Regeneration of peritoneum using amniotic membrane to prevent postoperative adhesions.
OBJECTIVE
Adhesions following intraperitoneal surgery are frequent causes of small bowel obstruction. Attempts to prevent postoperative adhesions have mostly proven disappointing clinically. Currently used by ophthalmologists in ocular surface disorders, amniotic membrane transplantation can reduce inflammation and promote re-epithelization. We used amniotic membrane for facilitating peritoneal regeneration and prevention of adhesions with surgical trauma.


METHODS
20 rats were randomized in equal number into treatment or control groups. Seven days after operation, the incidence and severity of adhesions were evaluated. Histologic and immunohistochemical analyses were examined at 1, 4, 10 weeks after operation.


RESULTS
While severe adhesions were observed after 1 week between the cecum and surrounding organs in the control group, adhesion formation was significantly reduced in the amniotic membrane group. Histologic examination demonstrated that free-floating myofibroblasts in the peritoneal cavity attached to surfaces of amniotic membrane grafts to form a layered structure. Free-floating mesothelial cells were incorporated into the regenerating mesothelium on the myofibroblast layer in 4 weeks, while implanted amniotic membrane grafts were absorbed by 10 weeks. In the amniotic membrane group the cecum appeared nearly normal.


CONCLUSIONS
Amniotic membrane grafts reduced intraperitoneal adhesions after surgical trauma, were well absorbed, and served as a substrate for regenerating mesothelium.
Kuriu
Yoshiaki
Y
Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Yamagishi
Hisakazu
H
Otsuji
Eigo
E
Nakashima
Susumu
S
Miyagawa
Koji
K
Yoshikawa
Tetsuji
T
Kin
Syuichi
S
Nakase
Yuen
Y
Fukuda
Ken-Ichiro
K
Okamoto
Kazuma
K
Sakakura
Chohei
C
Hamuro
Junji
J
Kurihara
Eiji
E
Hagiwara
Akeo
A
D000650:Amnion / Q000637:transplantation*; D000818:Animals; D002432:Cecum / Q000601:surgery*; D008297:Male; D010529:Peritoneal Cavity / Q000601:surgery*; D011897:Random Allocation; D051381:Rats; D017208:Rats, Wistar; D012038:Regeneration; D000267:Tissue Adhesions / Q000517:prevention & control*