissue Adhesions

Although hyaluronic acid-carboxymethylcellulose (HA-CMC) membrane has the advantage of preventing intraabdominal adhesions, it has theoretical risk of negative effects on the healing of intestinal suture lines by forming a barrier between the suture lines and neighboring serosal surfaces. This study evaluated the effect of HA-CMC on bowel anastomoses, scar healing, and intraabdominal adhesion formation. Two groups of 10 male Sprague-Dawley rats were examined. In the first group, laparotomy was performed with a median incision. Colotomy on the cecum and a single-layer repair of the bowel wall was performed. HA-CMC membrane was placed on the cecal suture line and under the laparotomy incision before abdominal closure. The second group had the same procedure but no HA-CMC membrane was placed. The animals were killed on postoperative day 14. Intraabdominal adhesions, laparotomy suture line endurance, bursting pressure of the repaired cecal wall, and tissue hydroxyproline levels were determined. The repaired cecal wall was also examined histopathologically. The statistical analyses revealed that HA-CMC prevented intraabdominal adhesions significantly. No negative effects of this material on the healing of the bowel and laparotomy suture lines were observed. HA-CMC appears to be a safe material to prevent intraabdominal adhesions, without negative effects on the healing of abdominal incisions and bowel suture lines.

Topics: Abdomen; Adjuvants, Immunologic; Animals; Carboxymethylcellulose Sodium; Cecum; Hyaluronic Acid; Male; Membranes, Artificial; Postoperative Complications; Rats; Rats, Sprague-Dawley; Suture Techniques; Tissue Adhesions; Wound Healing

The purpose of this study was to assess the ability of four different either solid or fluid barriers to reduce adhesions in an established model of gynecological surgery.. 50 Chinchilla rabbits underwent bilateral deperitonealization and devascularization of the uterine horns (DUH). Afterwards solid membranes of either hyaluronic acid-carboxymethylcellulose (HA-CMC) or lactide-caprolactone-copolymer (LCC) were placed around the injured uterine horns or fluids (icodextrin (ID) or phospholipids (PL)) were intraperitonealy administered. The control group went without protection. After 10 days, adhesions were measured by planimetry.. Phospholipids (median 49.8 mm2) significantly reduced adhesion areas in comparison to all other groups: surgical controls (median 230.6 mm2), HA-CMC (median 194.9 mm2), LCC (median 327.1 mm2), and icodextrin (median 242.1 mm2).. These results prove the efficacy of phospholipids to reduce primary adhesion formation in the Chinchilla double uterine horn model compared to HA-CMC, LCC and icodextrin. Future clinical studies are recommended.

Topics: Animals; Carboxymethylcellulose Sodium; Female; Glucans; Glucose; Gynecologic Surgical Procedures; Hyaluronic Acid; Icodextrin; Models, Animal; Phospholipids; Polyesters; Postoperative Complications; Rabbits; Solutions; Tissue Adhesions; Uterus

There is a high incidence of adhesions after ventral hernia repair with polypropylene mesh. The purpose of the present study was to evaluate the efficacy of Seprafilm in the prevention of adhesion formation and effect on peritoneal fibrinolytic activity.. An incisional hernia model was created in rats. In the experimental group Seprafilm was placed between polypropylene mesh and abdominal organs. On the 14th day adhesions were evaluated and tissue plasminogen activator (tPA), urokinase plasminogen activator (uPA), plasminogen activator inhibitor (PAI) type 1 and 2 were measured in peritoneal biopsy specimens.. Adhesions were significantly reduced in the Seprafilm group (P = 0.002). Nevertheless, there were no difference between the two groups in levels of tPA, PAI-1 and PAI-2. However, the levels of uPA were significantly decreased in the Seprafilm group.. The adhesion preventive effect of Seprafilm is not directly related in peritoneal fibrinolytic activity. Instead, the physical properties (barrier, hydroflotation and sliconizing effect) of the membrane are primarily responsible for adhesion prevention.

Topics: Abdominal Wall; Animals; Carboxymethylcellulose Sodium; Female; Fibrinolysis; Hyaluronic Acid; Membranes, Artificial; Peritoneal Diseases; Peritoneum; Plasminogen Inactivators; Polypropylenes; Postoperative Complications; Rats; Rats, Wistar; Surgical Mesh; Tissue Adhesions; Tissue Plasminogen Activator; Urokinase-Type Plasminogen Activator

Postoperative adhesions (PAs) are usually clinically asymptomatic. Symptomatic cases, however, may present with chronic abdominal and pelvic pain, infertility, and intestinal obstruction; and they may require intensive, costly therapeutic modalities. Various agents have been used to prevent PAs, but the results indicate general suboptimal effectiveness. Our objective was to evaluate the comparative effectiveness of two pharmacologic agents for preventing PA: nadroparine calcium (low-molecular-weight heparin, or LMWH) and aprotinin, as well as a barrier agent, sodium hyaluronate/carboxymethycellulose (SCMC). Our subjects were 40 male Wistar-Albino rats divided into four groups, each consisting of 10 rats, which underwent standard cecal abrasion preceding midline laparotomy. In the control group (group 1) 1 ml of 0.9% NaCl was administered intraperitoneally before abdominal closure. In the three preventive groups, 100 U AXa (anti factor X activity) LMWH, 1800 IU aprotinin, and SCMC were administered intraperitoneally to groups 2, 3, and 4, respectively. Relaparotomy was performed on the 14th postoperative day. Visceral and abdominal wall adhesions were scored in a blinded fashion. The adhesion scores (mean +/- SD) for groups 1, 2, 3, and 4 were 2.00 +/- 0.67, 0.6.00 +/- 0.84, 1.10 +/- 0.74, and 0.20 +/- 0.42, respectively. The differences in the adhesion scores among all three preventive groups (groups 2, 3, 4) were statistically significant when compared with the control group ( p < 0.001, p = 0.017, p < 0.001, respectively). Intraperitoneal SCMC and administration of LMWH were more effective than giving aprotinin.

