Effect of the Antiadhesive Treatments,Carboxymethylcellulose Combined with Recombinant Tissue Plasminogen Activator and Seprafilm™,on Bowel Anastomosis in the Rat

Abstract

Abdominal adhesions are a significant cause of increased morbidity, mortality, and cost in patients undergoing abdominal surgery. Carboxymethylcellulose combined with recombinant tissue plasminogen activator (CMC + rtPA) and Seprafilm™ (sodium hyaluronate/carboxymethylcellulose bioresorbable membrane) have been shown to reduce adhesion formation in animal models. The effect these treatments may have on a healing bowel anastomosis is unknown. Forty-eight rats underwent a laparotomy and the distal colonic segment was transected and an anastomosis of the transected ends performed. Before abdominal closure one of three treatments—CMC + rtPA, Seprafilm™, and saline (control)—was placed in the rat abdomen around the anastomosis. A necropsy was performed 75 to 96 hours later and bowel anastomosis adhesions were scored using an adhesion scale. The anastomosis strength was then evaluated using a saline infusion bursting pressure model. No difference was observed in the extent of adhesion formation involving the bowel anastomosis among all groups. No statistically significant difference was found among the groups in the bursting strength of the colonic anastomosis. We conclude that CMC + rtPA and Seprafilm™ do not significantly reduce colonic bowel anastomosis bursting strength in the rat model.