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Carmichael SP, Chandra PK, Vaughan JW, Kline DM, Ip EH, Holcomb JB, Atala AJ. A Scoping Review of Animal Models for Development of Abdominal Adhesion Prevention Strategies. J Surg Res 2024; 302:364-375. [PMID: 39153357 DOI: 10.1016/j.jss.2024.06.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/12/2024] [Accepted: 06/22/2024] [Indexed: 08/19/2024]
Abstract
INTRODUCTION Abdominal adhesions represent a chronic postsurgical disease without reliable prophylaxis. Animal modeling has been a cornerstone of novel therapeutic development but has not produced reliable clinical therapies for prevention of adhesive small bowel obstruction. The purpose of this scoping review is to analyze animal models for abdominal adhesion generation by key considerations of external validity (i.e., fidelity, homology, and discrimination). METHODS A literature review was performed in accordance with the Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews guidelines. Peer-reviewed publications were included that described the development or quality assessment of experimental animal models for abdominal adhesions with inclusion of a scoring system. Studies that focused on treatment evaluation, implantation of surgical devices, models of nonsurgical etiologies for abdominal adhesions, non-in vivo modeling, and investigations involving human subjects were excluded. RESULTS Four hundred and fifteen (n = 415) articles were identified by prespecified search criteria. Of these, 13 studies were included for review. CONCLUSIONS Translation of investigational therapeutics for abdominal adhesion prevention is dependent upon high-quality experimental animal models that reproduce the clinical adhesions seen in the operating room as a disease of the entire abdomen.
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Affiliation(s)
- Samuel P Carmichael
- Department of Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina; Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
| | - Prafulla K Chandra
- Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - John W Vaughan
- Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David M Kline
- Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Edward H Ip
- Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - John B Holcomb
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Anthony J Atala
- Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Nian H, Pu Z, Li Z, Zhong P, Ma S, Li J. Establishment and evaluation of a stable and reliable rat model of peritoneal adhesions. Surgery 2024:S0039-6060(24)00457-4. [PMID: 39034213 DOI: 10.1016/j.surg.2024.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/04/2024] [Accepted: 06/19/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND In this study, we aimed to establish a stable and standardized animal model of peritoneal adhesions. METHODS Forty-eight male Sprague-Dawley rats were randomly divided (n = 12 each) into blank control, classic cecum sidewall, ischemic button, and cecum-sidewall suture groups. The modified American Fertility Society adhesion score was used on postoperative day 7 to evaluate adhesions. Sixty male Sprague-Dawley rats were used to dynamically observe the adhesion characteristics of cecum-sidewall ischemic injury suture model at different time points (n = 60, randomly divided into groups a-e with 12 rats each). The modified American Fertility Society and Zühlke histologic scoring systems, hematoxylin-eosin staining, Masson staining, and computed tomography of the abdomen were used to evaluate adhesions on postoperative days 1, 3, 5, 7, and 14. RESULTS No peritoneal adhesions were observed in the blank control group on postoperative day 7. In the classic cecum sidewall group, 8 rats had inconsistent adhesions, which had a modified American Fertility Society adhesion score of 2.25 ± 1.96. All rats in the ischemic button and cecum-sidewall suture groups developed significant adhesions with modified American Fertility Society scores of 3.08 ± 1.31 and 4.67 ± 0.78, respectively. When the modified American Fertility Society score was used, statistically significant differences were observed between the classic cecum sidewall groups and cecum-sidewall suture groups and between the ischemic button groups and cecum-sidewall suture groups. All animals in groups a-e developed adhesions; adhesion scores increased gradually with time. CONCLUSIONS The cecum-sidewall ischemic injury suture model is a stable and standardized animal model of peritoneal adhesions.
