Biomoteriak 16 zyxwvutsrqponmlkjih (1995) 1283-1289 0 1995 Elsevier Science Limited Printed in Great Britain. All rights reserved 014% 9612/95/$10.00 zyxwvutsrqp (Quantitative analysis of the :inflammatoryreaction surrounding isutures commonly used in operative procedures and the relation to postsurgical adhesion formation zyxwvutsrqponmlkjihgfed EA. Bakkum*+, R.A.J. Dalmeijer+, M.J.C. Verdel” , J. Henna&, CA. van Blitterswijk+ and J.B. Trimbos* zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGF Biomaterials Research Group, *Department of Gynecology, +Laboratory for Otobiology and Biocompatibility and tDepartment of Medical Statistics, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands ilnflammatory reaction as well as the extent of postsurgical adhesion formation are described as varying according to suture material or diameter used. Whether the inflammatory reaction influences tine formation of adhesions or is a mere consequence of surgical trauma itself or of type and amount of foreign body material used has never been elucidated entirely. In this study a quantitative analysis of bloth variables was therefore performed, according to previously described techniques, and correlated within 120 peritoneal defects of a standard side wall-uterine horn adhesion model in the rat. Three different suture characteristics, material (Prolene@, Vicryl@, Catgut@), diameter (USP gauges 3/O, 5/O, 6/O) and knot configuration (2~2, S x S x S x S x S) were analysed for this purpose. Both the inflam- matory reaction and the adhesion percentage showed significant differences within and in between suture characteristics, but no significant correlation between the two variables was found after statis- tical analysis. The conclusion is made that, when evaluated after 14 d, the extent of postsurgical adhesion formation is not related to the inflammatory reaction. K’eywords: Inflammatory reaction, postsurgical adhesion formation, sutures Received 18 July 1994; accepted 15 February 1995 Postsurgical adhesions are a frequently ensuing and well-known complication after abdominal surgical procedures19’. Adhesions may interfere with the functions of abdominal structures and are thus able to cause chronic pelvic pain, bowel obstruction and/ or infertility33 4. Despite extensive therapeutic research in order to prevent or to reduce adhesion formation, a prominent improvement in treatment has not yet been achieved5’“. Adhesions are frequently observed to form on or to extend from sutures . Sutures, therefore, might be of influence in inducing postsurgical formation. In an earlier study different suture characteristics were investigated for this reason’, in which suture material was found to influence both the extent and type of postsurgical adhesion formation. Suture diameter was found to affect only the extent, while knot configuration did not influence the adhesion formation in any aspect’. In most theoretical pathways discussing adhesion Correspondence to Dr E.A. Bakkum. formation the inflammatory reaction is considered to be an important aetiological denominatorg-**, though this is mostly analysed with qualitative methods only. Since suture characteristics, like material, are described to evoke different inflammatory reactions and were indeed found to induce different adhesion percen- tages’, the theory evolved that the extent or type of the inflammatory reaction surrounding sutures might influence the extent of postsurgical adhesion formation. Therefore, an analysis of the inflammatory reaction was performed and related to the extent of postsurgical adhesion formation around sutures commonly used in standard operative procedures. Both analyses were performed in a quantitative way so that objective intercomparison between the extent of inflammatory reaction and the extent of adhesion formation w as possible in order to elucidate any possible underlying mechanism. To assess the inflammatory reaction, use w as made of techniques described pieviously’2913. This allowed a definition of the width of the inflamma- tion zone from the periphery of the suture outward, independent of the shape of the suture. In this inflam- 1283 Biomaterials 1995, Vol. 16 No. 17