The Effects of Barrier Agents in Postoperative Pelvic Adhesion Formation: A Comparative Study of a Temperature-Sensitive Poloxamer-Based Solution/Gel and a Hyaluronic Acid-Based Solution in a Rat Uterine Horn Model

Abstract

Objective: The aim is to evaluate the efficacy of poloxamer/alginate/CaCl2 mixture (PACM) solution/gel and hyaluronic acid/carboxymethylcellulose (HA-CMC) solution for reducing pelvic adhesion in a rat uterine horn model. Study Design: A total of 48 females, Sprague Dawley rats, were divided into three groups according to the applied materials. A uterine horn adhesion model was created. The control group (group CO; n=16) received no special materials except saline infusion. The experimental groups were treated with 1.0mL HA-CMC solution (group HA-CMC; n=16) or 1.0mL PACM solution/gel (group PACM; n=16). Adhesion scores were evaluated with macroscopic, microscopic, and immunohistochemistry grading 14 days postoperatively. Results: Macroscopic adhesion scores, including extent, severity, and total scores in group HA-CMC and group PACM, were significantly lower than those in group CO (P<.001). Among these three categories of scoring, group PACM had a significantly lower score than did group HA-CMC in adhesion severity (P=.025). In the microscopic adhesion score analysis, the fibrosis scores in group HA-CMC and group PACM were also significantly lower than that of group CO. In group PACM, the fibrosis score was significantly lower than that of group HA-CMC. There were no statistical differences across all three groups in the microscopic inflammation and immunohistochemistry staining. Conclusion: Both HA-CMC solution and PACM solution/gel effectively reduced adhesion formation. PACM solution/gel was superior to HA-CMC solution in preventing pelvic adhesion, especially in adhesion severity and microscopic fibrosis.