Evaluation of Amniotic Membrane as Adhesion Prophylaxis in a Novel Surgical Gastroschisis Model

Abstract

Adhesions are a leading cause of bowel obstruction and infertility. The coverage of peritoneal defects, as in gastroschisis, is still a crucial problem. Despite biodegradable substitutes and synthetic implants such as PTFE membrane, a satisfactory replacement for gastroschisis has not been identified. The amniotic membrane, which is available at birth with a low antigenicity, was evaluated as a peritoneal substitute. Viable, partially viable, and inversed-used amniotic membranes were compared in a rat model. A full-thickness abdominal wall defect was made and the amniotic membrane sutured into this defect. The skin was closed over the amniotic membrane. Reoperation was performed 3 weeks after initial surgery, and the adhesion formation was measured by computerized area calculation. Viable amniotic membrane showed 0 to 3% area adhesion formation, while partially viable (50%) amniotic membrane demonstrated 33% area adhesion formation. Inversed-used amniotic membrane, with the stromal side directed toward the abdominal cavity, showed 70% of the amniotic membrane area to be covered with adhesions. The same amount was found in the control group, in which no substitute was sutured into the defect. This animal model is suitable for the straightforward evaluation of peritoneal substitutes with regard to adhesion formation. It is easy to perform and mimics surgical needs. Viable amniotic membrane proved to be an excellent antiadhesive tissue.

The influence of various storage conditions on cell viability in amniotic membrane

“…Nowadays, in addition to the use in ophthalmology, amnion is widely applied in surgery and wound treatment e.g. for burned skin, bedsore, ulcers (Faulk et al 1980;Subrahmanyam 1995;Gruss and Jirsch 1978;Ward et al 1989;Gajiwala and Gajiwala 2004), reconstruction of artificial vagina (Burger 1937;Dhall 1984;Nisolle and Donnez 1992), in head and neck surgery (Zohar et al 1987) as well as to prevent tissue adhesion in surgical procedures of the abdomen, head and pelvis (Rennekampff et al 1994;Arora et al 1994;Young et al 1991).…”

Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions

“…It has been used to treat variable diseases such as non-healing skin ulcers, vaginal atresia, and severe ocular surface disease [9,35]. Moreover, it can serve as adjunctive tissue to reduce surgical adhesions in abdominal surgery and otolaryngologic surgery [25,29,36]. Furthermore, AM is an immuneprivileged tissue and rarely causes immunologic rejection [15].…”

Evaluation of Seprafilm and Amniotic Membrane as Adhesion Prophylaxis in Mesh Repair of Abdominal Wall Hernia in Rats

“…Szabo/Haj/Waxsman/Eitan most of these materials and techniques have major limitations, some promising results have been reported with physical barriers, such as HAM [6] and carboxymethylcellulose and hyaluronic acid (Seprafilm) [7,8].…”

“…Should abdominal surgery be needed after hernia repair with mesh, the surgeon will face enormous difficulties to release the adhesions safely and to perform the planned operation. Physical barriers, namely human amniotic membrane (HAM) and Seprafilm, have been reported to prevent intra-abdominal adhesions [6][7][8].…”