Use of a modified chitosan-dextran gel to prevent peritoneal adhesions in a rat model.
BACKGROUND
Intra-abdominal adhesions are a major cause of morbidity and a significant drain on healthcare resources. Numerous anti-adhesion products have reached clinical use but none has been wholly satisfactory. This study examines the application of a modified chitosan-dextran (CD) gel to the intraperitoneal cavity to reduce adhesion formation. This is a unique synthetic gel, its active ingredients being succinyl chitosan and dextran aldehyde.


METHODS
Eighty adult male Wistar albino rats were randomized to undergo surgery alone or to receive CD gel at the time of surgery. Control groups using modified dextran only gel were also included. The surgical procedures comprised of laparotomy and either cecal abrasion or anastomotic simulation by enterotomy of the cecum with primary closure. At postoperative d 21 rats were euthanized by CO2 inhalation, and adhesions graded by an investigator blinded to the treatment groups, using a predetermined adhesion measurement score.


RESULTS
Adhesions were significantly reduced in the cecal abrasion group with median adhesion scores for the treatment group of 0 versus 3 in the control group (P<0.001, Fisher's exact test). Further reduction in adhesion formation was noted in the enterotomy group with median scores of 2 versus 5 for treatment and control groups respectively (P=0.003, Fisher's exact test).


CONCLUSIONS
Chitosan-dextran gel appears to significantly reduce the formation of intra-abdominal adhesions without adversely affecting wound healing. This is a noteworthy advancement in the safe prevention of post operative, intra-abdominal adhesions.
Lauder
Chris I W
CI
University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Woodville, South Australia, Australia.
Garcea
Giuseppe
G
Strickland
Andrew
A
Maddern
Guy J
GJ
D000818:Animals; D000925:Anticoagulants / Q000494:pharmacology; D001672:Biocompatible Materials / Q000494:pharmacology; D002432:Cecum / Q000601:surgery; D048271:Chitosan / Q000494:pharmacology*; D003911:Dextrans / Q000494:pharmacology*; D004195:Disease Models, Animal; D005782:Gels / Q000494:pharmacology; D007813:Laparotomy; D008297:Male; D010529:Peritoneal Cavity / Q000473:pathology / Q000601:surgery; D010537:Peritoneum / Q000187:drug effects* / Q000473:pathology* / Q000601:surgery; D051381:Rats; D017208:Rats, Wistar; D000267:Tissue Adhesions / Q000473:pathology / Q000517:prevention & control*; D014945:Wound Healing / Q000502:physiology
D000925:Anticoagulants; D001672:Biocompatible Materials; D003911:Dextrans; D005782:Gels; D048271:Chitosan