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

7 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 cmH 2 O. 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.

LanguageEnglish
Pages349-357
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

Cite this

Renz, Bernhard W. ; Leitner, Kurt ; Odermatt, Erich ; Worthley, Daniel L. ; Angele, Martin K. ; Jauch, Karl Walter ; Lang, Reinhold A. / PVA gel as a potential adhesion barrier : A safety study in a large animal model of intestinal surgery. In: Langenbeck's Archives of Surgery. 2014 ; Vol. 399, No. 3. pp. 349-357.
@article{ca2f29fa49be473d906add17b32be758,
title = "PVA gel as a potential adhesion barrier: A safety study in a large animal model of intestinal surgery",
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 cmH 2 O. 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.",
keywords = "Adhesiolysis, Adhesion, Animal study, Prophylaxis",
author = "Renz, {Bernhard W.} and Kurt Leitner and Erich Odermatt and Worthley, {Daniel L.} and Angele, {Martin K.} and Jauch, {Karl Walter} and Lang, {Reinhold A.}",
year = "2014",
month = "1",
day = "1",
doi = "10.1007/s00423-013-1159-1",
language = "English",
volume = "399",
pages = "349--357",
journal = "Langenbeck's Archives of Surgery",
issn = "1435-2443",
publisher = "Springer Verlag",
number = "3",

}

PVA gel as a potential adhesion barrier : A safety study in a large animal model of intestinal surgery. / Renz, Bernhard W.; Leitner, Kurt; Odermatt, Erich; Worthley, Daniel L.; Angele, Martin K.; Jauch, Karl Walter; Lang, Reinhold A.

In: Langenbeck's Archives of Surgery, Vol. 399, No. 3, 01.01.2014, p. 349-357.

Research output: Contribution to journalArticle

TY - JOUR

T1 - PVA gel as a potential adhesion barrier

T2 - Langenbeck's Archives of Surgery

AU - Renz, Bernhard W.

AU - Leitner, Kurt

AU - Odermatt, Erich

AU - Worthley, Daniel L.

AU - Angele, Martin K.

AU - Jauch, Karl Walter

AU - Lang, Reinhold A.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - 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 cmH 2 O. 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.

AB - 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 cmH 2 O. 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.

KW - Adhesiolysis

KW - Adhesion

KW - Animal study

KW - Prophylaxis

UR - http://www.scopus.com/inward/record.url?scp=84898885572&partnerID=8YFLogxK

U2 - 10.1007/s00423-013-1159-1

DO - 10.1007/s00423-013-1159-1

M3 - Article

VL - 399

SP - 349

EP - 357

JO - Langenbeck's Archives of Surgery

JF - Langenbeck's Archives of Surgery

SN - 1435-2443

IS - 3

ER -