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Prevention of postsurgical adhesions using an ultrapure alginate-based gel

Authors


  • Surgical relevance

    Intra-abdominal adhesions are a major source of morbidity and mortality after abdominal surgery. Although numerous antiadhesive barriers claim efficacy, none has found widespread use because of several drawbacks.

    In the present study an ultrapure alginate gel consistently reduced postoperative adhesion formation in a rat model without adverse effects on wound healing. The gel is easy to apply after laparotomy and laparoscopy, and is able to achieve broad coverage of the anatomical structures of the abdomen. The alginate gel is a promising tool in the efforts to develop an optimal and low-cost adhesion-preventing barrier that is effective in all types of gastrointestinal surgery.

    Presented to the 21st European Tissue Repair Society Congress, Amsterdam, The Netherlands, October 2011, the 47th Annual Congress of the European Society of Surgical Research, Lille, France, June 2012, and the European Congress on Surgical Infection, Lund, Sweden, June 2012

Correspondence to: Mr A. A. Chaturvedi, Department of Surgery, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 Nijmegen, The Netherlands (e-mail: a.chaturvedi@chir.umcn.nl)

Abstract

Background

Postoperative adhesion formation is a common consequence of abdominal surgery, and constitutes a major source of morbidity and mortality. This study evaluated an ultrapure alginate-based antiadhesive barrier gel.

Methods

Experiments were performed in a rat model with caecal abrasion and peritoneal side wall excision. The primary endpoint was the incidence of adhesions at 14 days after surgery. In experiment 1 (24 rats), animals treated with alginate gel were compared with controls that had no antiadhesive barrier. In experiment 2 (42 rats), alginate gel was compared with sodium hyaluronate carboxymethyl cellulose (HA/CMC) membrane and with no antiadhesive barrier. To check for any remote action of the gel, in experiment 3 (45 rats) application of alginate gel to the ipsilateral versus contralateral side of injury was compared with no antiadhesive barrier.

Results

In experiment 1, ultrapure alginate gel reduced the incidence of adhesions from eight of 12 in control animals to one in 12 (P = 0·009). Tissue healing assessed by histology was similar in both groups. In experiment 2, ultrapure alginate gel and HA/CMC membrane showed similar antiadhesive effectiveness, reducing the incidence of adhesions from ten of 14 rats in the control group to three of 14 (P = 0·021) and two of 14 (P = 0·006) respectively. In experiment 3, ultrapure alginate gel reduced the incidence of adhesions at the site of direct application (1 of 15) compared with controls (13 of 15; P = 0·001), but not if applied remotely (9 of 15; P = 0·214).

Conclusion

Ultrapure alginate gel decreased the incidence of postoperative adhesion formation in this rat model.

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