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Affiliation(s)
- Hongyu Nian
- The First School of Clinical Medical, Gansu University of Chinese Medicine, Lanzhou, China; Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province, Gansu Provincial Hospital, Lanzhou, China
| | - Zhenjun Pu
- The First School of Clinical Medical, Gansu University of Chinese Medicine, Lanzhou, China; Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province, Gansu Provincial Hospital, Lanzhou, China
| | - Zhiyuan Li
- The First School of Clinical Medical, Gansu University of Chinese Medicine, Lanzhou, China
| | - Pengfei Zhong
- The First School of Clinical Medical, Gansu University of Chinese Medicine, Lanzhou, China
| | - Shengxu Ma
- The First School of Clinical Medical, Gansu University of Chinese Medicine, Lanzhou, China
| | - Junliang Li
- The First School of Clinical Medical, Gansu University of Chinese Medicine, Lanzhou, China; Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province, Gansu Provincial Hospital, Lanzhou, China; Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China; Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China.
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Malekhosseini SA, Alizadeh B, Hosseinzadeh A, Shahriarirad R, Naseri R, Kazemi K, Shamsaeefar A, Tanideh N. Comparison of the preventive effect of colchicine versus diphenhydramine, prednisolone, and a combination therapy on intraperitoneal adhesion bands: an experimental study in rats. BMC Surg 2023; 23:79. [PMID: 37032367 PMCID: PMC10084595 DOI: 10.1186/s12893-023-01981-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/31/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Peritoneal adhesion formation is an inevitable consequence of abnormal repair of the peritoneum following different peritoneal injuries of intra-abdominal operations with the subsequent morbidity that they represent. Vast efforts have been made to elucidate the cause and prevent the development of abdominal adhesions. The aim of our study is to compare the capability of colchicine versus diphenhydramine (DPH) and methylprednisolone (MP), and also prednisolone in adhesion prevention. METHODS Sixty-one male Wistar stock rats were divided into four groups. The first group attended as the control group. Groups 2, 3, and 4 received oral combination of MP + DPH solution (20 mg/kg), colchicine (0.02 mg/kg), and prednisolone (1 mg/ kg), respectively. Adhesion bands were induced by standardized abrasion of the peritoneum through a midline laparotomy. All rats were sacrificed on the 15th-day post medication administration and the subjects underwent an exploratory laparotomy. The presence of adhesions was evaluated with the modified using Nair's classification. RESULTS The proportion of the control group with substantial adhesion bands (73.3%) was significantly higher than that of the MP + DPH (13.3%), colchicine (33.3%), and prednisolone (31.3%) groups. There were significant differences between the scores of the control and the MP + DPH, colchicine, and prednisolone groups (P = 0.001, 0.028, and 0.019, respectively). There was no statistically significant difference to favor colchicine against MP + DPH (P = 0.390) or MP + DPH against prednisolone (P = 0.394). CONCLUSIONS Both colchicine and combination of DPH + MP prevented postoperative abdominal adhesions separately in our study. However, the lowest adhesion formation rate was observed in the DPH + MP group, even lower than the prednisolone group.
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Affiliation(s)
- Seyed Ali Malekhosseini
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behzad Alizadeh
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Hosseinzadeh
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reyhaneh Naseri
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran.
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Kourosh Kazemi
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Shamsaeefar
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nader Tanideh
- Stem Cells Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Pharmacology Department, Shiraz University of Medical Sciences, Shiraz, Iran
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Chandel AKS, Shimizu A, Hasegawa K, Ito T. Advancement of Biomaterial-Based Postoperative Adhesion Barriers. Macromol Biosci 2021; 21:e2000395. [PMID: 33463888 DOI: 10.1002/mabi.202000395] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/28/2020] [Indexed: 01/16/2023]
Abstract
Postoperative peritoneal adhesion (PPA) is a prevalent incidence that generally happens during the healing process of traumatized tissues. It causes multiple severe complications such as intestinal obstruction, chronic abdominal pain, and female infertility. To prevent PPA, several antiadhesion materials and drug delivery systems composed of biomaterials are used clinically, and clinical antiadhesive is one of the important applications nowadays. In addition to several commercially available materials, like film, spray, injectable hydrogel, powder, or solution type have been energetically studied based on natural and synthetic biomaterials such as alginate, hyaluronan, cellulose, starch, chondroitin sulfate, polyethylene glycol, polylactic acid, etc. Moreover, many kinds of animal adhesion models, such as cecum abrasion models and unitary horn models, are developed to evaluate new materials' efficacy. A new animal adhesion model based on hepatectomy and conventional animal adhesion models is recently developed and a new adhesion barrier by this new model is also developed. In summary, many kinds of materials and animal models are studied; thus, it is quite important to overview this field's current progress. Here, PPA is reviewed in terms of the species of biomaterials and animal models and several problems to be solved to develop better antiadhesion materials in the future are discussed.
