Chemical Scalpel: An Experimental Collagenase-Based Treatment for Peritoneal Adhesions

Abstract

(1) Background: Abdominal adhesions are a common disease appearing after any type of abdominal surgery and may prolong surgical time and cause intestinal obstruction, infertility, or chronic pain. We propose the use of intraperitoneal collagenase to perform chemical adhesiolysis based on the pathophysiology and histology of adhesions. (2) Methods: We generated an adhesion model with intraperitoneal polypropylene meshes. Four months later, we evaluated the efficacy of the treatment in blinded form, i.e., 0.05% collagenase vs. placebo at 37 °C for 20 min. Protocol 1: Ten rats with ten mesh fragments, in which an attempt was made to remove the maximum number of meshes in a 5-min period. Protocol 2: Six rats with four mesh fragments in the sides of the abdominal cavity in which adhesiolysis was performed using a device that measures burst pressure. (3) Results: Protocol 1: 42% efficacy in the collagenase group versus 8% in the control group (p < 0.013). Protocol 2: 188.25 mmHg (SD 69.65) in the collagenase group vs. 325.76 mmHg (SD 50.25) in the control group (p < 0.001). (4) Conclusions: Collagenase allows for the safe and effective chemical adhesiolysis in this experimental model of adhesions.

Chitosan-crosslinked polyvinyl alcohol anti-swelling hydrogel designed to prevent abdominal wall adhesion

“…This improvement could be explained by the AS hydrogel material's ability to reduce pericellular inflammation. Inflammation following surgical trauma and damage frequently promotes the development of postoperative abdominal adhesions [ 39 , 40 ]. Therefore, effectively reducing inflammation is essential for avoiding these kinds of adhesions.…”

Experimental Animal Models for Studying Intestinal Obstruction

“…Cecal abrasion alone or combined with other methods of intestinal manipulation is probably the most commonly cited method for postoperative intestinal adhesions, and it is accepted that the extent of adhesion formation is directly proportional to the extent of abrasion, even though quality and quantity are not standardized [23]. Simple laparotomy or laparoscopy with or without handling of the intestine, abrasion of cecum with or without abrasion of other organs, abrasion of the peritoneum, abrasion of the abdominal wall, intraperitoneal injection of various substances, drains, and modification of these experimental techniques by changing force, time, suturing materials, gloves, use of electrocautery, healing agents, meshes, inflammation agents and instrumentation have all been applied to replicate postoperative adhesive bowel obstruction [23,[143][144][145][146][147][148][149][150][151][152][153]. Authors have also published their experiments on how radiation, desiccation, thermal injury, bleeding, ischemia, endometriosis, cancer, pain, and peritoneal irritation affect the formation of adhesions [23,[154][155][156][157][158].…”