Topics: Abdomen; Animals; Aprotinin; Biocompatible Materials; Carboxymethylcellulose Sodium; Hyaluronic Acid; Male; Membranes, Artificial; Nadroparin; Postoperative Complications; Rats; Rats, Wistar; Tissue Adhesions

Treatments addressing variously theorised pathophysiological mechanisms of small intestinal adhesions have been reported. This study applied those classes of treatments to the most clinically relevant aetiology of post operative adhesions.. Treatments addressing the pathophysiology of ischaemia-reperfusion induced adhesions would accordingly reduce the incidence of adhesions from this model.. Four classes of treatments were administered for 72 h to 16 foals subjected to complete ischaemia followed by reperfusion to create peritoneal adhesions. These groups were: 1) FPG group--flunixin meglumine (1.1 mg/kg bwt i.v., divided q.i.d.), potassium penicillin G (22,000 iu/kg bwt i.v., q.i.d.) and gentamicin (2.2 mg/kg bwt i.v., t.i.d.); 2) HEP group--heparin (80 iu/kg bwt subcut., b.i.d.); 3) DMSO group--dimethylsulphoxide (DMSO) (20 mg/kg bwt [diluted in 500 ml normal saline] i.v., b.i.d.); and 4) SCMC group--sodium carboxymethylcellulose (500 ml 3% sterile solution intraperitoneally, administered only at the beginning of surgery).. Post operative intestinal obstruction did not occur in any foal. After 10 days, necropsy revealed bowel-to-bowel adhesions in none of the FPG or DMSO groups, in 2/4 of the SCMC group, in 3/4 of the HEP group and 5/6 foals subjected to the procedure without treatment (UIR group).. Inhibition of the inflammation associated with ischaemia and reperfusion in foals treated with FPG or DMSO decreased small intestinal adhesions in foals.. Although anti-inflammatory therapy was shown to eliminate bowel-bowel adhesions in this controlled study, it must be remembered that clinical cases are without control. These therapies are advised to improve the result but are unlikely to eliminate the problem.

Topics: Animals; Animals, Newborn; Anti-Bacterial Agents; Carboxymethylcellulose Sodium; Dimethyl Sulfoxide; Heparin; Horse Diseases; Horses; Intestinal Diseases; Intestine, Small; Ischemia; Peritoneal Diseases; Peritoneum; Postoperative Complications; Random Allocation; Reperfusion Injury; Tissue Adhesions

The current study was designed to investigate the efficacy of a hyaluronate/carboxymethylcellulose membrane for the prevention of post-operative adhesion in a rat uterine horn model. This is a prospective double-blinded controlled study. Nineteen injured uterine horns were treated with a hyaluronate/carboxymethylcellulose membrane as a barrier and 19 injured uterine horns without any treatment served as a control group. Two weeks later, second look laparotomies were performed in order to assess the degree of the adhesion. Total adhesion scores, histopathological analysis of inflammation process and vascularization of adhesions were compared with control group. P values of 5% or less were considered statistically significant. Animals treated with a hyaluronate/carboxymethylcellulose membrane had significantly reduced post-surgical adhesion scores when compared with control group. In histopathological examination, there was less vascularization in the treatment group. The types and extent of inflammation were similar in two groups. Clinically and histopathologically, a hyaluronate/carboxymethylcellulose membrane is effective in reducing postoperative adhesion formation in the rat uterine horn model.

Topics: Animals; Carboxymethylcellulose Sodium; Double-Blind Method; Female; Hyaluronic Acid; Membranes, Artificial; Postoperative Complications; Rats; Rats, Wistar; Tissue Adhesions; Ultrasonography; Uterus

In this study, we aimed to investigate whether the use of a sodium hyaluronate and carboxy-methylcellulose-based antiadhesive membrane (Seprafilm, Adhesion Barrier; Genzyme Corp, Cambridge, Mass) is associated with fewer adhesions around the pelvis and rectal pouch.. Forty Wistar albino female rats were divided into 4 equal groups. Each rat underwent segmental left-sided colonic resection and end colostomy. The groups were as follows: group 1, colostomy alone (control group); group 2, colostomy and Seprafilm application around distal rectal pouch; group 3, colostomy and Seprafilm application beneath laparotomy incision; and group 4, colostomy and application of Seprafilm on both rectal pouch and laparotomy incision. All animals were operated on the 21st day and intra-abdominal adhesions were evaluated.. The results were assessed by analysis of variance and Tukey multiple comparison tests. Intra-abdominal adhesions were significantly (P<.05) reduced in groups 2 through 4 compared with the control group, whereas no statistically significant difference was observed between these 3 groups.. The use of Seprafilm during the initial step of the Hartmann colostomy reduced intra-abdominal adhesions on the reversal. This result might be beneficial in the prevention of adhesion-related difficulties during second operation and its application beneath laparotomy incision seems to be sufficient to ensure this effect.

