PVA gel as a potential adhesion barrier: A safety study in a large animal model of intestinal surgery

Bernhard W. Renz, Kurt Leitner, Erich Odermatt, Daniel L. Worthley, Martin K. Angele, Karl Walter Jauch, Reinhold A. Lang

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Intra-abdominal adhesions following surgery are a major source of morbidity and mortality including abdominal pain and small bowel obstruction. This study evaluated the safety of PVA gel (polyvinyl alcohol and carboxymethylated cellulose gel) on intestinal anastomoses and its potential effectiveness in preventing adhesions in a clinically relevant large animal model. Methods: Experiments were performed in a pig model with median laparotomy and intestinal anastomosis following small bowel resection. The primary endpoint was the safety of PVA on small intestinal anastomoses. We also measured the incidence of postoperative adhesions in PVA vs. control groups: group A (eight pigs): stapled anastomosis with PVA gel compared to group B (eight pigs), which had no PVA gel; group C (eight pigs): hand-sewn anastomosis with PVA gel compared to group B (eight pigs), which had no anti-adhesive barrier. Animals were sacrificed 14 days after surgery and analyzed. Results: All anastomoses had a patent lumen without any stenosis. No anastomoses leaked at an intraluminal pressure of 40 cmH2O. Thus, anastomoses healed very well in both groups, regardless of whether PVA was administered. PVA-treated animals, however, had significantly fewer adhesions in the area of stapled anastomoses. The hand-sewn PVA group also had weaker adhesions and trended towards fewer adhesions to adjacent organs. Conclusion: These results suggest that PVA gel does not jeopardize the integrity of intestinal anastomoses. However, larger trials are needed to investigate the potential of PVA gel to prevent adhesions in gastrointestinal surgery.

Original languageEnglish
Pages (from-to)349-357
Number of pages9
JournalLangenbeck's Archives of Surgery
Volume399
Issue number3
DOIs
Publication statusPublished - 1 Jan 2014

Keywords

  • Adhesiolysis
  • Adhesion
  • Animal study
  • Prophylaxis

ASJC Scopus subject areas

  • Surgery

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