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Prevention of Intra-abdominal Abscesses and Adhesions Using a Hyaluronic Acid Solution in a Rat Peritonitis Model
Michel M. P. J. Reijnen, MD;
Jacques F. G. M. Meis, MD, PhD;
Victor A. Postma;
Harry van Goor, MD, PhD
Arch Surg. 1999;134:997-1001.
Hypothesis Hyaluronic acid (HA)–based bioresorbable membrane and 0.4% HA solution reduce intra-abdominal adhesion and abscess formation in a rat peritonitis model.
Design Randomized laboratory experiment.
Setting A university hospital.
Interventions In 72 male Wistar rats, a bacterial peritonitis was induced using the cecal ligation and puncture model. Animals were randomized to receive isotonic sodium chloride solution (group 1), HA-carboxymethylcellulose bioresorbable membrane (group 2), or 0.4% HA solution (group 3). Half of each group were killed at day 7 and half at day 21, and adhesions were scored in a blind fashion. The presence and sizes of intra-abdominal abscesses were noted. Cultures were taken for bacterial analysis.
Main Outcome Measures Intra-abdominal adhesions and abscesses.
Results The median severity of adhesions was significantly lower in group 3 compared with group 1 rats at day 7 (II [range, I-IV] vs IV [range, I-IV], respectively; P=.02) and at day 21 (II [range, I-III] vs IV [range, II-IV], respectively; P=.02). There was no significant difference between group 2 and group 1 rats on either day. At day 7, abscesses larger than 2 cm were found in 6 of 12 group 1 rats and in 4 of 12 group 2 rats, but in 0 of 11 group 3 rats (P=.01). At day 21, 0 of 11 group 3 rats had an intra-abdominal abscess, in contrast to 4 (33%) of 12 group 1 rats and 5 (45%) of 11 group 2 rats. All cultures of abscesses revealed polymicrobial flora.
Conclusion Adhesion and abscess formation are reduced using a 0.4% HA solution, and not HA-carboxymethylcellulose bioresorbable membrane, in a rat model of generalized bacterial peritonitis.
From the Departments of Surgery (Drs Reijnen and van Goor and Mr Postma) and Medical Microbiology (Dr Meis), University Hospital Nijmegen, Nijmegen, the Netherlands.
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