Original article Postoperative adhesion prevention using a statin-containing cellulose film in an experimental model M. Lalountas 1 , K. D. Ballas 1 , A. Michalakis 5 , K. Psarras 1 , C. Asteriou 4 , D. E. Giakoustidis 2 , C. Nikolaidou 3 , I. Venizelos 3 , T. E. Pavlidis 1 and A. K. Sakantamis 1 1 Laboratory of Scientific Research and Experimental Surgery, Second Propedeutical Department of Surgery, and 2 Department of Transplant Surgery, Medical School, Aristotle University, and Hippokration General Hospital, 3 Department of Histopathology, Hippokration General Hospital, and 4 Department of Thoracic Surgery, Theagenio Cancer Hospital, Thessaloniki, and 5 School of Mining and Metallurgical Engineering, National Technical University, Athens, Greece Correspondence to: Dr M. Lalountas, Laboratory of Scientific Research and Experimental Surgery, Second Propedeutical Department of Surgery, Medical School, Aristotle University, and Hippokration General Hospital, 49 Konstantinoupoleos Street, 546 42 Thessaloniki, Greece (e-mail: miltiadislalountas@yahoo.gr) Background: Intraperitoneal adhesions are a common problem in abdominal surgery. The aim of this study was to compare the effectiveness of Statofilm, a novel antiadhesive film based on cross- linked carboxymethylcellulose and atorvastatin, with that of sodium hyaluronate – carboxymethylcellulose (Seprafilm  ) in the prevention of postoperative intraperitoneal adhesions in rats. Methods: One hundred male Wistar rats underwent a laparotomy and adhesions were induced by caecal abrasion. The animals were allocated to five groups: a control group with no adhesion barrier, Seprafilm  group, placebo group with a film containing carboxymethylcellulose without atorvastatin, and low- and high-dose groups with films containing carboxymethylcellulose and atorvastatin 0·125 and 1 mg per kg bodyweight respectively. Adhesions were classified by two independent surgeons 2 weeks after surgery. Caecal biopsies were obtained for histological evaluation of fibrosis, inflammation and vascular proliferation. Results: All antiadhesive film groups (Seprafilm  , placebo, low-dose and high-dose) had statistically significant adhesion reduction compared with the control group (P < 0·001, P = 0·015, P < 0·001 and P < 0·001 respectively). The low-dose Statofilm was superior to Seprafilm  in terms of adhesion pre- vention (P = 0·001). Adhesions were present in three-quarters of rats in the Seprafilm  group, but only one-quarter in the low-dose Statofilm group. Conclusion: The data suggest that the newly developed adhesion barrier Statofilm has better results than Seprafilm  in preventing postoperative adhesions in rats. A low-dose atorvastatin-containing film, such as Statofilm, could be evaluated for future clinical application. Surgical relevance Intraperitoneal adhesions are a frequent problem in abdominal surgery. Adhesion prevention is an important goal in surgical practice and many strategies have been applied, including fibri- nolytic agents and synthetic solid barriers, yet none with durable results. In this experimental study, a novel antiadhesive film containing the statin (3-hydroxy-3-methyl-glutaryl-CoA reduc- tase inhibitor) atorvastatin was synthesized; it was similar to Seprafilm  but sodium hyaluronate was substituted by ator- vastatin. The novel barrier (Statofilm), based on cross-linked carboxymethylcellulose and a low dose of atorvastatin, was com- pared with Seprafilm  in postoperative adhesion prevention in rats. Statofilm proved better in this experimental model than Seprafilm  for adhesion prevention. This novel barrier could be evaluated for future clinical application to prevent adhesions after abdominal surgery. Paper accepted 31 October 2011 Published online 13 January 2012 in Wiley Online Library (www.bjs.co.uk). DOI: 10.1002/bjs.7817  2012 British Journal of Surgery Society Ltd British Journal of Surgery 2012; 99: 423–429 Published by John Wiley & Sons Ltd Downloaded from https://academic.oup.com/bjs/article/99/3/423/6138722 by guest on 13 June 2022