The use of intra-abdominal carboxymethylcellulosis

Peritoneal adhesions, abnormal fibrous bands between bowel segments or between the intestine and the abdominal wall, cause a major concern in human (1, 2) and equine abdominal surgery and can lead to chronic abdominal pain, to severe recurrent colic and death (3). The incidence of adhesion formation in human medicine is well established considering that nearly every abdominal surgery causes adhesions (4) but not all adhesions were clinically significant. The mechanism of adhesion formation has been extensively studied in experimental and clinical studies (12). Serosal lesions during abdominal surgery are covered by fibrin, and in presence of blood and inflammation, the fibrinolysis diminishes by the increase of plasminogen activator inhibitor. Fibroblasts and vessels subsequently invade the fibrin, which leads to the formation of fibrous bands (13-15). In order to study the efficacy of preventive treatments, different experimental models for the induction of adhesions in horses have been developed, using serosal abrasion and suture placement (16-18) or creation of vascular lesion (19) or small intestinal resection (20). As adhesions are favoured by serosal lesions and the presence of blood, the most important prevention is proper surgical technique, gentle handling of the intestine and good haemostasis (15, 21, 22). Confusing results are obtained with several experimental studies about the use of carboxymethylcellulose, especially between experimental and clinical studies. In addition, the results from human studies cannot be transposed completely to horses due to the huge difference of the digestive tract between species. Therefore, large randomized clinical trials are warranted for determining more objectively the best adhesion prevention strategy in order to improve short- and long-term survival after equine abdominal surgery.