We would like to thank Dr Amid for his comments regarding our article. In his letter, Dr Amid suggests that polypropylene mesh combined with nonresorbant barriers may be superior to the combination of bioresorbant and synthetic meshes when compared for their potential to prevent biomaterial-related intestinal adhesion, bowel obstruction, and fistula formation.1-3 However, these cited studies do not support the conclusion about an eventual superiority of nonresorbant materials in comparison with resorbant membranes. To our knowledge, there are no published studies indicating a significant reduction in the incidence, severity, and extent of peritoneal adhesions due to the application of nonresorbant materials. Hyaluronate sodium is the only substance known to significantly reduce the incidence, severity, and extent of peritoneal adhesions, in both preclinical4,5 and clinical trials.6-8 The pathophysiologic characteristics of hyaluronate's adhesion-preventing effects are not completely known. Two characteristics of this bioresorbant material may partly explain its effects. First, the hyaluronate membrane seems to act as a temporary surface separator (physical barrier); second, it liberates hyaluronate so that the biochemistry of this substance can influence mediators of inflammation. As a physical barrier, it separates the peritoneal surface by completely covering the lesion for a minimum of 7 days during remesothelialization, subsequent to its transformation into a gel within the first day.6,9 Because of its biochemical characteristics, hyaluronate is supposed to promote and moderate wound healing at the same time.10,11
Kramer K, Senninger N, Herbst H, Probst W. Hyaluronate Does Not Prevent Adhesions—Reply. Arch Surg. 2002;137(11):1313–1314. doi:
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