The Use of Hyaluronic Acid Polymers to Reduce Postoperative Adhesions

The use of adjuvant therapy in an attempt to prevent adhesion formation and reformation is widely practiced. Proteoglycans, such as heparin, heparan, chondroitin sulfate, and others, have been shown, at least in experimental models, to decrease adhesion development. This study examines the ability of another proteoglycan, hyaluronic acid (HA) polymers (Pharmacia AB, Sweden), in four different formulations, to reduce adhesion formation in a rabbit model. New Zealand white rabbits underwent a midline laparotomy with bilateral ovarian bisection and were randomized to four treatment groups. Groups 1, 2, and 3 consisted of viscous solutions of HA polymers of differing molecular weights (2 ml applied to the treated ovary), and group 4 consisted of a polymer slab (2 × 2 cm piece applied to the treated ovary). The animals were killed 10–14 days after the initial laparotomy, and the adhesions were scored by a blinded observer. None of the formulations of HA solutions resulted in a reduction of ovarian adhesions. Only the polymer slab significantly reduced adhesion formation.