A barrier composed of chemically cross-linked hyaluronic acid (Incert) reduces postoperative adhesion formation 1 1Incert is a registered trademark of Anika Therapeutics, Inc., Woburn, Massachusetts.

Objective: To test whether a barrier of chemically cross-linked pure hyaluronic acid reduces postoperative adhesion formation. Design: The material was evaluated in the murine uterine horn model using excision and electrocautery injuries and in animals who had amounts of material inserted into the abdomen to evaluate toxicity. Setting: Academic medical center. Subject(s): Mice. Intervention(s): Insertion of the barrier between uterine horns and into the peritoneal cavity. Main Outcome Measure(s): Adhesion formation at 14 days; the histology of the peritoneum, liver, and spleen at 42 days; and the number, differential count, morphology, and flow cytometry of peritoneal leukocytes 3 days postoperatively. Result(s): Fewer adhesions were present when excision injuries were separated by the barrier (12 of 28 sites [43%] versus 23 of 26 control sites [88%]), whereas the number of adhesions was unchanged after electrocautery injuries (14 of 26 sites [54%] versus 17 of 26 control sites [65%]). The uterine horn sites covered by the barrier were histologically indistinguishable from controls. No adverse impact on the peritoneum and peritoneal fluid leukocyte population was observed with barrier insertion. Conclusion(s): The use of a barrier composed of a chemically cross-linked hyaluronic acid derivative (Incert, Anika Therapeutics, Inc., Woburn, MA) reduced postoperative adhesion formation in this model without any adverse impact on the peritoneum and peritoneal leukocyte population. This barrier material shows promise in preventing postoperative adhesions and deserves clinical evaluation.