106: Thermal Damage and Coagulations—What Do We Need To Know?

Abstract

Adhesions still account for great numbers of postoperative complications in pelvic surgery, leading to intestinal obstruction, chronic pelvic pain, female infertility plus complicated following surgeries and increasing hospitalization costs. The objective was to determine the benefit and efficacy of novel barriers agents in adhesion prophylaxis in an established rat uterine horn model. All “barriers” were evaluated in a prospective, randomized study with six study groups (each n = 18) and a control group (lRS, n = 18) in comparison to clinical routine (RL). Synthetic peritoneum (XA-1-2002 membrane and foil (Supraseal, PDLA-Copolymer, PDLA 1-3); Interceed (oxidized, regenerated cellulose, ORC) and innovative barrier solutions (Adept 4% Icodextrin, ICT); Hyalobarrier Gel (Hyaluronic acid) were compared to simulated Aszites (lactated Ringer’s solution, RL) and histomorphological results were captured applying the Masson trichrome staining. Both the visceral and parietal peritoneum and the uterine horn were traumatized (Perlon brushing) and treated with alloplastic agents and evaluated four weeks postoperatively at 2nd-look Laparatomy. Groups treated with Adept, Hyalobarrier Gel, Interceed and SupraSeal showed significantly less and only moderate adhesions when compared to RL. Among these groups, no significant varieties in the protective impact could be ascertained. Fibroblast rich tissue with acute inflammatory reaction could be demonstrated for ORC and PDLA 2. Solid barriers carry the risk of material residua and lead to an accumulation of adhesion appearance at the suture sites. Hydroflotation formulas like Adept, spread intra-abdominally and develop their protective impact evenly. The present study emphasizes the need to apply innovative anti-adhesion agents in surgery known to carry a high risk of adhesions.