Background: The aim of this study was to compare the anti-adhesion efficacy of a biodegradable, in situ, macromolecular cross-linking hydrogel made from oxidized dextran/N-carboxyethyl chitosan (Odex/CEC) with a commercially available carboxymethylcellulose/modified hyaluronan barrier film (Seprafilm; Genzyme Corporation, Cambridge, MA) in a rat cecum abrasion model. Methods: The rat model utilized a cecal abrasion and abdominal wall insult surgical protocol. The 2% Odex/CEC hydrogel treatment was applied by syringe to coat both the cecal and the abdominal wall insults, while other animals were treated with Seprafilm applied to the cecal injury only. Control animals did not receive any treatment. Animals were sacrificed after post operative day 21 and adhesion severity was quantitatively graded using a whole number scale from 0 - 3. Histological analysis was also performed for animals receiving Odex/CEC hydrogel treatment and no treatment (control). Results: Mean adhesion score was 2.09 ± 1.22 for control animals, 1.00 ± 1.00 for 2% Odex/CEC hydrogel animals, and 1.25 ± 1.22 for Seprafilm animals. Hydrogel treated animals showed significantly lower adhesion scores than control animals (P < 0.05), while Seprafilm demonstrated a marginally lower adhesion score (P < 0.1) compared with the controls. Histological analysis of an Odex/CEC treated rat showed tissue repair and small fragments of hydrogel inside both healed abdominal and cecal surfaces. Conclusions: Both Seprafilm and the 2% Odex/CEC hydrogel showed a significantly decreased adhesion score compared with the control. However, the hydrogel, compared with Seprafilm, offers ease of application and ability to conform to complex tissue geometries that could provide surgeons with another prophylactic treatment to prevent abdominal adhesions.
Bibliographical noteFunding Information:
This research was supported by a grant from the New York State Foundation of Science, Technology and Innovation (NYSTAR) administered through the Center for Biotechnology of the State University of New York-Stony Brook. Partial support was also provided by the National Institutes of Health (DK068401). We also gratefully acknowledge the assistance of Wei Zhu, Ph.D., with the data and statistical analysis and Sharon Liang, M.D., Ph.D., for her expertise and assessment of the histological slides.
- post surgical adhesion