Abstracts
1999 Digestive Disease Week

# 2174 THE EFFICACY OF A SODIUM HYALURONATE-BASED BIORESORBABLE MEMBRANE IN THE PREVENTION OF PERITONITIS-INDUCED ADHESIONS
Ali M Ghellai, James M Becker, Boston Univ Sch of Medicine, Boston, MA; Kevin C Skinner, Daniel J Lynch, M Jude Colt, Genzyme Corp, Cambridge, MA; Arthur F Stucchi, Boston Univ Sch of Medicine, Boston, MA

Adhesions remain a significant postoperative complication of abdominal surgery; however, recent evidence suggests that physical barriers may reduce their incidence. Although these adhesion-prevention barriers are efficacious when used in aseptic conditions, little is known about their use in the presence of peritonitis, which is associated with an increased incidence of abdominal adhesions. A sodium hyaluronate and carboxymethylcellulose bioresorbable membrane (HA membrane) has been shown recently to reduce postoperative adhesions in several animal models and in two clinical trials. Our earlier work showed that peritonitis significantly increased the incidence of adhesions in rats. Methods. To investigate the efficacy of HA membrane in the presence of peritonitis, generalized peritonitis was induced in rats by either cecal ligation and puncture (CLP) or cecal ligation (CL) alone. The ceca were resected after 12 hours and animals were randomly assigned to receive (control;con) or not receive (treated;treat) HA membrane applied to the cecum. At day 7, abdominal adhesions and abscesses were scored. Results. HA membrane in the presence of peritonitis did not significantly reduce the number or tenacity of adhesions. A trend toward increased abscess formation was associated with HA membrane in the CL group (Table). Conclusion. Although HA membrane has been shown to reduce the incidence and severity of abdominal adhesions under aseptic conditions, this study demonstrates that it is not efficacious in preventing abdominal adhesions in the presence of peritonitis. The association between HA membrane and abscess formation in the presence of experimental peritonitis requires further investigation.

Adhesion Parameter (Mean ± SEM)	CLP (n=38)			CL (n=24)
	Con	Treat	p	Con	Treat	p
# of abdominal adhesion	4.3 ± -0.6	4.1 ± 0.7	0.78	2.8 ± 0.4	2.3 ± 0.6	0.26
# of cecal adhesions	2.0 ± 0.6	3.0 ± 0.5	0.85	2.4 ± 0.3	1.9 ± 0.3	0.39
Cecal adhesion tenacity	2.6 ± 0.1	2.7 ± 0.1	0.43	2.4 ± 0.2	2.5 ± 0.3	0.42
Abdominal abscess rate	26%	35%	0.56	8%	42%	0.13

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