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Effective Prevention of Adhesions With Hyaluronate
Klaus Kramer, MD;
Norbert Senninger, MD, FACS;
Hermann Herbst, MD, MRCPath;
Wolfgang Probst, MD
Arch Surg. 2002;137:278-282.
Hypothesis 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.
Design 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.
Setting Experimental animal model.
Interventions 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.
Main Outcome Measures 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.
Results 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.
Conclusions 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.
From the Department of Surgery (Drs Kramer and Senninger) and the Gerhard-Domagk Institute of Pathology (Dr Herbst), University of Muenster, Muenster, Germany; and the Department of Surgery, Ammerland Hospital, Westerstede, Germany (Dr Probst).
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