Prevention of intra-abdominal adhesions by a hyaluronic acid gel; an experimental study in rats

Abstract

Background In 80% to 90% of the patients intra-abdominal adhesions occur after abdominal surgery, which can cause small-bowel obstruction, chronic abdominal pain, female infertility and difficulty during reoperation. A novel crosslinked hyaluronic acid gel is evaluated regarding its anti-adhesive capacities in an ischemic button model in rats. Method 51 adult, male Wistar rats from a registered breeder, received eight ischemic buttons each and were treated with hyaluronic acid gel (HA, HyaRegen©), hyaluronic acid carboxymethylcellulose (HA-CMC, Seprafilm©) or no anti-adhesive barrier. After 14 days, the animals were sacrificed and adhesions were scored macroscopically. The number of buttons and organs involved in adhesions were recorded. Per animal, one button with adhesions and one without adhesions was explanted for qPCR analysis. Mann-Whitney U, Fisher’s exact and Wilcoxon signed rank test were used for data analysis. A p-value of 0.05 was considered significant. Results Macroscopic evaluation of adhesion formation did not differ between the groups. The number of organs involved in adhesions in the HA gel group was significantly lower compared to HA-CMC (p = .041) and the control group (p = .012). A significantly, 1.36-fold higher clec10a (p = 0.25), 1.80-fold higher cd163 (p = 0.003) and 5.14-fold higher mmp1 expression (p = 0.028) was found in ischemic buttons with adhesions compared to buttons without adhesions. Conclusion HA gel application reduces the number of organs involved in adhesions in an ischemic button model, but no overall reduction in adhesion formation was encountered. Macrophage subtype 2 polarization and high mmp1 expression are associated with adhesion formation. Further investigation is needed in the exact pathophysiologic process of adhesion formation and the role of macrophage polarization.

Autologous Blood-Derived Patches Used as Anti-adhesives in a Rat Uterine Horn Damage Model

“…When analyzing the uterine horns, it was not possible to determine the placement of the patch after the recovery period. One recent study 29 reported that the formation of adhesions is a rather localized process, however we do postulate that the placement of the patches must have been sufficient for it to produce a significant reduction of macroscopic adhesions.…”

Types and Localization of Abdominal Adhesions after Open Operations (Experimental Study)

“…Creating an animal model of abdominal adhesions with consistent, reliable and reproducible results for positive control is a major challenge. Currently, researches are ongoing to find more efficient anti-adhesion agents and components [7,13,15]. In this experimental study, anti-adhesion agents, such as mezogel, metronidazole, dextran, and contrykal, were used.…”

Evaluation of In Vivo Adhesion Properties of New Generation Polyglactin, Oxidized Regenerated Cellulose and Chitosan-Based Meshes for Hernia Surgery

“…Laparoscopic and minimally invasive techniques have been adopted to reduce the trauma that may occur during surgical intervention. Laparoscopic surgery is associated with less intraabdominal adhesion than classical open surgery, but postoperative adhesion still occurs in 37.7% of patients operated with laparoscopic methods [ 8 ]. Surgical technique is not sufficient to reduce postoperative adhesions and related complications.…”