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Affiliation(s)
- Arvind K Singh Chandel
- Center for Disease Biology and Integrative Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Atsushi Shimizu
- Department of Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | - Kiyoshi Hasegawa
- Department of Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | - Taichi Ito
- Center for Disease Biology and Integrative Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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van Steensel S, Liu H, Vercoulen TF, Hadfoune M, Breukink SO, Stassen LP, Lenaerts K, Bouvy ND. Prevention of intra-abdominal adhesions by a hyaluronic acid gel; an experimental study in rats. J Biomater Appl 2020; 35:887-897. [PMID: 32878535 DOI: 10.1177/0885328220954188] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND In 80% to 90% of the patients intra-abdominal adhesions occur after abdominal surgery, which can cause small-bowel obstruction, chronic abdominal pain, female infertility and difficulty during reoperation. A novel crosslinked hyaluronic acid gel is evaluated regarding its anti-adhesive capacities in an ischemic button model in rats. METHOD 51 adult, male Wistar rats from a registered breeder, received eight ischemic buttons each and were treated with hyaluronic acid gel (HA, HyaRegen©), hyaluronic acid carboxymethylcellulose (HA-CMC, Seprafilm©) or no anti-adhesive barrier. After 14 days, the animals were sacrificed and adhesions were scored macroscopically. The number of buttons and organs involved in adhesions were recorded. Per animal, one button with adhesions and one without adhesions was explanted for qPCR analysis. Mann-Whitney U, Fisher's exact and Wilcoxon signed rank test were used for data analysis. A p-value of 0.05 was considered significant. RESULTS Macroscopic evaluation of adhesion formation did not differ between the groups. The number of organs involved in adhesions in the HA gel group was significantly lower compared to HA-CMC (p = .041) and the control group (p = .012). A significantly, 1.36-fold higher clec10a (p = 0.25), 1.80-fold higher cd163 (p = 0.003) and 5.14-fold higher mmp1 expression (p = 0.028) was found in ischemic buttons with adhesions compared to buttons without adhesions. CONCLUSION HA gel application reduces the number of organs involved in adhesions in an ischemic button model, but no overall reduction in adhesion formation was encountered. Macrophage subtype 2 polarization and high mmp1 expression are associated with adhesion formation. Further investigation is needed in the exact pathophysiologic process of adhesion formation and the role of macrophage polarization.
