Two natural materials found to reduce adhesion formation in a rat uterine horn model

Abstract

Background/Aim: Post-operative pelvic adhesions cause various problems in patients, pose surgical difficulties to clinicians, and an increase in health costs. We compared the effectiveness of two natural materials, Trehalose (TRZ), Human Amnion Fluid (HAF), with oxidized regenerated cellulose (ORC) in terms of adhesion prevention after gynecological operations. Methods: In this controlled experimental study, twenty-four female Wistar Hannover rats were divided into four groups: Control, TRZ, HAF, and ORC. The control group received medication used for the surgical procedure only. 3% TRZ, cell-free HAF, and 1 cm2 ORC (interceed®) were laid on the tissue on the antimesenteric side of each uterine horn damaged with a 10-Watt bipolar cautery. Adhesions were scored 30 days after the first surgical procedure. Results: The extent, severity, degree, total adhesion, inflammation, and fibrosis scores of the control group were significantly higher than those of the TRZ and HAF groups (P<0.05 for each). There was no significant difference between the Control and ORC groups in terms of inflammation (P=0.055), but all other parameters were significantly higher in the control group compared to the ORC group (P<0.05). The TRZ group had lower total adhesion scores (P=0.019) and histopathological scores (P=0.015, P=0.001) than the ORC group. Conclusions: TRZ and HAF may be useful in preventing pelvic adhesions.

Keywords

• Adhesions
• human amnion fluid
• interceed
• oxidised regenerated cellulose
• trehalose

References

1. 1. Monk BJ, Berman ML, Montz F. Adhesions after extensive gynecologic surgery: clinical significance, etiology, and prevention. Am J Obstet Gynecol. 1994;170:1396-403.
2. 2. Liakakos T, Thomakos N, Fine PM, Dervenis C, Young RL. Peritoneal adhesions: etiology, pathophysiology, and clinical significance. Dig Surg. 2001;18:260-73.
3. 3. Ellis H. The clinical significance of adhesions: focus on intestinal obstruction. The European journal of surgery Supplement:= Acta chirurgica Supplement. 1997:5.
4. 4. Mutsaers SE, Wilkosz S. Structure and function of mesothelial cells. Peritoneal Carcinomatosis: Springer; 2007. p. 1-19.
5. 5. Schnüriger B, Barmparas G, Branco BC, Lustenberger T, Inaba K, Demetriades D. Prevention of postoperative peritoneal adhesions: a review of the literature. The American Journal of Surgery. 2011;201:111-21.
6. 6. Çim N, Elçi E, Elçi GG, Almalı N, Yıldızhan R. Are the skin scar characteristics and closure of the parietal peritoneum associated with pelvic adhesions? Turkish journal of obstetrics and gynecology. 2018;15:28.
7. 7. Holmdahl L, Eriksson E, Eriksson BI, Risberg B. Depression of peritoneal fibrinolysis during operation is a local response to trauma. Surgery. 1998;123:539-44.
8. 8. Medicine PCotASfR. Control and prevention of peritoneal adhesions in gynecologic surgery. Fertil Steril. 2006;86:S1-S5.

