Adhesion reformation and the limited translational value of experiments with adhesion barriers: A systematic review and meta-analysis of animal models

Strik, Chema; Wever, Kimberley E.; Stommel, Martijn W J; Goor, Harry van; Broek, Richard P. G. ten

doi:10.1038/s41598-019-52457-2

Cited by 20 publications

(24 citation statements)

References 37 publications

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“…Recent systematic review and meta‐analysis of animal models by Strik et al. [ 234 ] reported that 57% and 36% of all the studies used a cecal abrasion model and uterine horn model, respectively. The details of surgical techniques of the cecal abrasion models have plenty of variety.…”

Section: Animal Modelsmentioning

confidence: 99%

Advancement of Biomaterial‐Based Postoperative Adhesion Barriers

Chandel

Shimizu

Hasegawa

et al. 2021

Macromolecular Bioscience

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Postoperative peritoneal adhesion (PPA) is a prevalent incidence that generally happens during the healing process of traumatized tissues. It causes multiple severe complications such as intestinal obstruction, chronic abdominal pain, and female infertility. To prevent PPA, several antiadhesion materials and drug delivery systems composed of biomaterials are used clinically, and clinical antiadhesive is one of the important applications nowadays. In addition to several commercially available materials, like film, spray, injectable hydrogel, powder, or solution type have been energetically studied based on natural and synthetic biomaterials such as alginate, hyaluronan, cellulose, starch, chondroitin sulfate, polyethylene glycol, polylactic acid, etc. Moreover, many kinds of animal adhesion models, such as cecum abrasion models and unitary horn models, are developed to evaluate new materials’ efficacy. A new animal adhesion model based on hepatectomy and conventional animal adhesion models is recently developed and a new adhesion barrier by this new model is also developed. In summary, many kinds of materials and animal models are studied; thus, it is quite important to overview this field's current progress. Here, PPA is reviewed in terms of the species of biomaterials and animal models and several problems to be solved to develop better antiadhesion materials in the future are discussed.

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Section: Animal Modelsmentioning

confidence: 99%

Advancement of Biomaterial‐Based Postoperative Adhesion Barriers

Chandel

Shimizu

Hasegawa

et al. 2021

Macromolecular Bioscience

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“…72 In terms of incidence of adhesion reformation and adhesion score, both the laparoscopic and open approach reported similar outcomes. 73 Patient selection for LAL is essential, and "conversion is not a crime." 74 The Bologna guidelines recommend LAL in stable patients with no signs of diffuse peritonitis or perforation, and caution advised in patients with grossly distended bowel loops or multiple complex adhesions, as this can increase the risk of enterotomy.…”

Section: Surgical Managementmentioning

confidence: 99%

“…95 A systematic review of 93 studies reported that Seprafilm, icodextrin, and polyethylene glycol reduced the adhesion score of reformed adhesions, but none of the current commercially available adhesion barriers reduced the incidence of adhesion reformation in animal models. 73 Studies involving newer adhesion barriers such as novel dextrin hydrogel (AdSpray, Italy) reported reduced incidence 96 and severity of adhesions. 97 Starch-based formulation 4DryField PH (UK) also showed its utility in reducing adhesion severity, the extent of reoperations, 98 and adhesion prevention.…”

Section: Mechanical Barriersmentioning

confidence: 99%

“…However, a meta‐analysis found no significant differences in rates of intraoperative injury to the bowel, wound infection, or mortality 72 . In terms of incidence of adhesion reformation and adhesion score, both the laparoscopic and open approach reported similar outcomes 73 74 The Bologna guidelines recommend LAL in stable patients with no signs of diffuse peritonitis or perforation, and caution advised in patients with grossly distended bowel loops or multiple complex adhesions, as this can increase the risk of enterotomy 36 …”

Section: Managementmentioning

confidence: 99%

“…An increase in the local expression of growth factors and antifibrinolytic factors reduces the efficacy of adhesion barriers 95 . A systematic review of 93 studies reported that Seprafilm, icodextrin, and polyethylene glycol reduced the adhesion score of reformed adhesions, but none of the current commercially available adhesion barriers reduced the incidence of adhesion reformation in animal models 73 …”

Section: Prevention Of Abdominal Adhesionsmentioning

confidence: 99%

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Adhesive small bowel obstruction – an update

Tong

Lingam

Shelat

2020

Acute Medicine & Surgery

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Small bowel obstruction (SBO) accounts for 12–16% of emergency surgical admissions and 20% of emergency surgical procedures. Even with the advent of laparoscopic surgery, intra‐abdominal adhesions remain a significant cause of SBO, accounting for 65% of cases. History and physical examination are essential to identify signs of bowel ischemia as this indicates a need for urgent surgical exploration. Another critical aspect of evaluation includes establishing the underlying cause for obstruction and distinguishing between adhesive and non‐adhesive etiologies as adhesive SBO (ASBO) can be managed non‐operatively in 70–90% of patients. A patient with a history of abdominopelvic surgery along with one or more cardinal features of obstruction should be suspected to have ASBO until proven otherwise. Triad of severe pain, pain out of proportion to the clinical findings, and presence of an abdominal scar suggest possible closed‐loop obstruction. Computed tomography has higher sensitivity and specificity compared to plain films and is recommended by the Bologna guidelines. Correcting fluid and electrolyte imbalance is an initial crucial step to mitigate severe hypovolemia. Patients should proceed with surgery if symptoms of bowel compromise are present, or if symptoms do not resolve or have worsened. Surgery is indicated in patients with ischemia, strangulation, perforation, peritonitis, or failure of non‐operative treatment. With advances in minimal access technology and increasing experience, laparoscopic adhesiolysis is recommended. Mechanical adhesion barriers are an effective measure to prevent adhesion formation.

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Stable and Efficient Animal Models of the Peritoneal Adhesion

Zhou

Zhang

Chen

et al. 2023

Advanced Therapeutics

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Peritoneal adhesion (PA) is a widespread complication of surgery arising from physiological problems. Various therapies and medicines for anti‐PA have been studied but lack unified and standard PA models. Various experimental techniques are applied to establish and investigate reliable models for inducing PA in pigs and rats. This study utilizes four scoring systems to evaluate the severity of adhesions. In pigs, U‐shape incision, L‐shape incision, ileum resection, cecum abrasion & peritoneum abrasion, and cecum purse‐string & peritoneum abrasion models are established, to assess the impact of laparotomy incision and double opposed wound on adhesion formation. For rat models, the exposed double opposed wound models are created, including peritoneum resection & cecum abrasion, peritoneum abrasion & cecum abrasion, two knots & cecum abrasion, and four knots & cecum abrasion models, to explore the influence of double opposed wounds and foreign materials. The findings suggest that the peritoneum resection & cecum abrasion model is a reliable and reproducible PA model, as it exhibits a high adhesion rate and consistent adhesion scores across all evaluation approaches. The utilization of the double‐opposed wound model and evaluation systems contributes to more scientifically rigorous and efficient preclinical evaluations of various anti‐adhesion agents.

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Adhesion reformation and the limited translational value of experiments with adhesion barriers: A systematic review and meta-analysis of animal models

Cited by 20 publications

References 37 publications

Advancement of Biomaterial‐Based Postoperative Adhesion Barriers

Advancement of Biomaterial‐Based Postoperative Adhesion Barriers

Adhesive small bowel obstruction – an update

Stable and Efficient Animal Models of the Peritoneal Adhesion

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