Combined effects of tissue plasminogen activator and carboxymethylcellulose on adhesion reformation in rabbits.

OBJECTIVE

To test the effectiveness, in combination, of recombinant tissue plasminogen activator (rt-PA) and carboxymethylcellulose (CMC), which have both been investigated as adjuncts in the prevention of postsurgical adhesion reformation.

METHODS

A total of 45 mature New Zealand rabbits underwent laparotomy and bilateral uterine horn abrasion using a scalpel for scarification. Adhesions were scored according to the extent of uterine horn involvement and quality of the adhesions. Three weeks later, after the adhesions were scored and lysed using microsurgical technique, the animals were randomized to receive 20 mL of one of four adjunctive treatments: (1) abnormal saline; (2) 2% sodium CMC, (3) 10 mg rt-PA mixed in 2% sodium CMC, or (4) 32% dextran 70. The adhesions were scored again 3 weeks later at necropsy.

RESULTS

Although adhesion scores decreased slightly in all groups, there was no statistically significant difference in adhesion reformation between the four groups. Four rabbits died of intra-abdominal hemorrhage following lysis of adhesions, including three in the rt-PA/CMC group. The combination of intraperitoneal rt-PA and CMC did not reduce postsurgical adhesion reformation, and was associated with hemorrhagic complications.