Meta-Analysis of the Effects of Adhesion Barriers on Adhesion Formation in the Horse.
Authors: Munsterman Amelia S, Kottwitz Jack J, Reid Hanson R
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Adhesion Barriers in Equine Surgery Postoperative adhesions represent a significant complication following equine abdominal surgery, often requiring repeat surgical intervention and compromising long-term outcomes. This 2016 meta-analysis pooled data from nine randomised controlled trials to quantify the effectiveness of various adhesion-barrier products—including sodium carboxymethylcellulose (CMC) solutions, hyaluronate/carboxymethylcellulose (HA/CMC) membranes, hyaluronate alone, and fucoidan solutions—in reducing adhesion formation in healthy horses undergoing experimental procedures. Treated horses demonstrated substantially lower odds of developing adhesions compared with untreated controls (odds ratio 0.102), with HA/CMC membranes and CMC solutions proving most effective (odds ratios 0.061 and 0.119 respectively). Whilst these findings support the clinical use of adhesion barriers as a preventative strategy, practitioners should interpret results cautiously given the modest sample sizes across studies and inherent publication bias favouring positive outcomes. The evidence does suggest that selecting a HA/CMC membrane or CMC solution during colic or small intestinal surgery could meaningfully reduce adhesion-related complications, though individual case factors and barrier selection remain important clinical considerations.
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Practical Takeaways
- •Use of adhesion barriers—particularly HA/CMC membranes or CMC solutions—significantly reduces post-surgical adhesion formation in horses undergoing abdominal surgery
- •These barriers should be considered standard practice when performing celiotomy to improve post-operative outcomes and reduce colic recurrence risk
- •Interpretation should account for small sample sizes and potential publication bias; further high-quality trials would strengthen recommendations
Key Findings
- •Adhesion barriers reduced odds of adhesion formation by 89.8% compared to untreated controls (OR=0.102, P<0.001)
- •HA/CMC membranes were most effective with 93.9% reduction in adhesions (OR=0.061, P<0.001)
- •CMC solutions reduced adhesions by 88.1% (OR=0.119, P<0.001)
- •Analysis included 9 randomized trials from 354 publications screened, with acknowledged publication bias toward positive findings