Topics: Animals; Biocompatible Materials; Carboxymethylcellulose Sodium; Colostomy; Female; Hyaluronic Acid; Membranes, Artificial; Pelvis; Postoperative Complications; Rats; Rats, Wistar; Reoperation; Tissue Adhesions

Intra-abdominal administration of antiadhesive barriers may reduce the extent and severity of postoperative adhesions. This study aimed to compare the effectiveness of a novel liquid antiadhesive barrier with a conventional sheet (Seprafilm) antiadhesive barrier in a murine cecal abrasion model.. One hundred fifty Swiss-Wister mice underwent laparotomy and cecal abrasion and were randomly assigned to receive Adcon-P (n = 30) or Seprafilm (n = 30) or to a control group (n = 90). At postoperative Day 21, the mice underwent relaparotomy and complete adhesiolysis. An investigator who was blinded to the group assignment scored the extent of adhesion formation and the difficulty of adhesiolysis using a 6-point scale that ranged from 0 (no adhesions) to 5 (full-thickness intestinal injury with adhesiolysis). Results are reported as median (range).. Median adhesion scores in mice receiving Adcon-P (0 (range, 0-1)) and Seprafilm (1 (range, 0-3)) were lower than in mice in the control group (2 (range, 0-5); P < 0.0001 for both comparisons). In addition, the median adhesion score for the Adcon-P group was significantly lower than that of the Seprafilm group (P = 0.02).. This study suggests that both Adcon-P and Seprafilm trade mark decrease the incidence of postoperative adhesions and the difficulty of adhesiolysis in the murine cecal abrasion model. However, Adcon-P appeared to be superior to Seprafilm. This agent is an attractive device that requires additional studies.

Topics: Absorbable Implants; Animals; Biocompatible Materials; Carboxymethylcellulose Sodium; Gels; Hyaluronic Acid; Intestinal Diseases; Intestine, Small; Laparotomy; Membranes, Artificial; Mice; Models, Animal; Organic Chemicals; Postoperative Complications; Tissue Adhesions; Treatment Outcome

Adhesions between viscera and mesh may result in intestinal obstruction and fistulae formation. Fewer adhesions with sodium carboxymethylcellulose (SCMC)-coated polypropylene mesh (PM) has been reported, but impaired wound healing was the major concern. We investigated the adhesion-prevention effect of SCMC in different concentrations, as coating only on visceral face of PM and its effects on wound healing. A full-thickness abdominal wall defect was created in 28 rats, which were then divided into three groups. In Group I (control), the defect was repaired with PM only; in Group II and Group III, the defects were repaired with 1% and 1.6% SCMC-coated-PM, respectively. All animals were sacrificed at day 30, and histological evaluation and adhesion scoring were done. Animals in the group in which 1.6% SCMC-coated PM was used developed significantly fewer adhesions compared with other animals (P=0.04). Histological evaluation using a semiquantitative scoring system showed no difference between the groups in fibrosis and inflammation scores (P=0.9 and P=0.3, respectively), and thickness of fibrosis on mesh was also similar (P=0.5). SCMC in 1.6% concentration as coating only on the visceral face of PM reduced the incidence and severity of adhesions without impairing wound healing.

Topics: Animals; Carboxymethylcellulose Sodium; Coated Materials, Biocompatible; Disease Models, Animal; Female; Hernia, Ventral; Laparotomy; Male; Polypropylenes; Postoperative Complications; Probability; Rats; Rats, Sprague-Dawley; Reference Values; Sensitivity and Specificity; Surgical Mesh; Tissue Adhesions; Wound Healing

To evaluate the effects of two barriers, one solution, and two pharmacologic agents, in single or in combined use, for preventing postsurgical adhesion formation in the rat model.. A randomized, prospective study to evaluate the ability of leuprolide acetate, oxidized regenerated cellulose, medroxyprogesterone acetate, sodium hyaluronate, sodium hyaluronate/carboxymethyl cellulose, in single or in combined use, for preventing adhesion formation in a rat model.. Wistar female rats.. University animal laboratory.. Intramuscular injection of pharmacologic agents before surgery and intraperitoneal application of barriers and solution at the end of surgery.. Two weeks after surgery, a second laparotomy was performed and the extent of adhesion formation was determined.. All the treatment groups had fewer, less severe adhesions when compared with controls. The combination of medroxyprogesterone acetate and oxidized regenerated cellulose did enhance the adhesion-reducing capacity of oxidized regenerated cellulose. The performance of sodium hyaluronate solution for adhesion prevention was statistically significant, when compared with oxidized regenerated cellulose alone, or sodium hyaluronate used with carboxymethyl cellulose film.. Pharmacologic agents, barriers, or solutions result in significant reduction of postsurgical adhesions. The sodium hyaluronate solution alone and medroxyprogesterone acetate treatment alone had the least adhesion prevention scores. However, neither monotherapy nor combined therapy proved to be significantly more beneficial.

