Kurzfassung

Intraperitoneal adhesions remain the major post-surgical complication in abdominal and gynaecological surgery. Intraperitoneal adhesions revealed significant burden not only for the patients but also for the health care system with costs of $1.3 billion per year in the United States alone.
In the last decade great efforts have been made for a better understanding of the pathogenesis of adhesion formation and the strategies for its prevention. However, the exact pathomechanisms are not yet...Intraperitoneal adhesions remain the major post-surgical complication in abdominal and gynaecological surgery. Intraperitoneal adhesions revealed significant burden not only for the patients but also for the health care system with costs of $1.3 billion per year in the United States alone.
In the last decade great efforts have been made for a better understanding of the pathogenesis of adhesion formation and the strategies for its prevention. However, the exact pathomechanisms are not yet fully understood. Nevertheless, it is evident that adhesion formation is a result of serosal wound healing. In this context mesothelial cells, which covered as a single cell layer the serous membrane play a crucial role in the physiology and pathophysiology of serous membranes. Damages of the mesothelial cell layers due to surgical intervention, inflammation or peritoneal dialysis lead to fibrin exudation, micro bleeding and subsequent fibroblast ingrowth resulting in adhesion formation. To prevent these processes several barriers have been developed. SupraSeal® is a Lactide-caprolactone-trimethylene-carbonate copolymer, which is tested as a potential barrier in a rat model (Fig 1a).
Intraabdominal adhesions were provoked in a standardized adhesion formation model in rats. The serosal damages were treated with SupraSeal®. After 14 days the experiments were terminated and the peritoneal wall with the barrier-membrane including surrounding peritoneum was explanted. The barrier material and the interface to intact peritoneum were analysed with synchrotron-µCT (SR-µCT) histomorphology and by scanning electron microscopy. The results were compared with further fluid and solid barrier materials treated with the same model.
After implantation the experimental defect was completely covered by the membrane. After 14 days SupraSeal® was still attached on the side of the peritoneal defect with marked shrinking and folding surrounded by slight shining intact serosa. Focally at the suture site minor smooth adhesive strands could be observed. SR-µCT demonstrated great areas covered bay cells (Fig 2). Histologically, a minor inflammatory reaction with multinucleated giant cells occasionally could be observed. The surface of the barrier material was completely covered by a single layer of almost flat, resting mesothelial cells with microvili (Fig 1). Compared to further barrier materials SupraSeal® showed a better biocompatibility and mesothelial cells morphology.
SupraSeal® revealed excellent antiadhesive effects and good biocompatibility. This might be due to its rapid remesothelialization and its good biocompatibility. For the functionality of the mesothelial cells the porous structure of this membrane seemed to be important.
Material science could give innovative input for further developments for functionalized adhesive barriers leading to the rapid regeneration of the serosal membrane. In this context further studies regarding the material-cell-Interactions and the possible integration of active agents such as anti-inflammatory drugs are needed.» weiterlesen» einklappen