Effect of Hyaluronic Acid Solution on Healing of Bowel Anastomoses

Abstract

Hyaluronic acid (HA) solution has the ability to coat and lubricate serosal surfaces. and potentially prevent serosal trauma during surgery, which can result in the postoperative formation of adhesions in the abdomen. Previous animal studies utilizing HA have shown a reduction of intra-abdominal adhesion formation. Human clinical trials are currently underway. The prevention of adhesions could conceivably have deleterious effects on bowel anastomosis healing. As a result, solutions of HA were studied in rabbits to determine their effect on the healing of a bowel anastomosis. In 30 rabbits, test solutions of either HA (0.4 or 1.0%) or phosphate-buffered saline (PBS) as a control were instilled into the open peritoneal cavity just prior to the performance of small bowel anastomosis. At sacrifice 14 days later, intestinal bursting pressures were 110.5 +/-16.0 mm Hg (SEM) in the PBS group, 108.5 +/-15.2 mm Hg in the 0.4% HA group, and 138.7 +/-14.1 mm Hg in the 1.0% group. Average bursting pressures among the three groups did not vary significantly (p >.05). Small sterile mucoceles formed at the anastomosis in 70% of the PBS group, in 10% of the 0.4% HA group, and in 30% of the 1.0% HA group. Histologic examination of specimens taken at the anastomosis did not reveal any differences in the level of healing between groups. HA solution, when instilled in the presence of a small bowel anastomosis in rabbits, does not appear to interfere with the healing process.

Key Words:

• adhesions
• hyaluronic acid
• bowel anastomosis