Role of dextran 70 in microtubal surgery

Pelvic adhesion formation represents a major problem following fallopian tube surgery for infertility. Intraperitoneal dextran may prevent pelvic adhesions. Extensive personal clinical experience (W. H. U.) with intraperitoneal dextran organ-flotation on completion of tubal and ovarian surgery has appeared to limit adhesions. A specific study was designed to test the validity of this theory. Four randomized groups of rabbits were subjected to bilateral tubocornual division and microsurgical reanastomosis with total hemostasis and pelvic lavage. Routine peritoneal closure was performed on one group, but followed instillation of 30 to 50 ml of normal saline into the peritoneal cavities of the second group, and 30 to 50 ml of 6% dextran 70 into those of the third. Study of fourth group, which received 32% dextran 70 in the peritoneal cavity, was discontinued because of complications. A second laparotomy was performed 4 weeks later for precise assessment and photography of adhesion formation. Each animal was mated 4 weeks after the second operation in order to determine fertility rates. Reduced adhesion formation and increased fertility rates following the instillation of dextran are reported. A role for dextran 70 in infertility surgery is recommended. The role of microsurgical techniques and the use of low-molecular-weight Dextran 70 on adhesion formation and fertility rates were investigated in 4 randomized groups of rabbits which were subjected to bilateral tubocornual division and microsurgical reanastomosis with total hemostasis and pelvic lavage. The experiment with 1 group of rabbits using 32% Dextran 70 in the peritoneal cavity postoperatively was discontinued, but the 3 other groups were treated, respectively, with routine peritoneal closure following instillation of 30-50 ml of normal saline, 2) instillation of 30-50 of 6% Dextran 70 and then routine closure, or 3) simple, routine closure with no treatment. 4 weeks later a second laparotomy was performed to assess and photograph adhesive lesions. Then, within 4 weeks after the second operation, each animal was mated to determine fertility rates. Dextran 70 instilled prior to closure seemed to raise fertility rates and lessen the number of and degree of adhesion formation; therefore, use of Dextran in microsurgery is recommended.