Efficacy of hyaluronic acid - carboxymethyl cellulose membrane (Seprafilm®) and polylactic acid barrier film(Surgiwrap™) for the prevention of adhesions after thyroid surgery: an experimental model

anti-adhesive barriers may reduce complication rates of secondary thyroid operations. In this study, we investigated the efficacy of hyaluronic acid-carboxymethyl cellulose membrane (HA-CMC, Seprafilm®) and polylactic acid barrier film(PLA, Surgiwrap™) in reducing adhesions after thyroid surgery.Materials and methods: A randomized-controlled experimental animal model was utilized. Forty-eight male Wistar Albino rats were randomly divided into 3 equal groups, forming study and control groups. Thyroid surgery was performed in all subjects. HA-CMC and PLA were applied between the thyroid zone and strap muscles after thyroid surgery in the HA-CMC and PLA study groups, respectively. Eight animals in each group were sacrificed and re-operatedon day 7 and the rest on day 28. Two surgeons independently scored adhesion formation during the re-operation.Subsequently, thyroid and adjacent tissues were excised for histopathologic examination.Results: Surgical adhesion scores were significantly reduced in HA-CMC group compared to the control group both onday 7 and 28 re-operations (P = 0.005 and P = 0.001, respectively); however, no significant difference was observed between control and PLA groups. Histopathologically, on day 7 re-operations, cellular markers of adhesion were more prominent in both HA-CMC and PLA groups compared to the control group; however, on day 28 re-operations, adhesion markers were similar in HA-CMC and control subjects, whereas PLA subjects still had marked adhesion.Conclusion: Use of HA-CMC after primary thyroidectomy may reduce adhesion formation, and thereby the complication rate in secondary surgery. Similar studies are warranted to determine the clinical application of barrier agents in thyroid surgery.