Ultrapure alginate anti-adhesion gel does not impair colon anastomotic strength

J Surg Res. 2014 Dec;192(2):432-9. doi: 10.1016/j.jss.2014.05.085. Epub 2014 Jun 4.

Abstract

Background: Ultrapure alginate gel is promising in terms of adhesion prevention. Because anti-adhesive barriers have been shown to disturb healing of bowel anastomoses, the effect of ultrapure alginate gel on the repair of colon anastomoses was studied.

Materials and methods: In 102 male Wistar rats, a 0.5-cm segment was resected from the descending colon and continuity was restored by an inverted single-layer end-to-end anastomosis. Animals were randomized into a control, an alginate gel, and a sodium hyaluronate carboxymethyl cellulose film group, each n = 34. Half of each group was sacrificed at day 3 and 7 postoperatively. Anastomotic strength was assessed by measuring both bursting pressure and breaking strength. Hydroxyproline content was measured and histologic analysis was performed. The incidence of adhesion and abscess formation was scored at sacrifice.

Results: No difference in either anastomotic-bursting pressure or breaking strength was found between experimental groups and the controls at any time point. Both the incidence of adhesion formation (35% versus 71%, P = 0.007) and the adhesion score (0.38 versus 0.79, P = 0.009) were significantly lower in the alginate gel group than in the controls. The abscess rate was higher (46% versus 18%, P = 0.030) in the hyaluronate carboxymethyl cellulose group than in the controls and unchanged in the alginate gel group.

Conclusions: While reducing adhesion formation, ultrapure alginate gel does not interfere with the development of colonic anastomotic strength during the crucial early healing period.

Keywords: Abdominal adhesion; Colon anastomosis; HA/CMC; Ultrapure alginate gel.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdominal Abscess / prevention & control
  • Alginates / pharmacology*
  • Anastomosis, Surgical
  • Animals
  • Biocompatible Materials / pharmacology*
  • Collagen / metabolism
  • Colon / metabolism
  • Colon / surgery*
  • Disease Models, Animal
  • Gels
  • Glucuronic Acid / pharmacology
  • Hexuronic Acids / pharmacology
  • Hydroxyproline / metabolism
  • Male
  • Postoperative Period
  • Pressure
  • Random Allocation
  • Rats, Wistar
  • Tissue Adhesions / prevention & control*
  • Wound Healing / drug effects*

Substances

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