Evaluation of oxidized regenerated cellulose for prevention of postoperative intraperitoneal adhesions

Oxidized regenerated cellulose (ORC) is widely used to cover the denuded mesothelium and to promote hemostasis. We evaluated ORC in a rabbit model to assess the potential for adhesion reduction after uterine trauma and intestinal anastomosis. After surgery, a second laparotomy was done on postoperative day 7 for macroscopic evaluation of adhesion formation. The traumatized uterine horns wrapped in ORC had more numerous and higher grade adhesions compared with the non-surgical left, intact horns. However, when compared to the contralateral uterine horn which underwent trauma without ORC, a significant decrease in the grade of adhesion formation was noted. Rabbits undergoing intestinal anastomosis had the most pronounced degree of adhesion formation. Typically, the area of healing was encapsulated in a fibrin clot with adhesions attached to adjacent viscera. When ORC remained between the lesion and adjacent organs during mesothelial regeneration, adhesion formation decreased. However, the soft, gelatinous mass of ORC was also an effective nidus for clot formation. Where post- and intra-operative ooze produced a fibrin clot in the ORC, dense adhesions formed.