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Affiliation(s)
- Sebastiaan van Steensel
- Maastricht Universitair Medisch Centrum+, Maastricht, Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Hong Liu
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,Maastricht University, Maastricht, Netherlands
| | | | - M'hamed Hadfoune
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | | | | | - Kaatje Lenaerts
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,Maastricht University, Maastricht, Netherlands
| | - Nicole D Bouvy
- Maastricht Universitair Medisch Centrum+, Maastricht, Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
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van Steensel S, Liu H, Mommers EH, Lenaerts K, Bouvy ND. Comparing Five New Polymer Barriers for the Prevention of Intra-abdominal Adhesions in a Rat Model. J Surg Res 2019; 243:453-459. [DOI: 10.1016/j.jss.2019.05.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/20/2019] [Accepted: 05/29/2019] [Indexed: 11/29/2022]
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Mommers EH, Hong L, Jongen A, Bouvy ND. Baseline performance of the ischaemic button model for induction of adhesions in laboratory rats. Lab Anim 2018; 53:63-71. [PMID: 29768953 PMCID: PMC6376654 DOI: 10.1177/0023677218773116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The ischaemic button model is frequently used for the induction of adhesions in laboratory rats. Male rats are often used because of the common belief that the peritesticular (intra-abdominal) fat in males facilitates adhesion formation, although this theory is not evidence based. Comparing the model’s performance in both sexes is an important aspect of refining animal experiments. The aim of this study is to compare baseline performance of the modified ischaemic button model in both male and female rats. Follow-up was 1 week and noted endpoints were intra-abdominal adhesion formation and differences in welfare assessment. A total of 192 ischaemic buttons (96 male/96 female) were created in 24 Wistar Han rats (12 male/12 female). After 1 week of follow-up, 93 buttons survived in the male group (96.9%) compared with 91 in the female group (94.8%) (p = 0.409). In the male group, 85 out of 93 (91.4%) buttons induced adhesions compared with 84 out of 91 (92.3%) in the female group (p = 0.881). All but one animal had a Zühlke score of 3. There were no clinically relevant differences in welfare scores. Male animals increased in weight significantly faster compared to females (p < 0.001), after correcting for physiological growth. The ischaemic button model resulted in equal quality and quantity of intra-abdominal adhesions in both male and female Wistar Han rats. Both male and female Wistar Han rats are suitable for the induction of experimental adhesions in the ischaemic button model.
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Affiliation(s)
- Elwin Hh Mommers
- Department of Surgery, Maastricht University Medical Centre, The Netherlands
| | - Liu Hong
- Department of Surgery, Maastricht University Medical Centre, The Netherlands
| | - Audrey Jongen
- Department of Surgery, Maastricht University Medical Centre, The Netherlands
| | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Centre, The Netherlands
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Marshall CD, Hu MS, Leavitt T, Barnes LA, Cheung ATM, Malhotra S, Lorenz HP, Longaker MT. Creation of Abdominal Adhesions in Mice. J Vis Exp 2016. [PMID: 27685681 DOI: 10.3791/54450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Abdominal adhesions consist of fibrotic tissue that forms in the peritoneal space in response to an inflammatory insult, typically surgery or intraabdominal infection. The precise mechanisms underlying adhesion formation are poorly understood. Many compounds and physical barriers have been tested for their ability to prevent adhesions after surgery with varying levels of success. The mouse and rat are important models for the study of abdominal adhesions. Several different techniques for the creation of adhesions in the mouse and rat exist in the literature. Here we describe a protocol utilizing abrasion of the cecum with sandpaper and sutures placed in the right abdominal sidewall. The mouse is anesthetized and the abdomen is prepped. A midline laparotomy is created and the cecum is identified. Sandpaper is used to gently abrade the surface of the cecum. Next, several figure-of-eight sutures are placed into the peritoneum of the right abdominal sidewall. The abdominal cavity is irrigated, a small amount of starch is applied, and the incision is closed. We have found that this technique produces the most consistent adhesions with the lowest mortality rate.
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Affiliation(s)
- Clement D Marshall
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine;
| | - Michael S Hu
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine
| | - Tripp Leavitt
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine
| | - Leandra A Barnes
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine
| | - Alexander T M Cheung
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine
| | - Samir Malhotra
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine
| | - H Peter Lorenz
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine
| | - Michael T Longaker
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine
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Huang L, Huang L, Yan Q, Qin Y, Ma Y, Lin M, Xu X, Zheng J. The TCA Pathway is an Important Player in the Regulatory Network Governing Vibrio alginolyticus Adhesion Under Adversity. Front Microbiol 2016; 7:40. [PMID: 26870007 PMCID: PMC4735382 DOI: 10.3389/fmicb.2016.00040] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/11/2016] [Indexed: 12/24/2022] Open
Abstract
Adhesion is a critical step in the initial stage of Vibrio alginolyticus infection; therefore, it is important to understand the underlying mechanisms governing the adhesion of V. alginolyticus and determine if environmental factors have any effect. A greater understanding of this process may assist in developing preventive measures for reducing infection. In our previous research, we presented the first RNA-seq data from V. alginolyticus cultured under stress conditions that resulted in reduced adhesion. Based on the RNA-seq data, we found that the Tricarboxylic acid cycle (TCA pathway) might be closely related to adhesion. Environmental interactions with the TCA pathway might alter adhesion. To validate this, bioinformatics analysis, quantitative Real-Time PCR (qPCR), RNAi, and in vitro adhesion assays were performed, while V. alginolyticus was treated with various stresses including temperature, pH, salinity, and starvation. The expression of genes involved in the TCA pathway was confirmed by qPCR, which reinforced the reliability of the sequencing data. Silencing of these genes was capable of reducing the adhesion ability of V. alginolyticus. Adhesion of V. alginolyticus is influenced substantially by environmental factors and the TCA pathway is sensitive to some environmental stresses, especially changes in pH and starvation. Our results indicated that (1) the TCA pathway plays a key role in V. alginolyticus adhesion: (2) the TCA pathway is sensitive to environmental stresses.
