Adhesion re-formation in the rabbit uterine horn model: I. Reduction with carboxymethylcellulose

Adhesion re-formation frequently complicates the performance of adhesiolysis in reproductive pelvic surgery. To assess the ability of carboxymethylcellulose (CMC) to reduce adhesion re-formation, a rabbit uterine horn model was employed. Adhesions were created at laparotomy by scraping a 5-cm segment of each uterine horn. This injury reproducibly creates adhesions. Two weeks later, repeat laparotomy was performed, at which time all adhesions were lysed by sharp dissection. Animals were then randomly assigned to the control or CMC (20 mL of 2% solution) group. Necropsy was performed 2 weeks later. At both the second operative procedure and the time of necropsy, adhesions were graded in a blind fashion for severity and tenacity. There was no difference in adhesion score in the control and CMC-treated rabbits at the time of adhesiolysis. Subsequently, at the time of necropsy, the mean adhesion reformation score in the control group was 3.96 (median = 4.0). In contrast, adhesion re-formation in the CMC-treated group was significantly less (mean score = 2.15; median = 2.0; sign test, P less than .01). In summary, CMC significantly reduced adhesion re-formation in the rabbit uterine horn model. The mechanism by which CMC was able to reduce adhesion reformation is uncertain, but may be related to "hydroflotation" or "siliconizing" effects.