Topics: Animals; Biocompatible Materials; Carboxymethylcellulose Sodium; Cellulose, Oxidized; Disease Models, Animal; Double-Blind Method; Drug Therapy, Combination; Female; Fertility Agents, Female; Hyaluronic Acid; Leuprolide; Medroxyprogesterone Acetate; Membranes, Artificial; Postoperative Complications; Progesterone Congeners; Rats; Rats, Wistar; Tissue Adhesions

Hyaluronate sodium in the form of a bioresorbant membrane reduces the development of intra-abdominal adhesions frequently found after implantation of synthetic mesh in the context of surgical hernia repair.. The effect of hyaluronate on the formation of adhesions was evaluated when applied laparoscopically as a bioresorbant membrane to protect the peritoneal surface of a synthetic mesh.. Experimental animal model.. A peritoneal defect 5 cm in diameter was bilaterally created in the abdominal wall of each of 9 pigs by laparoscopy. A polypropylene mesh was fixed with clips onto these defects on both sides. In each of the animals, only on one side, the synthetic mesh was also covered by a hyaluronate membrane.. The incidence and severity of adhesions (grade 0-4, where 0 indicates no adhesion; 1, filmy avascular adhesions; 2, vascular adhesions; 3, cordlike fibrous adhesions; and 4, plain fibrous adhesions) were determined after 45 days, comparing treated and untreated sides by autopsy results and histological features.. Adhesions, mainly grades 3 and 4, occurred in 7 of the 9 animals in those meshes not covered by hyaluronate; 2 untreated animals did not develop adhesions. On the other hand, only 1 of the 9 animals developed adhesions (grade 2) at the mesh concealed by the hyaluronate membrane.. The bioresorbant hyaluronate membrane significantly reduced the formation of peritoneal adhesions (1-sided sign test, P<.05) induced by the insertion of a polypropylene mesh, when compared with the contralateral implants not protected by hyaluronate. Thus, hyaluronate membranes are efficient for reducing the incidence of peritoneal adhesions.

Topics: Animals; Biocompatible Materials; Carboxymethylcellulose Sodium; Disease Models, Animal; Hernia, Ventral; Hyaluronic Acid; Incidence; Laparoscopy; Membranes, Artificial; Polypropylenes; Postoperative Complications; Severity of Illness Index; Surgical Mesh; Swine; Tissue Adhesions

We previously demonstrated that an auto-cross-linked hyaluronan-based antiadhesion agent (auto-cross-linked polysaccharide [ACP] gel) was effective in postsurgical adhesion prevention after open laparotomy and laparoscopic surgery with adequate hemostasis in animal models. This study assessed the ability of different preparations of ACP gel to prevent adhesions in the presence of bleeding or inadequate hemostasis.. Ninety-seven female rabbits were subjected to a standardized surgical lesion with subsequent exudative abdominal bleeding (oozing model), and 97 animals were subjected to a standardized surgical lesion with severe abdominal bleeding (bleeding model). After injury, the animals were randomly assigned to 5 groups of treatment: 3 different preparations of ACP gel (20, 40, and 60 mg/mL), a hyaluronan-carboxymethylcellulose film, and no treatment. Three weeks after operation, the animals were killed, and the adhesions were assessed by a blinded observer who measured the length and area of the adhesions and who used the Blauer scoring system.. All 3 preparations of ACP gel and the hyaluronan-carboxymethylcellulose film reduced adhesion formation in both models (P <.01) as measured by the number of adhesion-free animals, mean Blauer score, and the mean length and surface area of the adhesions. There were no statistical differences between the different treatment groups.. These data suggest that different hyaluronan based agents in the presence of severe bleeding or exudative abdominal bleeding reduce de-novo postsurgical adhesion formation.

Topics: Animals; Carboxymethylcellulose Sodium; Drug Combinations; Female; Gels; Hemostasis; Hyaluronic Acid; Hysteroscopy; Laparotomy; Polysaccharides; Postoperative Complications; Rabbits; Tissue Adhesions; Uterine Diseases; Uterus

To evaluate the ability of collagen film, collagen gel, sodium hyaluronate/carboxymethylcellulose film, and fibrin glue to prevent adhesion formation.. Randomized trial using a rat model of a standardized abdominal wound and cecal wound.. University research laboratory.. Sprague-Dawley female rats.. Resorbable barriers or no barrier (controls) were placed between an abdominal wall wound (1 cm x 2 cm) and a similarly sized cecal wound.. Adhesion formation between wounds was assessed and quantitated 7 days after surgery.. Without treatment, 34 of 35 untreated rats (97%) developed adhesions. Treatment with collagen gel (3 of 33 rats), collagen film (3 of 10 rats), or sodium hyaluronate/carboxymethylcellulose film (2 of 10 rats) significantly reduced the incidence of adhesion formation. Treatment with fibrin sealant resulted in 9 of 10 animals having adherent wounds 7 days after surgery.. Resorbable barriers of collagen gel, collagen films and sodium hyaluronate/carboxymethylcellulose film were effective in significantly reducing adhesion formation. Fibrin sealant at 7 days had an incidence of adhesion formation similar to that in untreated control animals.

