The prevention of postoperative pelvic adhesions: an animal study comparing barrier methods with dextran 70.

There are two major approaches to the prophylaxis for adhesions: chemical methods (e.g., dextran) and barrier methods. Theoretically, dextran prevents the formation of adhesions by a surface-coating or hydroflotation effect, whereas the barrier methods either prevent the formation of or mask adhesions by covering and isolating the injured area with an inert substance. This study compared the efficacy of two different concentrations of dextran 70 and various barriers in preventing the formation of adhesions in the female rabbit pelvis. Symmetrical cut and scrape lesions were made on both sides of each rabbit's uterus; for the barrier-treated animals, the lesions on one side were covered with a barrier, and the contralateral side served as a control. The barriers tested were: Gelfilm, Surgicel, Silastic, Gelfoam paste, amnion, peritoneum, and omentum (five rabbits per subgroup). The same cut and scrape lesions were induced in 16 additional rabbits in the chemical group. These rabbits were subsequently treated with 10 ml/kg of intraperitoneal 6% dextran 70 (five rabbits), and 32% dextran 70 (five rabbits), and were compared with six external control rabbits. The severity of the adhesions that formed was graded by a numerical scoring system. The barrier methods tested resulted, generally, in an increased formation of adhesions when a comparison was made with control and with dextran-treated animals. The degree of formation of adhesions in the dextran-treated rabbits did not differ from that in the control animals. The data suggest that the barrier methods actually promote the formation of adhesions whereas the findings with dextran 70 were inconclusive.