Evaluation of a sheep laparoscopic uterine trauma model and repeat laparoscopy for evaluation of adhesion formation and prevention with sodium carboxymethylcellulose

OBJECTIVE: To evaluate topical application of 1% sodium carboxymethyl cellulose (SCMC) for prevention of postoperative adhesions in a laparoscopic model of uterine trauma in sheep. STUDY DESIGN: Experimental study. ANIMALS: Fourteen non-pregnant ewes. METHODS: Ewes were randomly assigned to 1 of 2 groups: control (saline solution) or 1% SCMC treatment. By left flank laparoscopy, traumatic forceps were used to create serosal trauma (1.5 x 5 cm) and hemorrhage on the left uterine horn. Either 30 mL saline solution or 30 mL 1% SCMC was applied topically to the traumatized uterine horn. Adhesion formation was evaluated by repeat laparoscopy at days 14 and 21. Sheep were euthanatized on day 28 for necropsy evaluation of adhesions. RESULTS: Five control sheep had adhesions of the uterine horn by day 14, but only 4 had adhesions at day 21, and 2 at day 28. Adhesions did not occur in SCMC-treated sheep. No adhesions occurred elsewhere in the abdomen. CONCLUSIONS: Laparoscopically created uterine trauma is an effective method for induction of uterine adhesions, and laparoscopy is an excellent method for serial evaluation of adhesion formation. SCMC (1%) was effective at preventing adhesion formation in sheep and no inflammatory response was noted. CLINICAL RELEVANCE: SCMC (1%) should be considered for prevention of adhesions in abdominal surgery in sheep.