Effect of Different Barriers of Oxidized Regenerated Cellulose (ORC) on Cecal and Sidewall Adhesions in the Presence and Absence of Bleeding

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Abstract
Adhesion formation after bowel surgery is a significant problem. The objective of this study was to evaluate two adhesion barriers composed of oxidized regenerated cellulose (ORC) in a model of bowel surgery, with and without bleeding. Ceca of female New Zealand White rabbits were abraded with gauze and a 3x5 cm patch of peritoneum and underlying muscle was excised from the right sidewall. Animals were randomized to receive no treatment, INTERCEED Barrier (Ethicon, Inc.), or neutralized INTERCEED (nTC7). ORC fabrics were applied to the excision site. Seven days later the percentage of the site and length of cecum with adhesions were estimated. The study was replicated in the presence of blood by nicking small vessels near the site sufficient to saturate the fabrics with blood. With hemostasis, the percentage of the sidewall with adhesions was reduced (p < .01) from 63.2 +/- 14.7% in controls (n=6) to 4 +/- 2.7% with INTERCEED Barrier(n=6) and 3 +/- 1.2% (n=5) with nTC7. With bleeding, however, control (n=5) levels of adhesions (67 +/- 17.5%) were reduced significantly with nTC7 (5.5 +/- 4%, n=4; p < .01), but not INTERCEED Barrier (34.2 +/- 18.4%, n=4). Similar trends were observed when the extent of adherent cecum was examined, since the cecum was the main site of adherence to the sidewall. However in the presence of blood, there was no effect of INTERCEED Barrier on cecal adhesions. We conclude that with hemostasis, both absorbable fabrics of ORC reduced adhesion formation between the injured cecum and abdominal sidewall. The effectiveness of INTERCEED Barrier, but not nTC7, was reduced but not eliminated in the presence of bleeding. This confirms similar observations in models of gynecologic surgery.