title: Tissue response to five commercially available peritoneal adhesion barriers-A systematic histological evaluation.
abstract: Separating wounded serosa by physical barriers is the only clinically approved adjunct for postoperative adhesion prevention. Since the optimal adhesion barrier has not been found, it is essential to improve our pathogenic understanding of adhesion formation and to compare the effects of different barrier materials on tissue and cells. Wistar rats underwent standardized peritoneal damage and were treated either with Seprafilm, Adept, Intercoat, Spraygel, SupraSeal or remained untreated as a control. 14 days postoperatively, the lesions were explanted and histomorphologically analyzed using the European ISO score to evaluate material implants. Striking differences between the material groups were present regarding the inflammation, fibrosis, and foreign body reaction. According to the ISO score, Intercoat and Spraygel were considered as nonirritating to tissue. Adept, Seprafilm, and SupraSeal were assessed as mild-irritating materials. Interestingly, the most effective material in adhesion prevention revealed moderate inflammation accompanied by minor fibrosis. The degree of inflammation to barrier materials does not predict the efficacy in the prevention of adhesions. Histopathological investigations are crucial to improve our understanding of the cellular mechanisms during adhesion formation and elucidate the tissue response to material approaches used in adhesion prevention. This will lead to improved antiadhesive strategies and the development of functional barrier biomaterials. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 598-609, 2018.
authors.affiliation: Cardiology I, Centre for Cardiology, University Medical Centre, Johannes Gutenberg University of Mainz, Mainz, Germany.
authors.forename: Volker H
authors.initials: VH
authors.lastname: Schmitt
authors.affiliation: REPAIR-lab, European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Institute of Pathology, University of Regensburg, Regensburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Mamilos
authors.affiliation: Department of Internal Medicine, St. Vincenz and Elisabeth Hospital of Mainz (KKM), Mainz, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Schmitt
authors.affiliation: Department of Gynaecology and Obstetrics, University of Tuebingen, Tuebingen, Germany.|German Centre of Biomaterials and Artificial Organs e.V. Denkendorf, Germany.
authors.forename: Constanze N E
authors.initials: CNE
authors.lastname: Neitzer-Planck
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Taufiek K
authors.initials: TK
authors.lastname: Rajab
authors.affiliation: Department of Internal Medicine, St. Vincenz and Elisabeth Hospital of Mainz (KKM), Mainz, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Hollemann
authors.affiliation: Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, Germany.
authors.forename: Willi
authors.initials: W
authors.lastname: Wagner
authors.affiliation: Department of Gynaecology and Obstetrics, University of Tuebingen, Tuebingen, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Krämer
authors.affiliation: German Centre of Biomaterials and Artificial Organs e.V. Denkendorf, Germany.|Institute of Textile Technology and Process Engineering, Denkendorf, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Hierlemann
authors.affiliation: Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: James Kirkpatrick
authors.affiliation: Department of Internal Medicine, St. Vincenz and Elisabeth Hospital of Mainz (KKM), Mainz, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Brochhausen
mesh_terms: D000818:Animals; D001672:Biocompatible Materials / Q000494:pharmacology*; D005260:Female; D005355:Fibrosis / Q000209:etiology / Q000473:pathology; D005549:Foreign-Body Reaction / Q000209:etiology / Q000473:pathology; D006820:Hyaluronic Acid / Q000494:pharmacology*; D007249:Inflammation / Q000209:etiology / Q000473:pathology; D008567:Membranes, Artificial; D010537:Peritoneum / Q000187:drug effects* / Q000601:surgery; D011183:Postoperative Complications / Q000188:drug therapy* / Q000473:pathology / Q000517:prevention & control; D051381:Rats; D017208:Rats, Wistar; D000267:Tissue Adhesions / Q000188:drug therapy* / Q000473:pathology / Q000517:prevention & control
chemical_list: D001672:Biocompatible Materials; D008567:Membranes, Artificial; C118198:Seprafilm; D006820:Hyaluronic Acid
keywords: adhesion prevention; barrier materials; histomorphology; mesothelial cells; peritoneal adhesion