Safety and Efficacy of Alginate Adhesion Barrier Gel in Compromised Intestinal Anastomosis

Surg Infect (Larchmt). 2017 Aug/Sep;18(6):670-675. doi: 10.1089/sur.2016.086. Epub 2017 Jun 5.

Abstract

Background: For any anti-adhesive barrier developed for abdominal surgery, the use under conditions in which anastomotic healing is compromised needs to be investigated. The current study evaluates the effect of a new ultrapure alginate gel on early healing of high-risk anastomoses in the ileum and compares this with the gold standard used in clinical practice.

Materials and methods: In 75 adult male Wistar rats, a 5 mm ileal segment was resected and continuity was restored by construction of an inverted anastomosis. Rats were divided randomly into a control group and groups receiving either alginate gel or a sodium hyaluronate carboxymethylcellulose (HA/CMC) film around the anastomosis (n = 25 each). Carprofen, given in a daily dose of 1.25 mg/kg, was used to compromise anastomotic healing. At day three, animals were killed and scored for signs of anastomotic leakage and the presence of adhesions.

Results: The incidence of adhesion formation was 95% in the HA/CMC film group, which was significantly higher than in the controls (64%, p = 0.010) and the alginate gel group (52%, p = 0.004). The adhesion score was nearly 40% lower in the alginate gel group compared with the HA/CMC film group. The incidence of ileal leakage in the HA/CMC film group (92%) was significantly higher than in the controls (68%, p = 0.016). Leakage rate did not differ between the alginate gel and control groups. There was no significant difference between groups in either incision bursting pressure or incision breaking strength.

Conclusion: Ultrapure alginate gel does not interfere with repair of ileal anastomoses constructed under conditions in which chances of anastomotic dehiscence are high. The alginate gel performs better than the HA/CMC film.

Keywords: adhesion; anastomotic leak; ileum; sodium hyaluronate carboxymethylcellulose; ultrapure alginate gel.

MeSH terms

  • Alginates / pharmacology*
  • Alginates / therapeutic use*
  • Anastomosis, Surgical / adverse effects
  • Anastomosis, Surgical / methods*
  • Anastomotic Leak
  • Animals
  • Carboxymethylcellulose Sodium
  • Glucuronic Acid / pharmacology
  • Glucuronic Acid / therapeutic use
  • Hexuronic Acids / pharmacology
  • Hexuronic Acids / therapeutic use
  • Hyaluronic Acid
  • Ileum / drug effects*
  • Ileum / surgery
  • Male
  • Peritonitis / drug therapy
  • Peritonitis / prevention & control
  • Random Allocation
  • Rats
  • Rats, Wistar
  • Tissue Adhesions / drug therapy*
  • Tissue Adhesions / prevention & control*

Substances

  • Alginates
  • Hexuronic Acids
  • Glucuronic Acid
  • Hyaluronic Acid
  • Carboxymethylcellulose Sodium