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Affiliation(s)
- Lixing Huang
- Key Laboratory of Healthy Mariculture for the East China Sea, Ministry of Agriculture, Fisheries College, Jimei University Xiamen, China
| | - Li Huang
- Key Laboratory of Healthy Mariculture for the East China Sea, Ministry of Agriculture, Fisheries College, Jimei University Xiamen, China
| | - Qingpi Yan
- Key Laboratory of Healthy Mariculture for the East China Sea, Ministry of Agriculture, Fisheries College, Jimei University Xiamen, China
| | - Yingxue Qin
- Key Laboratory of Healthy Mariculture for the East China Sea, Ministry of Agriculture, Fisheries College, Jimei University Xiamen, China
| | - Ying Ma
- Key Laboratory of Healthy Mariculture for the East China Sea, Ministry of Agriculture, Fisheries College, Jimei University Xiamen, China
| | - Mao Lin
- Key Laboratory of Healthy Mariculture for the East China Sea, Ministry of Agriculture, Fisheries College, Jimei University Xiamen, China
| | - Xiaojin Xu
- Key Laboratory of Healthy Mariculture for the East China Sea, Ministry of Agriculture, Fisheries College, Jimei University Xiamen, China
| | - Jiang Zheng
- Key Laboratory of Healthy Mariculture for the East China Sea, Ministry of Agriculture, Fisheries College, Jimei University Xiamen, China
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de Vries A, Kuhry E, Mårvik R. Operative procedures in warm humidified air: Can it reduce adhesion formation? A randomized experimental rat model. INTERNATIONAL JOURNAL OF SURGERY OPEN 2016. [DOI: 10.1016/j.ijso.2016.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bianchi E, Boekelheide K, Sigman M, Lamb DJ, Hall SJ, Hwang K. Ghrelin ameliorates adhesions in a postsurgical mouse model. J Surg Res 2015; 201:226-34. [PMID: 26850207 DOI: 10.1016/j.jss.2015.10.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 10/03/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Peritoneal adhesion formation is a well-recognized consequence of abdominal and pelvic surgery, causing infertility, chronic pelvic pain, and intestinal obstruction. We hypothesized that ghrelin, a 28-amino acid peptide predominantly found in the stomach, plays an important role in preventing postoperative surgical adhesions. The purpose of this study was to develop a new surgical peritoneal adhesion model to define the role that ghrelin plays in wound healing and adhesion formation. MATERIALS AND METHODS C57BL/6 wild-type mice (n = 40) and growth hormone secretagogue receptor-knockout (GHSR KO) mice (n = 20) underwent a midline laparotomy to establish a peritoneal adhesion model characterized by the combination of two different techniques: ischemic peritoneal buttons and cecal multiple abrasion. All mice received intraperitoneal injections with ghrelin (0.16 mg/kg) or saline twice daily for 20 d after surgery. Peritoneal ischemic buttons were harvested to determine protein expression of collagen (Masson trichrome, picrosirius red stain, and Western blot). RESULTS The novel mouse model demonstrated consistent and easily reproducible formation of intra-abdominal adhesions. Ghrelin administration significantly reduced postoperative adhesion formation (P < 0.001) in wild-type mice. The antifibrotic effect of ghrelin in wild-type mice was confirmed by measuring collagen I protein levels via Western blot analysis. The anti-adhesion effect of ghrelin seen in wild-type mice was not detected in GHSR KO mice demonstrating that this effect is mediated by the GHSR-1a receptor. CONCLUSIONS Ghrelin administration may improve surgical outcome by reducing peritoneal adhesion formation and fibrotic response in a mouse model.
