Prevention of postsurgical adhesions using an ultrapure alginate-based gel

Br J Surg. 2013 Jun;100(7):904-10. doi: 10.1002/bjs.9131. Epub 2013 Apr 17.

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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Alginates / therapeutic use*
  • Animals
  • Biocompatible Materials / therapeutic use*
  • Cecum / surgery
  • Gels
  • Glucuronic Acid / therapeutic use
  • Hexuronic Acids / therapeutic use
  • Male
  • Peritoneum / surgery
  • Postoperative Complications / pathology
  • Postoperative Complications / prevention & control*
  • Rats
  • Rats, Wistar
  • Sutures
  • Tissue Adhesions / pathology
  • Tissue Adhesions / prevention & control*

Substances

  • Alginates
  • Biocompatible Materials
  • Gels
  • Hexuronic Acids
  • Glucuronic Acid