Reduction of postoperative pelvic adhesions in the rabbit with Gore-Tex surgical membrane

Abstract

Gore-Tex (W.L. Gore and Associates, Inc., Flagstaff, AZ) surgical membrane (SM), a nonreactive expanded polytetrafluoroethylene (PTFE), was used in 24 mature New Zealand rabbits (2200 to 3000 gm) to cover 2-cm2 ischemic defects in the pelvic sidewall peritoneum to reduce adhesion formation in a rabbit pelvic sidewall/uterine horn injury model. SM was randomly assigned to cover one defect; the opposite defect remained uncovered, each animal serving as its own control. Rabbits were sacrificed 3 weeks later, and adhesions between uterine horn and pelvic sidewall or SM were scored for extent (0 to 4), type (0 to 4), and tenacity (0 to 3). Injury sites were removed en bloc for histologic study. The mean (+/- standard deviation [SD]) adhesion score for SM-covered lesions (4.3 +/- 1.8) was significantly lower than for controls (9.1 +/- 2.5) (P less than 0.001; Wilcoxon Signed Rank test). By histology, none of 24 SM-covered lesions demonstrated adhesions to the membrane itself, whereas 19 of the 24 control lesions showed dense adhesions to the injury site (P less than 0.001; chi-square test). By both gross and microscopic assessment, SM was nonadherent to the underlying sidewall defect in 100% of cases. In conclusion, Gore-Tex surgical membrane is an effective barrier for reducing primary adhesions in this pelvic injury model and offers promise for adhesion reduction in human pelvic surgery.