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Affiliation(s)
- Enrica Bianchi
- Department of Surgery, Division of Urology, Brown University, Providence, Rhode Island; Department of Pathology and Laboratory Medicine, Brown University, Providence, Rhode Island
| | - Kim Boekelheide
- Department of Pathology and Laboratory Medicine, Brown University, Providence, Rhode Island
| | - Mark Sigman
- Department of Surgery, Division of Urology, Brown University, Providence, Rhode Island; Department of Pathology and Laboratory Medicine, Brown University, Providence, Rhode Island
| | - Dolores J Lamb
- Department of Urology, Baylor College of Medicine, Houston, Texas
| | - Susan J Hall
- Department of Pathology and Laboratory Medicine, Brown University, Providence, Rhode Island
| | - Kathleen Hwang
- Department of Surgery, Division of Urology, Brown University, Providence, Rhode Island; Department of Pathology and Laboratory Medicine, Brown University, Providence, Rhode Island.
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Beyene RT, Kavalukas SL, Barbul A. Intra-abdominal adhesions: Anatomy, physiology, pathophysiology, and treatment. Curr Probl Surg 2015; 52:271-319. [PMID: 26258583 DOI: 10.1067/j.cpsurg.2015.05.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/12/2015] [Indexed: 12/18/2022]
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A new poly(1,3-trimethylene carbonate) film provides effective adhesion reduction after major abdominal surgery in a rat model. Surgery 2015; 157:1113-20. [DOI: 10.1016/j.surg.2015.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 02/04/2015] [Accepted: 02/13/2015] [Indexed: 12/08/2022]
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Li M, Wang G, Zhou B, Xia X, Li N. Does long intestinal tube splinting aggravate intestinal adhesions? J INVEST SURG 2014; 27:169-75. [PMID: 24785831 DOI: 10.3109/08941939.2013.863986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
OBJECTIVE Long intestinal tube splinting (LITS) is useful for clinically reducing the recurrence of adhesive small bowel obstruction (ASBO). However, a controversy exists whether LITS aggravates intestinal adhesions. This study evaluated the postoperative effects of LITS relative to simple enterolysis on intestinal adhesions in an experimental porcine model. METHODS A porcine model (n = 24) of dense intestinal adhesion was established by abrading the ileal wall with sterile P240 sandpaper. Enterolysis was performed on postoperative day 14. Animals were randomly divided into a group that underwent enterolysis only (control; n = 12) and those who underwent LITS as well as enterolysis (LITS; n = 12). The long intestinal tube was removed on post-LITS day 14, after abdominal radiography. All animals were euthanized on postenterolysis day 28 for assessment of intestinal adhesions using a semiquantitative macroscopic grading scale, hematoxylin-eosin histology, and hydroxyproline assay. RESULTS Prior to enterolysis, the experimentally induced intestinal adhesions of the two groups were similar in extent and severity. On postenterolysis day 28 the LITS and control groups were comparable with regard to adhesion loop length (p = .440), macroscopic adhesion severity (p = .820), serosal fibrosis grading (p = .450), and hydroxyproline content of the adhesion ileal segment (p = .630). CONCLUSION Placement of the long intestinal tube did not aggravate intestinal adhesions over that of simple enterolysis in this intestinal adhesion porcine model.