9. 9. Li J, Feng X, Liu B, Yu Y, Sun L, Liu T, et al. Polymer materials for prevention of postoperative adhesion. Acta Biomater. 2017; 61:21-40.
10. 10. Zhang Y, Liu Q, Yang N, Zhang X. Hyaluronic acid and oxidized regenerated cellulose prevent adhesion reformation after adhesiolysis in rat models. Drug Des Devel Ther. 2016; 10:3501.
11. 11. Collins J, Robinson C, Danhof H, Knetsch C, Van Leeuwen H, Lawley T, et al. Dietary trehalose enhances virulence of epidemic Clostridium difficile. Nature. 2018; 553:291-4.
12. 12. Chou L-F, Cheng Y-L, Hsieh C-Y, Lin C-Y, Yang H-Y, Chen Y-C, et al. Effect of trehalose supplementation on autophagy and cystogenesis in a mouse model of polycystic kidney disease. Nutrients. 2019; 11:42.
13. 13. Wu N, Chen L, Yan D, Zhou M, Shao C, Lu Y, et al. Trehalose attenuates TGF‑β1‑induced fibrosis of hSCFs by activating autophagy. Mol Cell Biochem. 2020.
14. 14. Fujino H, Lee S, Suzuki S, Chung U-i, Mochizuki M, Nishimura R, et al. Trehalose may prevent postsurgical adhesions in a rabbit model of hysterotomy. J Vet Med Sci. 2011:1102030454-.
15. 15. Sciarretta S, Yee D, Nagarajan N, Bianchi F, Saito T, Valenti V, et al. Trehalose-induced activation of autophagy improves cardiac remodeling after myocardial infarction. J Am Coll Cardiol. 2018; 71:1999-2010.
16. 16. Koh S, Anandakumar C, Arulkumaran S, Chua S, Yuen W, Ng B, et al. Amniotic fluid plasminogen activators and inhibitors and TAT-complex levels during 2nd trimester pregnancy and labour. Fibrinolysis. 1995; 9:121-6.
17. 17. Longaker MT, Adzick NS, Hall JL, Stair SE, Crombleholme TM, Duncan BW, et al. Studies in fetal wound healing, VII. Fetal wound healing may be modulated by hyaluronic acid stimulating activity in amniotic fluid. J Pediatr Surg. 1990; 25:430-3.
18. 18. Tahmasebi S, Tahamtan M, Tahamtan Y. Prevention by rat amniotic fluid of adhesions after laparatomy in a rat model. International Journal of Surgery. 2012; 10:16-9.
19. 19. Kerimoğlu S, Livaoğlu M, Sönmez B, Yuluğ E, Aynacı O, Topbas M, et al. Effects of human amniotic fluid on fracture healing in rat tibia. J Surg Res. 2009; 152:281-7.
20. 20. Özgenel GY, Fílíz G. Combined application of human amniotic membrane wrapping and hyaluronic acid injection in epineurectomized rat sciatic nerve. J Reconstr Microsurg. 2004; 20:153-7.
21. 21. Kaya C, Sever N, Cengiz H, Yıldız Ş, Ekin M, Yaşar L. A randomized controlled study of the efficacy of misoprostol and hyaluronic acid in preventing adhesion formation after gynecological surgery: a rat uterine horn model. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2014; 176:44-9.
22. 22. Kelekci S, Uygur D, Yilmaz B, Sut N, Yesildaglar N. Comparison of human amniotic membrane and hyaluronate/carboxymethylcellulose membrane for prevention of adhesion formation in rats. Arch Gynecol Obstet. 2007; 276:355-9.
23. 23. Güney G, Kaya C, Oto G, Yıldırım S, Özdemir H, Tokmak A. Effects of quercetin and surgicel for preventing adhesions after gynecological surgery: A rat uterine horn model. J Obstet Gynaecol Res. 2017; 43:179-84.
24. 24. Esmaeili A, Abbasian B, Kazemini H, Adibi S. Effect of bovine amniotic fluid on intra-abdominal adhesion in male rats. International Journal of Surgery. 2010; 8:639-42.
25. 25. Ohata A, Tamura N, Iwata K, Abe N, Doi K, Saito Y, et al. Trehalose solution protects mesothelium and reduces bowel adhesions. J Surg Res. 2014;191:224-30.
26. 26. Leach RE, Burns JW, Dawe EJ, SmithBarbour MD, Diamond MP. Reduction of postsurgical adhesion formation in the rabbit uterine horn model with use of hyaluronate/carboxymethylcellulose gel. Fertil Steril. 1998;69:415-8.
27. 27. Hooker GD, Taylor BM, Driman DK. Prevention of adhesion formation with use of sodium hyaluronate–based bioresorbable membrane in a rat model of ventral hernia repair with polypropylene mesh—A randomized, controlled study. Surgery. 1999;125:211-6.
28. 28. Ray NF, Denton WG, Henderson SC, Seymour Perry M. Abdominal adhesiolysis: inpatient care and expenditures in the United States in 1994. J Am Coll Surg. 1998;186:1-9.
29. 29. Takagi K, Araki M, Fukuoka H, Takeshita H, Hidaka S, Nanashima A, et al. Novel powdered anti-adhesion material: preventing postoperative intra-abdominal adhesions in a rat model. Int J Med Sci. 2013;10:467.
30. 30. Tanaka K, Kawamura M, Otake K, Toiyama Y, Okugawa Y, Inoue Y, et al. Trehalose does not affect the functions of human neutrophils in vitro. Surg Today. 2014;44:332-9.
31. 31. Lee SJ, Miwa, Y., Nishimura, R., Chung, U. I., Suzuki, S. and Sasaki, N. Effects of trehalose and sodium carboxymethyl cellulose on prevention of organ adhesion after laparotomy: A preliminary study. Jpn J Vet Anesth Surg. 2009;40:19-26.
32. 32. Dahl L, Kimpton W, Cahill R, Brown T, Fraser R. The origin and fate of hyaluronan in amniotic fluid. J Dev Physiol. 1989;12:209-18.
33. 33. Durmus AS, Han, M. C. . Effect of bovine amniotic fluid on intra abdominal adhesions. Indian Vet J. 2006;83:621-3.
34. 34. Golan A, Stolik O, Wexler S, Niv D, Ber A, David M. The effect of amniotic fluid on intraperitoneal adhesion formation--an experimental study. Int J Fertil. 1991;36:317-20.