Effects of 5-fluorouracil released from different prosthetic meshes on post-operative adhesion formation in rats

Abstract

Objective: Post-operative adhesion is a common problem in abdominal surgery. Especially, foreign materials are strong stimulus for the development of adhesions. The aim of this study was to investigate whether drug release material coated prosthetic mesh decreases intra-abdominal adhesion formation or not.

Methods: 5-Fluorouracil (5-FU) releasing "chitosan gels" were loaded to polypropylene and polyglactin-910 grafts. Polypropylene, polyglactin-910 grafts, chitosan gel, and 5-FU-loaded polyglactin 910, polypropylene grafts were used to cover abdominal defects of rats which were created under sterile conditions (n=84). Each group was divided into two subgroups (n=6). Subgroups were sacrificed on the 7^th and 30^th days.

Results: The 7^th day macroscopic examinations were similar. Polypropylene group was most adhesive group on the 30^th day. There were less adhesions in chitosan gel and 5-FU-loaded groups. Capsule and capsule margins showed no difference on both the 7^th and 30^th days. Polypropylene-5-FU group and polypropylene-chitosan gel group showed significantly less macroscopic adhesions than polypropylene control group. Furthermore, polyglactin-910-chitosan gel group was less adhesive than polypropylene control group.

Conclusion: This study showed that 5-FU decreases the adhesions but the dosage and release kinetics need further investigations.

Keywords: 5-fluorouracil; Adhesions; polyglactin 910-chitosan gel; polypropylene.

FIGURE 1

(A) Polypropylene 30 days Grade 4 adhesion, (B) polyglactin 910 7^th day Grade 1 adhesion, and (C) polyglactin 910 30 days Grade 0 adhesion.

FIGURE 2

Light microscopy images of the 7^th and 30^th days. HE: Hematoxylin and eosin; MT: Mason trichrome; P: Polyprolene; V: Polyglactin; J: Chitosan gel; BD: Connective tissue; O: Omentum; K: Abdominal muscle.

FIGURE 3

Electron microscopic images of the 7^th and 30^th days. Uranyl acetate lead citrate, Cap: Capillary; En: Endothelial cell; Dm: Vessel; F: Fibroblast; L: Lymphocyte; M: Macrophage; GBD: Loose connective tissue; PK: Polypropylene control; VK: Polyglactin 910 control; J: Chitosan gel; P5FU: Polypropylene 5-fluorouracil; V5FU: Polyglactin 910 5-fluorouracil; PJ: Polypropylene gel; VJ: Polyglactin 910 gel. Uranyl acetate lead citrate.