Polyvinyl Alcohol Sponges Reduce Intraperitoneal Adhesions After Abdominal Surgery

Abstract

Introduction

The use of cotton sponges in the operating room has been linked to intraperitoneal adhesion formation. Inert, nonlinting polyvinyl alcohol (PVA) sponges have been used as an alternative to reduce intraoperative tissue trauma and particle remnants in other surgical fields. We investigate the effect of PVA sponges on reducing postoperative intraperitoneal adhesions in a murine model.

Methods and methods

In total, 189 C57BL/6 mice were randomly divided into three groups by abdominal packing intervention. Following laparotomy on day 0, the abdominal cavity was packed with cotton gauze (n = 53), PVA wipe (n = 54), or no packing (sham; n = 58) for three rounds of 10 min each before packing was removed. Mice were euthanized, and necropsies were performed between postoperative days 13-15. Adhesions were graded by two blinded observers using a validated system composed of adhesion extent, tenacity, and density. Adhesion scores were compared between the three groups.

Results

Compared to adhesions in gauze-packed mice, adhesions in PVA-packed mice were significantly less extensive, less tenacious, and less dense (P < 0.001 for all), which equated to lower total adhesion scores in PVA-packed mice (0 [0, 3] versus 5 [2, 7], P < 0.001). The adhesion scores for sham group mice were significantly lower than PVA and gauze mice in all categories.

Conclusions

This is the first study to directly compare postoperative intra-abdominal adhesion formation following the use of gauze and PVA sponges in an animal model. PVA sponges significantly reduce postoperative adhesions when compared to standard cotton gauze sponges. PVA should be further explored as a useful alternative to reduce postoperative adhesion-related morbidity.