Polyvinyl Alcohol Gel Prevents Adhesion Re-Formation After Adhesiolysis in a Rabbit Model

• Published in: The Journal of surgical research 2009-05, Vol.153 (1), p.12-16
• Main Authors: Lang, Reinhold A., M.D, Weisgerber, Christiane, Grüntzig, Patricia M, Weis, Christine, Ph.D, Odermatt, Erich Kurt, Ph.D, Kirschner, Martin H., M.D
• Format: Article
• Language: English
• Subjects: adhesiolysis; adhesion re-formation; Animals; barrier; Biological and medical sciences; Disease Models, Animal; Gels - administration & dosage; General aspects; Medical sciences; polyvinyl alcohol; Polyvinyl Alcohol - administration & dosage; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; rabbit; Rabbits; relaparotomy; Secondary Prevention; sidewall model; Surgery; Tissue Adhesions - diagnostic imaging; Tissue Adhesions - prevention & control; Tissue Adhesions - surgery; Ultrasonography
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2008.04.018

Background Chronic pain, infertility, and bowel obstructions are possible consequences of abdominal adhesions, which can highly affect the patient's quality of life. Patients in whom adhesiolysis has been performed are at high risk for recurrence of adhesions. For that reason, the present study focused on the re-formation of adhesions after adhesiolysis and on the possibility of avoiding it by using the adhesion barrier polyvinyl alcohol (PVA)-gel. Materials and methods A randomized controlled study was conducted to prove the effectiveness of PVA-gel in reducing postoperative adhesion re-formation after relaparotomy. Moreover, ultrasound was evaluated as a noninvasive technique to determine abdominal adhesion in a rabbit model. All animals underwent an initial laparotomy to cause adhesions and subsequent adhesiolysis in the relaparotomy. PVA-gel was placed onto a side wall defect in 12 animals. Another 12 rabbits served as a control group without PVA-gel being used. Ultrasound before final laparotomy was performed to predict the prevalence of adhesions. Macroscopic evaluation of adhesion formation and planimetry were used to determine the amount of adhesion. Results PVA-gel was found to reduce significantly the amount of adhesion formation after relaparotomy ( P = 0.0001) in comparison with the control group. Here severe adhesion formation was found to develop. The positive-predictive value (100%) for adhesion evaluation using ultrasound is highly satisfying in the rabbit model. Conclusions Adhesion re-formation after relaparotomy was found to decrease significantly through the use of PVA-gel. Ultrasound as a noninvasive technique of adhesion detection is a sufficient and reliable method for detecting adhesion formations.