Does Human Amnion Membrane Prevent Postoperative Abdominal Adhesions?

Abstract

Background Adhesions are bands of tissue that form postoperatively after intra-abdominal surgery. Adhesions cause significant morbidity and despite ongoing research no agent or method has been shown to completely prevent adhesions. Human amnion-derived matrix is a complex tissue matrix derived from human placenta and has been used in other areas of surgery to promote healing and decrease scar tissue formation. Our hypothesis was that aerosolized human amnion-derived matrix particulate solution (HAMPS) applied during abdominal surgery would decrease adhesion formation in rats. Methods Twenty-four Sprague-Dawley rats were divided into 4 different groups. Group 1 was the control group (CG) which had cecal abrasion 20× with a surgical rasp to generate the adhesion model. Groups 2-4 were the treatment groups (TGs) and had cecal abrasion plus application of the HAMPS at concentrations of 6.25, 12.5, and 25 mg/cc, respectively. After 30 days, rats were euthanized and adhesion assessment performed. Results In all groups there were minimal adhesions noted at necropsy. Moderate inflammation was 33% in CG versus 11% in combined TGs. Average adhesion was 1.00 in CG versus 0.44 in combined TGs. This indicated an observational improvement in adhesions/inflammation in the TGs, although this did not reach statistical significance. There was a trend toward significance in the 12.5 mg/cc group alone ( P = .054). Conclusion Overall, HAMPS showed an observational decrease in adhesions in TGs although not statistically significant. There was a trend toward significance in the 12.5 mg group. Additional studies will have to be performed to further evaluate this subgroup.

Photosealed Neurorrhaphy Using Autologous Tissue

“…Amnion is a thin (~30 µm) membrane that can be easily wrapped around the peripheral nerve repair site, and its transparency allows the activating green light to penetrate through the amnion to the epineural-amnion interface [31,32] for efficient crosslinking. Additionally, amnion contains many growth factors that assist in wound healing and tissue regeneration [33] and has been used in a wide range of tissue repair models [34][35][36][37][38][39]. Many commercial nerve wraps do not possess the above characteristics that are essential for a photosealed wrap.…”

Effects of stem cells and amniotic fluid on uterus and ovaries in a rat model of abdominal adhesions: a controlled study

“…Studies to prevent intra-abdominal adhesions after surgery have been ongoing since the beginning of the last century ( 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ). Considering the significant postoperative complications caused by adhesions, such as second surgery, ileus, pain, intraoperative complications in further surgeries, and infertility, initiating an effective treatment is clinically available ( 1 ).…”

“…The regenerative characteristics of hUCMSCs and AF play a significant role in treating and preventing adhesions. Additionally, several animal studies utilising AFSCs have been published ( 33 , 34 , 35 , 41 ). However, adult stem cells have a limited capacity for regeneration, and foetal stem cells may be ethically unacceptable.…”

“…In a study by Canbaz et al ( 18 ) in a rat model, gonadotropin-releasing hormone agonist therapy successfully reduced postoperative adhesion formation but was not superior to intraperitoneal Ringer’s lactate solution. An increasing number of studies ( 19 ) have researched the adhesion prevention capability of various barrier agents ( 20 , 21 , 22 , 23 ), various combination gels ( 24 , 25 , 26 , 27 , 28 , 29 ), biomaterials ( 30 ), growth factor inhibitors ( 31 , 32 ), and stem cells ( 33 , 34 , 35 ), which is evidence of the importance of adhesion-related problems.…”