Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jun 30;13(7):524-32.
doi: 10.7150/ijms.15167. eCollection 2016.

Evaluation of the Effectiveness of Peritoneal Adhesion Prevention Devices in a Rat Model

D Poehnert  1 , L Grethe  1 , L Maegel  2 , D Jonigk  2 , T Lippmann  2 , A Kaltenborn  3 , H Schrem  4 , J Klempnauer  1 , M Winny  1
Affiliations

Evaluation of the Effectiveness of Peritoneal Adhesion Prevention Devices in a Rat Model

D Poehnert et al. Int J Med Sci. .

Abstract

Background: Abdominal operations are followed by adhesions, a prevalent cause of abdominal pain, and the most frequent cause for bowel obstruction and secondary female infertility. This rat study addresses adhesion prevention capability of Adept(®), Interceed(®), Seprafilm(®), and a novel device, 4DryField(®) PH which is provided as powder and generates its effect as gel.

Methods: Sixty-eight male Lewis rats had cecal abrasion and creation of an equally sized abdominal wall defect, and were grouped randomly: A control group without treatment (n=10); two groups treated with 4DryField(®) PH using premixed gel (n=15) or in-situ gel technique (n=16); one group each was treated with Seprafilm(®) (n=8), Interceed(®) (n=9), or Adept(®) (n=10). Sacrifice was on day 7 to evaluate incidence, quality, and quantity of adhesions, as expressed via adhesion reduction rate (AR). Histologic specimens were evaluated. Statistical analyses used ANOVA and unpaired t-tests.

Results: 4DryField(®) PH significantly reduced incidence and severity of adhesions both as premixed gel (AR: 85.2%) and as in-situ made gel (AR: 100%), a comparison between these two application techniques showed no differences in efficacy. Seprafilm(®) did not reduce incidence but severity of adhesions significantly (AR: 53.5%). With Interceed(®) (AR: 3.7%) and Adept(®) (AR: 16.1%) no significant adhesion-reduction was achieved. Except for inflammatory response with Interceed(®), histopathology showed good tissue compatibility of all other devices.

Conclusion: 4DryField(®) PH and Seprafilm(®) showed significant adhesion prevention capabilities. 4DryField(®) PH achieved the highest adhesion prevention effectiveness without restrictions concerning mode of application and compatibility and, thus, is a promising strategy to prevent abdominal adhesions.

Keywords: 4DryField® PH; Adept®; Adhesion prevention; Interceed®; Seprafilm®; abdominal surgery; rat model OPAM.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Photographs at surgery and pathological evaluation in a control animal (A and B) and animals with 4DryField® PH premixed gel (C and D) and in-situ gel treatment (E, F and G). Arrows indicate laparotomy scars, asterisks demonstrate the approximation of abdominal wall and caecum by meso-stich. (A) Site after optimized adhesion model (OPAM) surgery, i.e. creation of abdominal wall defect and abrasion of caecum. (B) Control animal at day 7 after OPAM with caecum agglutinated to abdominal wall. (C) Site after OPAM and treatment with 4DryField® PH as premixed gel. Note the meso-suture for approximation of caecum and abdominal wall. (D) Day 7 after premixed gel treatment revealing no adhesions, tip of forceps points to the area of the former abdominal wall defect. Peritoneum reveals a shiny surface in the area of the former OPAM injuries. (E) Site after application of 4DryField® PH, (F) after dripping with saline solution a 4DryField® PH gel was formed (in-situ mixed gel). (G) Site of surgery following 4DryField® PH in-situ gel treatment revealing no adhesion formation.
Figure 2
Figure 2
Photographs at surgery (A, B, C) and pathological evaluation at day seven (D, E, F) in rats with Seprafilm®, Interceed®, and Adept® treatment. Arrows indicate laparotomy scars, asterisks the meso-stich approximation of abdominal wall and caecum, arrowhead indicates Interceed® remnant. (A) Patch of Seprafilm® is applied to separate abdominal wall defect and abraded caecum. (B) Agglutinations after Seprafilm® application. (C) Patch of Interceed® is applied to abdominal wall defect. (D) Remnant of Interceed® agglutinated to the abdominal wall on one side and the caecum on the other side. (E) Application of Adept® intraperitoneally (12.5 ml/kg bodyweight). (F) Adherence of the caecum after treatment with Adept®.
Figure 3
Figure 3
Adhesion reduction rates of 4DryField® PH premixed gel, 4DryField® PH in-situ-mixed gel, Seprafilm® (SF), Interceed® (IC), and Adept® (AD).
Figure 4
Figure 4
Representative photomicrographs of tissues from animals of control and treatment groups taken one week after operation. 1: cecal mucosa, 2: smooth muscle layer of the caecum, 3: granulating tissue, 4: abdominal wall musculature (A) HE-staining in a control animal with agglutination of abdominal wall and caecum (top: overview, bottom: close-up of the agglutination site of abdominal wall and caecum connected by granulating tissue). (B) animal of 4DryField® PH premixed gel group, PAS-staining: Caecum (top) and abdominal wall (bottom) show no agglutination. A slight thickening of the sub-peritoneal tissue of the abdominal wall above the former abdominal wall defect and some remnants of 4DryField® PH are visible (chevron arrowheads). (C) animal of 4DryField® PH in-situ-mixed gel group, PAS-staining: Caecum (top) and abdominal wall (bottom) show no agglutination but a slight sickening of the sub-peritoneal tissue of the abdominal wall with some remnants of 4DryField® PH. (D) Animal treated with Seprafilm® revealing agglutination of abdominal wall and caecum. (E) Interceed®-treated animal with deposits of the product surrounded by granulating tissue (delta arrowheads), via which abdominal wall and caecum are agglutinated. (F) Adept®-treated animal with agglutination of caecum and abdominal wall. Original magnification: A, top: 20x; A, bottom and B-F: 100x.
See this image and copyright information in PMC

References

    1. Ellis H, Moran BJ, Thompson JN, Parker MC, Wilson MS, Menzies D, McGuire A, Lower AM, Hawthorn RJS, O'Brian F, Buchan S, Crowe AM. Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet. 1999;353(9163):1476–1480. - PubMed
    1. Menzies D, Ellis H. Intestinal obstruction from adhesions - how big is the problem? Ann R Coll Surg Engl. 1990;72(1):60–63. - PMC - PubMed
    1. Parker MC, Ellis H, Moran BJ, Thompson JN, Wilson MS, Menzies D, McGuire A, Lower AM, Hawthorn RJS, O'Brian F, Buchan S, Crowe AM. Postoperative adhesions: ten-year follow-up of 12,584 patients undergoing lower abdominal surgery. Dis Colon Rectum. 2001;44(6):822–829. - PubMed
    1. Parker MC, Wilson MS, van Goor H, Moran BJ, Jeekel J, Duron JJ, Menzies D, Wexner SD, Ellis H. Adhesions and colorectal surgery - call for action. Colorectal Dis. 2007;9(Suppl 2):66–72. - PubMed
    1. Arung W, Meurisse M, Detry O. Pathophysiology and prevention of postoperative peritoneal adhesions. World J Gastroenterol. 2011;17(41):4545–4553. - PMC - PubMed

MeSH terms