Prevention of peritoneal adhesion using a bacterial cellulose hydrogel, in experimental study.

Ana Paula Guimarães Barbosa,Flávia Crisina Morone Pinto,Arinaldo Vasconcelos Alencar,Laura Olinda Bregieiro Fernandes Costa,Elísio Rodrigues Coelho Junior,José Lamartine De Andrade Aguiar

doi:10.1590/s0102-865020150030000005

Abstract

To analyze the effectiveness of bacterial cellulose hydrogel as a barrier in preventing postoperative peritoneal adhesion in rat model. Experimental study with 45 Wistar rats (Rattus norvegicus) that were divided into three groups for the following treatments: A. Saline, B. Oxidized Regenerated Cellulose (ORC) barrier, and C Bacterial Cellulose Hydrogel (BCH) barrier. After 45 days of the surgery the adhesions were classified and graded according to the qualitative score. The histological parameters were evaluated using a modified semi-quantitative scale to rate the extent of fibrosis, inflammatory reaction and vascular proliferation. Compared with the saline group (A), the treatments with ORC barrier (B) and BHC barrier (C) resulted in a smaller number of adhesions (p=0.019 and p=0.003 on Fisher's exact test, respectively). Data from inflammation and neovascularization showed no statistically significant difference between the groups BHC and ORC (p=0.426 and 0.446 on chi-square test, respectively). Bacterial cellulose hydrogel is effective as a bio-re-absorbable barrier for preventing postoperative peritoneal adhesions.

Highlights

Adhesions are a frequent postoperative complication that may result in small-bowel obstruction, infertility, chronic abdominal pain, and high risk of complications in a second operation
The number of animals with adhesion, severity of adhesion and absolute cross-sectional areas of adhesions were evaluated in groups A - Saline, B - oxidized regenerated cellulose (ORC) and C – bacterial cellulose hydrogel (BCH)
ORC is the anti-adhesion barrier that has been used for a long time in randomized clinical trials as the product that reduces the degree of adhesion severity

Summary

Introduction

Adhesions are a frequent postoperative complication that may result in small-bowel obstruction, infertility, chronic abdominal pain, and high risk of complications in a second operation. The formation of adhesions continues to pose a challenge and is a major cause of morbidity and mortality rates[1]. Both general surgeons and gynecologists[2] are involved in increasing knowledge of the pathophysiology and the study of new mechanisms of adhesion prevention. We used a bacterial cellulose hydrogel (BCH), 0.8% cellulose in 99.2% water as a mechanical barrier. This bacterial cellulose[5] has been previously used with satisfactory results in various areas of experimental surgery such as in the scarring of cutaneous wounds[6] dressing used after hypospadias surgery[7], as well as in the grafting used in vascular surgery[8,9]. The biocompatibility of the bacterial cellulose suggests that it does not induce inflammatory reaction and might be used as a sealant to prevent adhesions following gynecological and abdominal surgery

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