The Effect of Hyaluronic Acid/Carboxymethylcellulose in the Prevention of Postoperative Adhesion in Guinea Pigs

Uygun cerrahi tekniğin tek başına adezyon oluşumunu azaltmaya yardımcı olabileceği fakat adezyon oluşumunu tümden engellemeye yetmeyeceği iyi bilinmektedir, ilaçlar ve bariyerler olmak üzere 2 ana grupta toplanan yardımcı yöntem kullanımı gereklidir. Bizim bu deneysel çalışmadaki amacımız, hem genel cerrahi hem de jinekoloji kliniklerinde giderek daha yaygın kullanılmaya başlanan, bariyer materyali HA-CMC'nin, adezyon oluşumunu engellemedeki etkinliğini, yara gerilim kuvveti üzerine olumsuz etkisinin olup olmadığını belirlemektir. Laparotomi sırasında peritoneal ve serozal hasar ile kan kullanılarak adezyojenik ortam oluşturulan 30 kobayın yarısına, batın kapatılmadan önce HA-CMC yerleştirildi. 3 haftanın sonunda yüksek doz eter anestezisi ile deneklerin hayatları sonlandı-rıldıktan sonra adezyon skorlaması ve yara gerilim kuvveti ölçümleri yapıldı. Adezyon oluşumu, çalışma grubunda kontrol grubuna göre anlamlı ölçüde daha azdı (U= 197, p< 0.05). Gruplar arasında, yara gerilim kuvvetlen yönünden istatistiksel anlamlı fark gözlenmedi (U= 113, p> 0.05). HA-CMC, yara gerilim kuvveti üzerine olumsuz etki yapmadan adezyon oluşumunu anlamlı derecede azaltmış fakat tamamen önleyememiştir. Yetersiz kaldığı durumların irdelenmesi, daha başarılı sonuçların alınmasına yardımcı olacaktır.

Anahtar Kelimeler:

Adezyon, hiyaluronik asit, karboksimetilselüloz.

Kobaylarda Postoperatif Adezyonların Önlenmesinde Hyaluronic Acid/Carboxymethylcellulose'un Etkisi

İt is well known that appropriate surgical techniçue alone will help decrease but not prevent intraabdominai adhesion for-mation. İt is necessary to use adjuvant therapy that falls into two main categories, drugs and barriers. This study was designed to determine the effectiveness of HA/CMC (Hyaluronic acid/Carboxymethylcellulose) as a barrier agent for preventing postoperative adhesions and also to determine whether it alters abdominal wound tensile strength. An adhesion forming State was created by traumatization of peritoneal and serozal surfaces and inocuiation of self biood on traumatized areas in 30 guinea pigs. HA/CMC was applied between the viscera and the abdominai wall before laparotomy clo-sure in the experimental group (n= 15). Three weeks after the operation the adhesion scores were obtained and the abdominai wall wound was evaiuated for tensile strength. Adhesion formation was significantly lower in the study group compared to the control group (U= 197, p< 0.05). There were no statistically significant difference for tensile strength betvveen the two groups (U=113, p> 0.05). HA/CMC has no adverse effect on wound tensile strength, while significantly lovvering adhesion formation. However, it does not totally prevent it. Future investigations on its insufficient States and causes will help in obtaining successfui results.

Keywords:

Prevention of adhesion formation, hyaluronic acid/carboxymethylcellulose.,

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