D. C. Koo1, P. N. Scalise1, C. A. Ostertag-Hill1, A. E. Naus1, M. Z. Chiu1, M. Mejia Bautista2, K. Moskowitzova1, S. J. Staffa3, G. Ramos Gonzalez1,4, J. M. Durgin1, A. Al-Ibraheemi2, E. J. Lee1, F. R. Demehri1, H. Kim1 1Boston Children’s Hospital, Surgery, Boston, MA, USA 2Boston Children’s Hospital, Pathology, Boston, MA, USA 3Boston Children’s Hospital, Anesthesia, Boston, MA, USA 4Johns Hopkins All Children’s Hospital, Surgery, St. Petersburg, FL, USA
Introduction:
Use of cotton sponges in the operating room has been linked to intraperitoneal adhesion formation, a major source of postoperative short- and long-term morbidity and mortality. In other surgical fields, inert non-linting polyvinyl alcohol (PVA) patties have been used as an alternative to cotton sponges. This study investigates the effect of PVA sponges on reducing postoperative intraperitoneal adhesions in a murine model.
Methods:
A total of 189 C57BL/6 8-week old male mice were randomly divided into 3 groups based on abdominal packing intervention. Following midline laparotomy on day 0, the abdominal cavity was packed with either cotton gauze (n=53), PVA wipe (n=54), or no packing (sham, n=58) for 3 rounds of 10 minutes each with temporary abdominal closure following each round of packing. Packing was removed and the mice were survived for two weeks following the procedure. On postoperative day 13-15, the mice were euthanized and necropsies were performed. Gross adhesion character was graded by two blinded observers using a validated adhesion scoring system composed of extent, tenacity, and density (0-4 for each category). A total adhesion score was calculated for each animal (0-12). Mean adhesion scores were compared between the three groups using Student’s t-tests with Bonferroni adjustments. A Kappa coefficient was calculated for inter-rater agreement.
Results:
Mice in the PVA group exhibited adhesions that were significantly less extensive (0.44±0.63 vs. 1.23±0.84, p<0.001), less tenacious (0.69±1.06 vs. 1.97±1.36, p<0.001), and less dense (0.55±0.83 vs. 1.46±0.55, p<0.001) compared to mice in the gauze group. Additionally, the total adhesion score was significantly lower in PVA-packed mice compared to gauze-packed mice (1.69±2.48 vs. 4.66±3.13, p<0.001). Mice in the sham group developed significantly less extensive, less tenacious, and less dense adhesions compared to mice in either the PVA or gauze groups. Kappa coefficients for the adhesion scoring components demonstrated substantial agreement between the two blinded observers.
Conclusions:
This is the first study to directly compare postoperative intra-abdominal adhesion formation between gauze and PVA sponges in an animal model. PVA sponges significantly reduce postoperative adhesions when compared to standard cotton gauze sponges. Therefore, PVA may be a useful alternative that reduces postoperative adhesion-related morbidity and mortality.
