Nanotechnology-Based Therapies for Preventing Post-Surgical Adhesions

Abstract

Adhesions are the body's natural response to various inflammatory causes, with surgery being the most common cause. However, the formation of postoperative adhesions can lead to significant complications, including intestinal obstruction and chronic pain. To prevent such postoperative complications associated with adhesions, developing effective strategies for adhesion prevention has been a major focus of research. Currently, several therapeutic models have been developed to achieve this objective. These include pharmaceuticals, inert polymers, functional biomaterials, and nanotherapeutics. Among the various strategies developed, nanotherapeutics, though still in its early stages, has shown promise as a potential approach. Other therapeutic models are associated with adverse side effects and complications related to their application. On the other hand, nanotherapeutic models are able to overcome the limitations of the other strategies and provide their own set of unique advantages. Hence, nanotherapeutics represents a promising area for further research. Further efforts should be made to refine existing nanotherapeutics for clinical application while also addressing associated safety and ethical concerns related to their use in medical practice. Therefore, this article aims to review the various nanotherapeutic approaches developed for the prevention of postoperative adhesions, explore their regulatory pathways, and discuss associated safety and ethical concerns.

Keywords: adhesion; hydrogels; nanocomposites; nanofibers; nanotherapeutics; post-operation.

Figure 1

Adhesions form most commonly between planes of soft tissue (A). They can also form between soft tissue and tendon (B), epidural space (C), and muscle (D). Adapted from Park et al. 2020, distributed under the terms and conditions of the Creative Commons Attribution (CC BY) licence (http://creativecommons.org/licenses/by/4.0/) (accessed on 16 December 2024) [1].

Figure 2

There are many pathways which interact with each other during the process of adhesion formation. Fibrin deposition, which leads to the production of fibrin clots, is mainly regulated by the coagulation cascade, inflammation system, anticoagulation system, and fibrinolytic system. Other elements which influence adhesion formation include matrix metalloproteinases and angiogenesis. When fibrin deposition exceeds fibrinolysis, adhesions are formed.

Figure 3

(A) When a mechanical barrier is not used, postoperative adhesions will form at the surgical site. (B) The use of a mechanical barrier at the surgical site will help to prevent the formation of postoperative adhesions. Adapted from Klicova et al. 2023, distributed under the terms and conditions of the Creative Commons Attribution (CC BY) licence (https://creativecommons.org/licenses/by-nc-nd/4.0/) (accessed on 16 December 2024) [33].

Figure 4

(A) This shows the surgical site which involves the tissue and organ surfaces. (B) Nanofibers are one of the newer approaches to preventing peritoneal adhesion. Drug-loaded nanofibers further prevent postoperative adhesions through controlled drug release. (C) The majority of the drug is released several days following the operation, and the nanofiber is left behind. Adapted from Baek et al. 2020, distributed under the terms and conditions of the Creative Commons Attribution (CC BY) licence (https://creativecommons.org/licenses/by/4.0/) (accessed on 16 December 2024) [52].