Meta‐Analysis of the Effects of Adhesion Barriers on Adhesion Formation in the Horse

Abstract

The meta-analysis demonstrated adhesion barriers provide a positive effect on the odds of adhesion formation. These results are tempered by the limitations of the study, including the small sample size and a bias towards publication of studies with only positive findings.

Effects of hyaluronate‐carboxymethylcellulose membranes on the clinical outcome of horses undergoing emergency exploratory celiotomy

“…Previous researchers using data based on postmortem examinations have reported that HA‐CMC membranes diminished intra‐abdominal adhesion formation in equine research models compared with untreated controls. A meta‐analysis determined that, compared with controls, research horses treated with HA‐CMC membranes or solutions had a lower odds ratio for intra‐abdominal adhesions . We found no difference in postoperative complications between horses with HA‐CMC membrane and controls, including nonspecific signs of abdominal adhesions such as colic and nasogastric reflux.…”

“…These strategies seek to diminish adhesion formation without inhibiting tissue healing . Therapeutic interventions to inhibit adhesion formation include abdominal and systemic heparin administration, omentectomy, intraoperative and postoperative abdominal lavage, abdominal drains, and serosal barriers . These barriers include high molecular weight solutions, such as sodium carboxymethylcellulose and bioabsorbable membranes made from hyaluronate‐carboxymethylcellulose (HA‐CMC) …”

“…A commercially available HA‐CMC membrane (Seprafilm; Genzyme, Cambridge, Massachusetts) has been found to reduce the occurrence and incidence of clinical signs related to intra‐abdominal adhesions in humans . HA‐CMC membranes also diminished adhesion formation in equine research models without affecting the healing of intestinal anastomoses . In people and horses, application of HA‐CMC membranes reduced both local adhesions at the site of intestinal damage or resection/anastomosis as well as adhesion formation at distant sites within the abdomen .…”

“…HA‐CMC membranes also diminished adhesion formation in equine research models without affecting the healing of intestinal anastomoses . In people and horses, application of HA‐CMC membranes reduced both local adhesions at the site of intestinal damage or resection/anastomosis as well as adhesion formation at distant sites within the abdomen . However, the application of HA‐CMC membrane directly over anastomotic sites in humans has been associated with pelvic abscess formation, peritonitis, and anastomotic leakage, without decreasing the rate of bowel obstruction requiring additional surgery .…”

Highlights of recent clinically relevant papers

“…In this meta‐analytical review Amelia Munsterman and colleagues in the USA aimed to determine the efficacy of adhesion barriers on adhesion formation in horses .…”