Adhesion prevention by solutions of sodium carboxymethylcellulose in the rat. I

Elkins TE; Bury RJ; Ritter JL; Ling FW; Ahokas RA; Homsey CA; Malinak LR

doi:10.1016/s0015-0282(16)47909-4

Reproductive Surgery Adhesion Prevention

Adhesion prevention by solutions of sodium carboxymethylcellulose in the rat. I

Elkins TE, Bury RJ, Ritter JL, Ling FW, Ahokas RA, Homsey CA, Malinak LR

Published June 1984 Fertility and Sterility, 41(6), 926-928

DOI 10.1016/s0015-0282(16)47909-4 PMID 6202559

RRM Academy Synopsis

Sodium carboxymethylcellulose solution reduced adhesions in rats

Sodium carboxymethylcellulose (SCMC) solution lowered adhesion rates in a 1984 rat experiment. The 100 rats in the adhesion experiment had a standardized injury to the cecum, part of the large intestine. At 2 weeks, significant adhesions affected about 2 out of 10 SCMC rats and every control rat. About 8 out of 10 rats given dextran 40 solution had them.

Study at a glance, controlled animal experiment of 100 rats: SCMC solution reduced adhesions in rats. Source: Elkins TE et al., 1984, PMID 6202559.

Key Findings

Each rat given SCMC solution had copious viscous abdominal fluid at 24 and 48 hours, while rats given dextran 40 had normal amounts. SCMC fluid amounts appeared normal at 7 days.
At 2 weeks, all 20 control rats had significant adhesions, as did 14 (82%) of the 17 rats given dextran 40 solution.
Significant adhesions occurred in 5 rats in the higher-concentration SCMC group and 5 in the lower-concentration group, which included one animal with obvious infection.
Sixteen rats (50%) in the lower-concentration SCMC group and 15 (48%) in the higher-concentration group had no adhesions at all.
Both SCMC solutions were better than control or dextran 40 (P < 0.001). The two SCMC groups did not differ statistically, and dextran 40 was not significantly better than control.

Interpretation

The study is a controlled animal experiment. Female rats received a standardized injury to the cecum, the first part of the large intestine, and the authors graded adhesions by gross inspection at 2 weeks. Fluid was instilled before the abdomen was closed, and the authors compared groups with two-tailed chi-square analysis. The authors call the results preliminary. They postulate that SCMC works because it stays in the abdomen longer than dextran 40, and they note that how and how fast it leaves the cavity requires further study. The animals were rats, with one 2-week time point.

RRM Context

Restorative reproductive medicine aims to preserve reproductive function. Adhesions after pelvic surgery matter to that aim. The 1984 authors noted that no method had shown consistently positive results at preventing them. Their idea was a thick fluid that keeps injured surfaces apart while they heal.

Our editorial summary of this paper, not the article's abstract.

Abstract

Solutions of sodium carboxymethylcellulose (SCMC) were studied in rats to determine their longevity within the peritoneal cavity and their potential for prevention of postoperative intraperitoneal adhesions. In 18 rats, test solutions of SCMC and 10% dextran 40 were instilled at laparotomy. At 48 hours copious amounts of SCMC remained, whereas no 10% dextran 40 could be detected. In addition, standardized surgical injury was produced on the ceca of 100 rats at laparotomy. All control animals had significant adhesions at 2 weeks. Eighty-two percent of the 10% dextran 40 group had significant adhesions, while only 16% of the 0.9 wt% SCMC and 17% of the 1.0 wt% SCMC groups had significant adhesions. Solutions of SCMC were significantly more effective than 10% dextran 40 in the prevention of adhesions (P less than 0.001). Properties of SCMC and a possible mechanism for its striking effectiveness in adhesion prevention in this study are discussed.

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Fertility-Preserving Surgery: Restorative, Specialist, and Conventional Approaches Compared

How fertility-preserving surgery differs by approach: restorative (RRM), specialist, and conventional, across endometriosis, ovarian cysts, PMOS / PCOS, fibroids, tubal disease, Asherman's syndrome, adenomyosis, cesarean scar, pelvic adhesions, and male-factor causes including varicocele and obstruction.

12 min read

Topics

Reproductive Surgery

Adhesion Prevention Barrier Agents

Reproductive Surgery › Adhesion Prevention › Barrier Agents

PMID 6202559 6202559 DOI 10.1016/s0015-0282(16)47909-4 10.1016/s0015-0282(16)47909-4 Elkins et al. 1984, Elkins 1984

Keywords

Animals, Carboxymethylcellulose Sodium/pharmacology, Dextrans/pharmacology, Female, Methylcellulose/analogs & Derivatives, Peritoneal Cavity/surgery, Postoperative Complications/prevention & Control, Rats, Sodium/pharmacology, Solutions, Time Factors, Tissue Adhesions/prevention & Control, Dextrans, Solutions, Methylcellulose, Sodium, Carboxymethylcellulose Sodium

Adhesion prevention by solutions of sodium carboxymethylcellulose in the rat. I

Sodium carboxymethylcellulose solution reduced adhesions in rats

Key Findings

Interpretation

RRM Context

Abstract

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Topics

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Keywords