Topics: Animals; Biomedical and Dental Materials; Carboxymethylcellulose Sodium; Collagen; Female; Fibrin Tissue Adhesive; Hyaluronic Acid; Postoperative Complications; Random Allocation; Rats; Rats, Sprague-Dawley; Surgical Equipment; Tissue Adhesions

In cases such as incisional hernia repair, polypropylene mesh (PPM) can be exposed to the underlying viscera and cause adhesions to the mesh. In this study, a composite prosthesis that was designed to be less susceptible to adhesion formation than PPM was evaluated in a rabbit incisional hernia repair model.. A 5 x 7-cm full-thickness defect was created in the abdominal wall of 30 female New Zealand White rabbits. Ten animals each were repaired with PPM, Bard Composix (PP/ePTFE), or Sepramesh biosurgical composite-a polypropylene mesh coated on one side with chemically modified sodium hyaluronate and carboxymethylcellulose (HA/CMC). The animals were sacrificed after 28 days and the overall performance, including adhesion formation and tissue integration by histology and mechanical testing, was evaluated.. In the Sepramesh group, there was a significant reduction in the percentage of surface area covered by adhesions and a significant increase in the percentage of animals with no adhesions compared to standard materials. The tissue integration strength and overall cellular response were similar in all groups. A partially remesothelialized peritoneal surface was often apparent overlying the Sepramesh implant.. Sepramesh biosurgical composite effectively repaired abdominal wall defects in rabbits and reduced adhesion development to the mesh compared to the use of a PPM and a PP/ePTFE composite.

Topics: Absorbable Implants; Animals; Carboxymethylcellulose Sodium; Cecal Diseases; Coated Materials, Biocompatible; Disease Models, Animal; Female; Hernia, Inguinal; Hyaluronic Acid; Polypropylenes; Postoperative Complications; Rabbits; Tissue Adhesions

To assess the efficacy of a bioabsorbable gel for reducing primary postoperative adhesions.. A randomized, prospective, blinded study.. Academic research environment.. Forty-one New Zealand Rabbits.. A chemically modified hyaluronate and carboxymethylcellulose (HA/CMC) gel formulation was applied to a bilateral uterine horn injury. Postoperative adhesions were assessed at a second-look laparoscopy.. The uterine horn model was shown to be adhesiogenic, with 29 (70%) of 42 untreated uterine horns found to have adhesions. After gel treatment, 22 (55%) of 40 uterine horns were free of adhesions compared with 12 (30%) of 42 controls.. Animals treated with HA/CMC gel had significantly reduced postsurgical adhesion scores when compared with controls.. Treatment of injured uterine horn with HA/CMC gel resulted in a significant reduction in postoperative surgical adhesions.

Topics: Animals; Carboxymethylcellulose Sodium; Female; Gels; Hyaluronic Acid; Postoperative Complications; Rabbits; Tissue Adhesions; Uterine Diseases; Uterus

Repeat cardiac surgical procedures are associated with increased technical difficulty and risk because of the previous formation of dense adhesions between the heart and the surrounding tissues. Dilute solutions of sodium hyaluronic acid (NaHA) and carboxymethyl cellulose (CMC) have been shown to prevent postoperative abdominal and pelvic adhesions and could therefore potentially inhibit adhesion formation following cardiac surgery. Adhesion prevention using 0.1% NaHA, 0.4% NaHA, or 0.1% CMC solutions was examined in a canine abrasion/desiccation pericardial adhesion model (5 animals/group) and compared to 10 animals treated with Ringer's lactate (RL) solution alone. The pericardium and heart were coated with 25 ml of test or control solution prior to and after pericardiotomy, after controlled gauze abrasion, after 30 min of desiccation, and prior to closure. At 6 weeks, animals were reexplored and adhesions were scored in a blinded manner by three to four surgeons using a 0-4 scale. Scores of 2 or greater were considered clinically significant. Mean adhesion scores from the left epicardium were 0.0 in animals treated with 0.1% NaHA, 0.6 in animals treated with 0.4% NaHA or 1% CMC, and 2.3 in animals treated with RL (P < 0.05 Duncan's ANOVA). In addition, none of the animals treated with 0.1% NaHA, 20% of the animals treated with 0.4% NaHA, and 20% of the animals treated with 1% CMC had clinically significant adhesions, whereas 80% of animals treated with RL had such adhesions. Sodium hyaluronic acid and CMC solutions, used as tissue coatings during cardiac surgery, inhibit the formation of undesired postoperative adhesions. Application of these biocompatible polymer solutions during surgery could reduce the technical difficulty and risk of repeat cardiac surgical procedures.

