Polymers that reduce intraperitoneal adhesion formation

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Abstract
Background: Viscous macromolecules and phospholipids have been shown to reduce postoperative adhesion formation. The ideal agent, or combination of agents, still remains to be identified. Methods: The effect of hydrophobically modified ethyl (hydroxyethyl) cellulose (HM-EHEC) and polyquarternium-24 (LM-200), two cellulose-derived polymers, and of sphingomyelin, was examined in an animal model. Adhesions were induced in the parietal peritoneum in a standardized manner and quantity, and the morphology of adhesion formation was evaluated after 7 days. Results: A significant reduction in adhesion formation was seen in animals receiving LM-200 (P = 0·013) and HM-EHEC (P = 0·012) as a short-term treatment compared with controls given saline, but not in animals receiving sphingomyelin (P = 0·733). Additional effects were seen in the animals receiving LM-200 as a prolonged treatment (P < 0·001) compared with controls. There was no difference in the magnitude of the inflammatory response between the groups. Conclusion: These results suggest that hydrophobically modified polymers are efficient in reducing adhesions, without affecting the inflammatory response.