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Affiliation(s)
- Min Li
- Department of General Surgery, Jinling Hospital, Medicine School of Nanjing University , Nanjing, Jiangsu Province , China
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New hepatectomy-induced postoperative adhesion model in rats, and evaluation of the efficacy of anti-adhesion materials. Surg Today 2013; 44:314-23. [PMID: 23504003 DOI: 10.1007/s00595-013-0530-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 11/15/2012] [Indexed: 12/19/2022]
Abstract
PURPOSE Repeated hepatic resections are not uncommon during the surgical management of liver tumors. Postoperative adhesions induced by hepatectomies can have a significant negative impact on subsequent surgeries. We recently developed a new hepatectomy-induced postoperative adhesion animal model to evaluate the anti-adhesion efficacy of commercially available sheet materials (Seprafilm(®) and Interceed(®)) and the recently reported hyaluronan-based in situ cross-linkable hydrogels. METHODS The median lobe (ML) and the left lateral lobe (LLL) of the liver (approximately 70 % of the total liver) of 43 male Sprague-Dawley rats were resected based on the classical procedure; anti-adhesion materials were then applied. A relaparotomy was performed 1 week later to evaluate the adhesions and histopathological findings. RESULTS The rats without the application of anti-adhesion materials (n = 14) showed the most severe adhesions (grade 3) between the cut surface of the liver and the small bowel or omentum. All the barrier materials produced slight anti-adhesion effects. Adhesions between the liver surface and the diaphragm and adhesions around the hepatic hilum were less severe, but were not remarkably reduced, by the anti-adhesion materials. CONCLUSION We successfully established a new hepatectomy-induced animal adhesion model, which may be useful for the development of new anti-adhesion materials.
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Intraabdominal adhesion formation is associated with differential mRNA expression of metabolic genes PDHb and SDHa. Arch Gynecol Obstet 2012; 286:683-6. [DOI: 10.1007/s00404-012-2364-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 04/23/2012] [Indexed: 10/28/2022]
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Rajab TK, Kraemer B, Petri N, Brochhausen C, Schmitt V, Wallwiener M. Intra-operative locally injected pharmacotherapy as a novel strategy for adhesion prophylaxis. Int J Surg 2012; 10:489-92. [DOI: 10.1016/j.ijsu.2012.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 07/11/2012] [Accepted: 07/14/2012] [Indexed: 11/15/2022]
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Brochhausen C, Schmitt VH, Rajab TK, Planck CNE, Krämer B, Wallwiener M, Hierlemann H, Kirkpatrick CJ. Intraperitoneal adhesions--an ongoing challenge between biomedical engineering and the life sciences. J Biomed Mater Res A 2011; 98:143-56. [PMID: 21548063 DOI: 10.1002/jbm.a.33083] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 01/12/2011] [Accepted: 01/20/2011] [Indexed: 01/29/2023]
Abstract
Peritoneal adhesions remain a relevant clinical problem despite the currently available prophylactic barrier materials. So far, the physical separation of traumatized serosa areas using barriers represents the most important clinical strategy for adhesion prevention. However, the optimal material has not yet been found. Further optimization or pharmacological functionalization of these barriers could give an innovative input for peritoneal adhesion prevention. Therefore, a more complete understanding of pathogenesis is required. On the basis of the pathophysiology of adhesion formation the main barriers currently in clinical practice as well as new innovations are discussed in the present review. Physiologically, mesothelial cells play a decisive role in providing a frictionless gliding surface on the serosa. Adhesion formation results from a cascade of events and is regulated by a variety of cellular and humoral factors. The main clinically applied strategy for adhesion prevention is based on the use of liquid or solid adhesion barriers to separate physically any denuded tissue. Both animal and human trials have not yet been able to identify the optimal barrier to prevent adhesion formation in a sustainable way. Therefore, further developments are required for effective prevention of postoperative adhesion formation. To reach this goal the combination of structural modification and pharmacological functionalization of barrier materials should be addressed. Achieving this aim requires the interaction between basic research, materials science and clinical expertise.
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Affiliation(s)
- Christoph Brochhausen
- REPAIR-Lab, Institute of Pathology, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
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