Topics: Animals; Carboxymethylcellulose Sodium; Cardiac Surgical Procedures; Disease Models, Animal; Dogs; Heart Diseases; Hyaluronic Acid; Pericardium; Postoperative Complications; Postoperative Period; Tissue Adhesions

Topics: Carboxymethylcellulose Sodium; Humans; Hyaluronic Acid; Membranes, Artificial; Postoperative Complications; Tissue Adhesions

A rabbit serosal scarification model was utilized to compare the ability of four drugs, previously administered peri-operatively to horses undergoing exploratory celiotomy, to prevent the development of postoperative intestinal adhesions. The substances compared were 32% Dextran 70 (7 mL/kg), 1% sodium carboxymethylcellulose (7 mL/kg), trimethoprim-sulfadiazine (30 mg/kg), and flunixin meglumine (1 mg/kg). The first two were administered intra-abdominally following surgery, while the latter two were administered systemically in the peri-operative period. Fibrous adhesions were evident in all animals in the untreated serosal scarification group. No significant difference in the number of animals with adhesions was found between the untreated control group and any treatment group, nor among the treatment groups. Microscopic examination of adhesions collected at postmortem examination revealed fibers consistent with cotton, surrounded by a giant-cell reaction and ongoing acute inflammation. The source of the fibers was likely the cotton laparotomy sponges used to scarify the intestinal surface, since the pattern in the granuloma and sponge fibers appeared similar under polarized light. Though consistent intestinal adhesion formation was produced in the rabbit, the presence of foreign body granulomas may prevent consideration of this model for future research. The drugs tested were ineffective in preventing the formation of postoperative small intestinal adhesions in this model.

Topics: Animals; Anti-Infective Agents; Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Carboxymethylcellulose Sodium; Cicatrix; Clonixin; Dextrans; Disease Models, Animal; Jejunal Diseases; Jejunum; Postoperative Complications; Rabbits; Random Allocation; Sulfadiazine; Tissue Adhesions; Trimethoprim

Peritoneal adhesions continue to be a significant cause of postoperative complications. Elucidating the origin of these adhesions has been hampered by the lack of a reproducible animal model. The purpose of this study was to create a standardized model in which a single, specific adhesion could be objectively measured. With this model the kinetics of adhesion formation were then evaluated. A variety of potential antiadhesive agents were then tested and compared.. In this study a reproducible, quantitative rat model was developed that used uniform defects on the peritoneal wall and cecal surface. The resulting adhesions were subsequently scored, and their strength was measured with a tensiometer. An evaluation of the kinetics of peritoneal adhesion formation was obtained by using a timed removal of silicone elastomer sheeting held between the two injured surfaces. The following antiadhesive agents were evaluated: Ringer's lactate solution; dextran 70 (32%); modified carboxymethylcellulose (1.0% and 2.0%); an absorbable barrier of specially knitted material composed of oxidized regenerated cellulose; fibrin sealant; silicone elastomer film; and expanded polytetrafluoroethylene membrane.. Evaluation of the kinetics of peritoneal adhesion formation indicated that the susceptibility for adhesion formation was significantly decreased or eliminated after the first 36 hours. Evaluation of antiadhesion agents indicated that the magnitude of adhesion prevention was directly proportional to the agent's ability to remain at the site of injury during the critical period of adhesion formation. Permanent barriers (silicone elastomer film, expanded polytetrafluoroethylene membrane) provided the greatest antiadhesion effect but were not believed to be ideal agents because they remained at the site of injury well after the critical period of adhesion formation. The incidence of adhesion formation for the other agents was as follows: control (34 of 34), Ringer's lactate (12 of 12), absorbable barrier of knitted cellulose (10 of 10), 32% dextran 70 (8 of 12), 1% carboxymethylcellulose (6 of 12), fibrin sealant (4 of 9), and 2% carboxymethylcellulose (4 of 12).. The efficacy of antiadhesion agents appears to be related to the agent's viscosity, ability to coat the wound surface, and residence time at the site of injury. In this rat model an agent that remained on the injured surfaces for at least 36 hours after injury appeared to be more effective in reducing adhesion formation than an agent with a shorter residence time.

Topics: Animals; Biocompatible Materials; Carboxymethylcellulose Sodium; Cecal Diseases; Cellulose; Dextrans; Disease Models, Animal; Disease Susceptibility; Female; Fibrin Tissue Adhesive; Isotonic Solutions; Kinetics; Membranes, Artificial; Peritoneal Diseases; Polytetrafluoroethylene; Postoperative Complications; Rats; Rats, Sprague-Dawley; Ringer's Lactate; Silicone Elastomers; Stress, Mechanical; Time Factors; Tissue Adhesions

A novel lyophilized carboxy-methylcellulose (CMC) sponge has been developed for prevention of surgical wound adhesions. One potential mechanism for preventing abdominal adhesion is suppression of the cytokine transforming growth factor beta (TGF-beta) and other macrophage derived fibroblast stimulating factors that partially mediate adhesion formation.. To study the efficacy and mechanisms of action of the CMC sponge, we performed standard cecal denudation and abdominal wall apposition on rats. A CMC sponge or a commercially available adhesion preventive barrier (Interceed) was placed on the denuded surface. After 14 days, adhesion severity was graded blindly on a scale ranging from 0 (no adhesion) to 5 (severe adhesion). TGF-beta expression was determined by immunocytochemical staining. To assess the secretion of macrophage derived fibrogenic factors in control and CMC rats, labeled thymidine and proline uptake and hydroxyproline production were measured in NRK rat fibroblasts cultured with conditioned medium of peritoneal macrophages.. The severity of adhesions in the CMC sponge group (0.7 +/- 0.3) was significantly lower than in the Interceed or control groups (2.2 +/- 0.3; 4.6 +/- 0.1). In control animals TGF-beta expression in endothelium and fibroblasts was maximal on day 3. Neither CMC nor Interceed reduced this expression. Conditioned media derived from sponge-exposed postsurgical peritoneal macrophages did not inhibit fibroblast growth or collagen formation.. In this model the CMC sponge was more effective than Interceed in preventing postoperative adhesions. Its action was not due to inhibition of TGF-beta expression or macrophage derived fibrogenic factors. These data highlight the primary importance of local barrier effect in adhesion prevention.

