Abstract
Serosal membranes cover body cavities and guarantee frictionless gliding of inner organs. Serosal damage carries the risk of adhesion formation, which represents a relevant postoperative complication. Due to pathophysiological similarities between serous and dermal wound healing, the efficacy of SupraSeal® in intraabdominal adhesion prevention was investigated at early time points. After standardized serosal damage, Wistar rats were examined macroscopically, histologically and immunohistochemically on days two, four and eight postoperatively. On day eight, all specimens of the control group presented distinctive adhesions consisting of fibrous tissue bands. In contrast, most specimens covered by SupraSeal® were adhesion-free. Merely mild adhesion formation due to suture material used for fixation was detected. Histologically, SupraSeal® revealed rapid clearance of fibrin and a marked lack of fibrosis. For the first time, the histomorphological effects of SupraSeal® on adhesion formation over time are described and the relevance of the early stage of wound healing elucidated.
Highlights
Intraperitoneal adhesions are bands of connective tissue which originate from the peritoneum after serosal damage due to trauma, surgical intervention and inflammation [1]
The histomorphological time course of the early tissue reaction to an absorbable barrier membrane based on a copolymer of D,L-polylactide, trimethylene carbonate and caprolactone, was examined in comparison to an untreated control in an animal model of peritoneal adhesion formation
The macroscopical findings of this study, with adhesion formation to a significantly lesser extent due to the implantation of Supra Seal® compared to the untreated control group, are in line with former animal studies from our group [8,9]
Summary
Intraperitoneal adhesions are bands of connective tissue which originate from the peritoneum after serosal damage due to trauma, surgical intervention and inflammation [1]. A multistep process lead to the development of this organised tissue with collagen fibre deposition, vascular and nerve fibre in growth. These tissue bands cause adherence between intraperitoneal organs or between the viscera and the abdominal wall [2,3]. Postoperative adhesion formation represents a relevant problem since they present a common complication in gynaecological and abdominal surgery [3,4,5]. Despite the developments during the last few years in reducing trauma by minimally invasive surgical procedures, postoperative adhesions are still responsible for increased postoperative morbidity and they still represent a significant problem in interventional medicine [10,11,12,13]
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