Peritoneal Adhesion is a severe case that frequently occurs in patients after laparotomy surgery. Adhesions are pathological attachment that usually appears between the omentum, intestine, and abdominal wall. Several barriers are made to prevent adhesions, including liquid barriers such as sodium hyaluronate and carboxymethyl cellulose (CMC) but are fast absorbed-time hydrogel. The solid barrier has weakness of difficulty in covering all parts of the wound surface. The study aims to synthesize degradable hydrogel from N,O-Carboxymethyl Chitosan (NOCC), Aldehyde-Hyaluronic Acid, and the addition of Allium sativum (garlic oil). The best sample with the concentration of A-HA/NOCC 30 : 10 g/ml was obtained. The composite hydrogel of NOCC/AHA/Allium sativum has susceptible antimicrobial properties. In vitro cytotoxicity assay showed that hydrogel is nontoxic. The degradation time is for two weeks. The in vivo evaluation in a mouse model with an abrasion defect side was done to identify the effectiveness of the NOCC/AHA/A. sativum as antiperitoneal adhesion. Seven days after surgery, the observation of adhesion was performed. Based on all assay results, it can be resumed that the NOCC/AHA/A. sativum hydrogel possibly acts as an innovation to prevent postoperative intraperitoneal adhesion.
Intraperitoneal adhesion is a serious case that often occurs with a prevalence of 90-97 % after undergoing gynecological surgery and laparotomy. This study aims are to characterized the hydrogel and identified the optimal composition of Hyaluronic acid (HA) - N, O-carboxymethyl chitosan (NOCC) as an anti-adhesion biomaterial barrier. The synthesis method involved firstly the synthesis of aldehyde derivative of hyaluronic acid (AHA) and also the conversion of chitosan into its derivative, N,O-carboxymethyl chitosan. These two compounds were mixed in various compositions and crosslinked to form N, O-carboxymethyl chitosan (NOCC) /AHA. Fourier-transform infrared spectroscopy has confirmed that the functional groups found -C = O stretching at 1644 cm-1 indicating the hyaluronic acid and carboxymethyl group (-CH2COOH) in 1380 cm-1 which indicate the presence of chitosan. The crosslink is evidenced by the group C = N stretching at a wavenumber of about 1630 cm-1. The best composition of intraperitoneal anti-adhesion is the ratio of hyaluronic acid: chitosan at 30:10 mg/ml. The swelling test is showed a swelling ratio of around 211.8 % in accordance with the standard as intraperitoneal anti-adhesion. Hydrogel has a degradation rate up to 86.87 % on day 10, and this is in accordance with the standard as intraperitoneal anti-adhesion. Cytotoxicity assay showed that hydrogel was nontoxic with a percentage of 92.9 % cell viability. The newly developed hyaluronic acid-carboxymethyl chitosan has characteristics that conform to the criteria of an intraperitoneal anti-adhesion.
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