A Novel Approach for Repairing of Intestinal Fistula Using chitosan hydrogel

Abstract

Intestinal fistula is associated with high morbidity and difficult to manage. Many fistulas require surgical treatment, which usually consists of segmental resection. In this study, using a rat model, the effectiveness of chitosan hydrogel as an intestinal fistula repair agent was investigated. Twenty rats underwent laparotomy under general anesthesia. The antimesentric portion of the cecum was incised (1 cm) and sutured to the abdominal wall. Chitosan hydrogel was applied daily to the fistula until it was completely closed. Blood samples taken from all animals were analyzed. After sacrifice, the cecum was removed and histopathologic investigation was performed. Spontaneous closure of the intestinal fistula was observed in all animals for both the control and chitosan hydrogel groups. Healing in the chitosan hydrogel group healing was faster than that in the control group. Blood analysis revealed significant differences between the chitosan hydrogel and control groups with regard to the total protein, albumin, total cholesterol and HDL before the surgery versus that on the day of sacrifice. Pathologic investigation also showed greater healing in the chitosan hydrogel group than the control group. This preliminary study showed the potential of chitosan hydrogel for repair of intestinal fistula. However further studies must be performed before we can approve testing chitosan hydrogel for intestinal fistula repair in humans.

Anti-MMP-9 Antibody

“…A model recapitulating the pathogenesis of intestinal fistula does not exist. Rat models in which fistula are surgically created have been used to assess repair agents such as chitosan hydrogel, 49 stable gastric pentadecapeptide BPC 157 50 or stem cell therapy. 51 Unfortunately, these models are not suitable for testing agents having the potential to control cellular and molecular processes leading to fistula development as those are bypassed in the surgical models.…”

Chitosan Hydrogels for Regenerative Engineering

“…Rabbani et al used an innovative approach to repair intestinal fistulas using chitosan hydrogels. The study revealed that the wound healing as well as antibacterial properties of chitosan hydrogel was very effective in healing cecal fistulas in rats [134]. Falabella et al demonstrated the efficacy of in situ-crosslinked oxidized dextran/N-carboxyethyl chitosan hydrogel in reducing intra-abdominal adhesion in rats by forming a physical barrier between the injured areas [135].…”

Nanocomposite hyaluronic acid-based hydrogel for the treatment of esophageal fistulas

“…Some of these properties are often present in hydrogels, three-dimensional polymeric structures able to entrap large amount of water, which upon an appropriate design can be injectable, forming in situ a tissue mimicking matrix. For example, the use of a chitosan based hydrogel has been reported to promote the healing of intestinal fistula in a rat model; however daily applications of the material were necessary [ 11 ]. In a clinical study, Krause et al.…”