Evaluation of 4DryField® PH as Adhesion Prevention Barrier Tested in an Optimized Adhesion Model in Rats

Abstract

Background: Adhesions due to pelvic/abdominal surgery are a common serious pathology possibly entailing severe complications. This study investigates the adhesion prevention capability of the novel starch-based agent 4DryField® PH, which together with saline solution forms a barrier gel. Herein, an optimized adhesion model (OPAM) inducing severe adhesions/agglutinations with high reproducibility was used. Methods: In 19 Lewis rats, a 1 × 2 cm abdominal wall defect was created, the peritoneum of the neighboring cecum was abraded, and both injured areas were approximated by suture. Rats were randomized to control (n = 10) or 4DryField PH treatment (n = 9) groups. Another 8 rats had sham surgery for safety assessment of 4DryField PH. At day 7, the quantity and quality of adhesions were assessed macro-/microscopically and evaluated statistically. Results: 4DryField PH treatment significantly reduced the incidence and severity of adhesions as verified by significantly improved adhesion scorings (0.4 vs. 4.5; 1.1 vs. 9). Histology revealed reconstitution of the cecum and abdominal wall including regeneration of the visceral/parietal peritoneum. In sham-operated rats, 4DryField PH did not induce adhesion formation. Conclusions: 4DryField PH gel was highly effective in preventing adhesions. Histologically, the injured cecum and abdominal wall regenerated well in the presence of 4DryField PH. Considering the severity of OPAM trauma, the potential of 4DryField PH to prevent adhesions can be rated excellent.

Effect of Emodin on Preventing Postoperative Intra‐Abdominal Adhesion Formation

“…The process of peritoneal healing plays an important role in postoperative abdominal adhesion formation. If the peritoneal cells can repair the locally injured peritoneal area in time, then, adhesion formation will be reduced [ 6 ]. Cytokeratin-18 is a specific marker for mesothelial cells [ 40 ].…”

“…Peritoneal adhesions can cause various problems, such as small-bowel obstruction, female infertility, chronic abdominal pain, and increased difficulty during reoperation, all of which greatly influence quality of life and increase medical costs [ 3 – 5 ]. The strategies to treat and prevent adhesions can be divided into four categories: general principles, surgical techniques, chemical agents, and mechanical barriers [ 6 , 7 ]. Although several methods have been applied to prevent adhesion formation, a “gold standard” for treatment has not been determined yet, and surgeons still need to seek more effective methods to prevent and treat postoperative abdominal adhesions [ 8 ].…”

Therapeutic alternatives for the prevention of intra peritoneal adhesions

“…In addition to its properties and biocompatibility, its practical application makes them interesting options to develop. [11][12][13][14][15] In 2017 Zhang E et al, used a biodegradable and thermosensitive gel of modified galactose and xyloglucan (mXG) which was evaluated as a physical barrier device for the prevention of post-operative adhesions. For the group with hydrogel (n = 16), 1ml at 4% (w/v) of mXG solution was applied to the injured areas and the gelation of this occurred in situ in 3 minutes.…”

“…11 On the other hand, in 2015, Poehnert D, et al, used the 4DryField gel in his experimental study. 13 In the experimental group, 300 mg of 4DryField PH gel (5grams of 4DryField in 20 ml of 0.9% sodium chloride solution) were applied to the injured areas. After 7 days the animals were sacrificed, and a second laparotomy was performed to evaluate the results.…”

“…The remaining 7 animals treated with 4DryField PH were free of adhesions, resulting in an overall mean Lauder score of 0,4. 13 Electrospinning is a technique widely used in tissue engineering, to manufacture membranes or scaffolds with nanometric fibers for biomedical application. Currently biocompatible membranes are being developed using these techniques.…”