Topics: Animals; Carboxymethylcellulose Sodium; Cellulose, Oxidized; Evaluation Studies as Topic; Fibroblasts; Immunohistochemistry; Male; Postoperative Complications; Rats; Rats, Sprague-Dawley; Surgical Sponges; Tissue Adhesions; Transforming Growth Factor beta

Various regimens to reduce postoperative intraperitoneal adhesion formation have been tested; however, none has been consistently successful. The purpose of this study was to compare the efficacy of three compounds instilled into the peritoneal cavity--32% dextran 70, 0.9% normal saline and sodium carboxymethylcellulose--to no therapy on their ability to prevent postoperative adhesion formation in the New Zealand white rabbit. Bilateral posterior uterine horn incisions and cecal and transverse colon abrasions were performed during a two-phased study on each of 25 rabbits that were randomly assigned in a blind fashion into one of four study groups. Two weeks postoperatively, each rabbit underwent an autopsy to assess the magnitude of intraperitoneal adhesion formation. Adhesion scores were determined by counting the number of adhesions and assigning one or two points for each thin, filmy or dense, broad adhesion. As compared to no therapy, all three substances tested significantly reduced adhesion formation. Although 32% dextran 70 and 0.9% normal saline showed similar results, the degree of adhesion formation was reduced most significantly with sodium carboxymethylcellulose (P < .002) Sodium carboxymethylcellulose is effective in preventing postoperative adhesion formation in the New Zealand white rabbit.

Topics: Animals; Carboxymethylcellulose Sodium; Dextrans; Disease Models, Animal; Drug Evaluation, Preclinical; Female; Genital Diseases, Female; Instillation, Drug; Peritoneal Diseases; Postoperative Complications; Rabbits; Random Allocation; Severity of Illness Index; Single-Blind Method; Sodium Chloride; Tissue Adhesions

Experimental studies on adhesion formation 90 days after laparotomy in the rat were done. Uterine horn adhesions after standardised procedures and trauma in a control group of 10 rats were compared with those obtained in six other 10-rat groups in whom heparin, carboxymethylcellulose (CMC), 32% dextran 70 and the fabric TC7 either alone or in various combinations were used at the time of laparotomy. Dextran 70 and CMC used on their own appeared to reduce adhesion formation but the improvement did not achieve statistical significance when compared with the control group. TC7 used alone had no anti-adhesion effect; when used with CMC or dextran 70, TC7 did not enhance the anti-adhesion benefit conferred by either substance used on its own.

Topics: Animals; Carboxymethylcellulose Sodium; Cellulose, Oxidized; Dextrans; Female; Genitalia, Female; Heparin; Microsurgery; Postoperative Complications; Rats; Rats, Wistar; Tissue Adhesions; Uterus

Previous studies have shown that dietary supplements of vitamin E or the intraperitoneal administration of sodium carboxymethyl cellulose (SCMC) solution reduces postoperative adhesions by approximately 50%. The aim of this study was to determine whether there is a synergistic beneficial effect of vitamin E and SCMC in reducing postoperative adhesions.. Sixty Sprague-Dawley rats were fed an identical diet containing 32 IU vitamin E/kg and were divided into four main groups: group A (control) and groups B, C, and D (experimental). Group D was further subdivided into three subgroups (D1, D2, and D3). Oral supplements of vitamin E in doses of 10 IU, 30 IU, and 30 IU/kg body weight were given to subgroups D1, D2, and D3 and group B, respectively, 5 days before operation and were continued until the fourteenth postoperative day when all animals were killed. Adhesions were created by scraping the cecum with mesh gauze followed by application of absolute alcohol and placement of silk suture in the parietal peritoneum. SCMC solution was administered intraperitoneally in groups C and D before closure. Adhesions were graded by two different investigators.. All control animals developed significant adhesions, compared with no adhesions in 30% of group B (vitamin E) (p < 0.04), 40% in group C (SCMC) (p = 0.0001), and an average of 90% in the D groups (SCMC+vitamin E) (p = 0.0001).. It appears that there is a synergistic beneficial effect of oral supplements of vitamin E and the intraperitoneal administration of SCMC solution in reducing the incidence and degree of intraperitoneal adhesions.

