Hyaluronic acid for preventing experimental postoperative intraperitoneal adhesions

Adhesions, which form in > 60% of patients following major abdominopelvic surgery, are a common cause of morbidity and infertility in women. Hyaluronic acid is a naturally occurring polysaccharide that has been shown to be beneficial in ophthalmic surgery and as intraarticular injections. This study was designed to examine the use of hyaluronic acid as an agent for adhesion prevention after experimental abrasion of rat uterine horns and to explore its possible mechanism of action. Twenty-nine female Sabra rats were randomly assigned to either a saline (n = 13) or hyaluronic acid (n = 16) group. Adhesions were created by local abrasion of the uterine surfaces. Five milliliters of 1% hyaluronic acid or saline was instilled intraperitoneally. Three weeks later the animals were killed and subjected to a second laparotomy. Intraabdominal adhesions were graded on the basis of gross appearance using a scoring system from 0 to 5. The adhesion score in the animals treated with hyaluronic acid was significantly (P < .001) lower than that in the control animals. Hyaluronic acid did not affect the attachment or proliferation of fibroblasts but had an inhibitory effect on platelet aggregation in a dose-dependent manner. Intraperitoneal instillation of 1% hyaluronic acid significantly minimized adhesions formed experimentally. The mechanism of action may involve inhibition of platelet aggregation.