Topics: Administration, Oral; Animals; Carboxymethylcellulose Sodium; Female; Male; Peritoneal Diseases; Postoperative Complications; Rats; Rats, Sprague-Dawley; Tissue Adhesions; Vitamin E

Polyvinylpyrrolidone (PVP) and carboxymethylcellulose (CMC) solutions were evaluated in a rat cecal abrasion model to test the effect of these high-molecular-weight hydrophilic polymer solutions on postoperative adhesion formation when used as tissue precoating solutions. Eleven groups of 5-20 animals each were studied including 25 control animals treated with Ringer's lactate (RL) solution. Animals were reoperated at 2 weeks and adhesions were scored according to a 0-4 grading scale. Tissue coating following cecal abrasion failed to inhibit adhesion formation. However, tissue coating with polymer solutions prior to cecal abrasion significantly reduced the formation of post-operative adhesions. Solutions of 1.5% CMC and 5% of a unique gamma-polymerized PVP in RL exhibited the greatest tissue-protective behavior compared to RL controls (P < 0.002). Both CMC and gamma-PVP solutions warrant further investigation as tissue precoatings to inhibit surgical adhesions.

Topics: Animals; Carboxymethylcellulose Sodium; Cecum; Female; Postoperative Complications; Povidone; Rats; Rats, Sprague-Dawley; Solutions; Tissue Adhesions

Topics: Animals; Aprotinin; Carboxymethylcellulose Sodium; Female; Genitalia, Female; Hydrocortisone; Methylcellulose; Microsurgery; Postoperative Complications; Rats; Tissue Adhesions

A study was designed to test chondroitin sulphate and other high-molecular-weight solutions, using the rabbit uterus as the surgical model, in the prevention of postoperative adhesions. Eighty-five mature white female New Zealand rabbits underwent surgical injury of each uterine horn, with surgical repair of the left horn only in all animals using 9-0 nylon. The rabbits were randomly divided into five groups: groups A, B and C received 25 mL of chondroitin sulphate, sodium carboxymethylcellulose or 32% dextran 70, respectively. The remaining two groups received either 50 mL of normal saline (D) or no solution (E). Postoperatively the animals were killed, and the adhesions were carefully scored. The results clearly demonstrated the superiority of chondroitin sulphate as an intraperitoneal treatment for the prevention of postoperative adhesions (P less than .001 vs. carboxymethyl cellulose, dextran, saline and control).

Topics: Animals; Carboxymethylcellulose Sodium; Chondroitin; Chondroitin Sulfates; Dextrans; Female; Injections, Intraperitoneal; Methylcellulose; Peritoneum; Postoperative Complications; Rabbits; Tissue Adhesions; Uterine Diseases

With the use of a rabbit surgical model, the ability of 1%, 2%, and 3% solutions of sodium carboxymethylcellulose to reduce postoperative uterine adhesions was determined. At all concentrations sodium carboxymethylcellulose was more effective than either 32% dextran 70 or heparinized lactated Ringer's solution. Neither the dextran nor Ringer's solution had a significant (p less than or equal to 0.05) effect. The beneficial effects of sodium carboxymethylcellulose were closely dose-dependent (correlation coefficient 0.97). Sodium carboxymethylcellulose is highly effective in reducing postoperative adhesions in laboratory animals, and additional studies are warranted to further define its efficacy and safety.

Topics: Animals; Autopsy; Carboxymethylcellulose Sodium; Dextrans; Dose-Response Relationship, Drug; Female; Isotonic Solutions; Methylcellulose; Microsurgery; Peritoneal Diseases; Postoperative Complications; Rabbits; Ringer's Lactate; Solutions; Tissue Adhesions; Uterus

Solutions of sodium carboxymethylcellulose (SCMC) were studied in rats to determine their longevity within the peritoneal cavity and their potential for prevention of postoperative intraperitoneal adhesions. In 18 rats, test solutions of SCMC and 10% dextran 40 were instilled at laparotomy. At 48 hours copious amounts of SCMC remained, whereas no 10% dextran 40 could be detected. In addition, standardized surgical injury was produced on the ceca of 100 rats at laparotomy. All control animals had significant adhesions at 2 weeks. Eighty-two percent of the 10% dextran 40 group had significant adhesions, while only 16% of the 0.9 wt% SCMC and 17% of the 1.0 wt% SCMC groups had significant adhesions. Solutions of SCMC were significantly more effective than 10% dextran 40 in the prevention of adhesions (P less than 0.001). Properties of SCMC and a possible mechanism for its striking effectiveness in adhesion prevention in this study are discussed.

Topics: Animals; Carboxymethylcellulose Sodium; Dextrans; Female; Methylcellulose; Peritoneal Cavity; Postoperative Complications; Rats; Sodium; Solutions; Time Factors; Tissue Adhesions

In a rat model, sodium carboxymethylcellulose (SCMC) was compared with normal saline and 32% dextran 70 in the prevention of surgically induced intraperitoneal adhesions. The 32% dextran 70 was similar to normal saline in the initial prevention of adhesions, and both appeared less effective than SCMC. After lysis of the initial adhesions, SCMC was significantly more effective than 32% dextran 70 in the prevention of the reformation of adhesions. Possible mechanisms of action, complications of SCMC, and the need for further research in finding an ideal solution for use in adhesion prevention are discussed.

Topics: Animals; Carboxymethylcellulose Sodium; Dextrans; Female; Methylcellulose; Peritoneal Cavity; Postoperative Complications; Rats; Sodium Chloride; Solutions; Time Factors; Tissue Adhesions