Kang Sung Il, Shin Hyun Ho, Hyun Da Han, Yoon Ghilsuk, Park Jun Seok, Ryu Ji Hyun
Department of Surgery, College of Medicine, Yeungnam University, Daegu, 42415, South Korea.
Department of Chemical Engineering, Wonkwang University, Iksan, Jeonbuk, 54538, South Korea.
Mater Today Bio. 2023 Sep 20;23:100806. doi: 10.1016/j.mtbio.2023.100806. eCollection 2023 Dec.
Preventing anastomotic leakage (AL) and postoperative adhesions after gastrointestinal surgery is crucial for ensuring a favorable surgical prognosis. However, AL prevention using tissue adhesives can unintentionally lead to undesirable adhesion formation, while anti-adhesive agents may interfere with wound healing and contribute to AL. In this study, we have developed a double-layer patch, consisting of an adhesive layer on one side, utilizing gallic acid-conjugated chitosan (CHI-G), and an anti-adhesive layer on the opposite side, employing crosslinked hyaluronic acid (cHA). These CHI-G/cHA double-layer adhesives significantly prevented AL by forming physical barriers of CHI-G and reduced post-surgical adhesion at the anastomosis sites by the anti-adhesive layers of cHA. The bursting pressure (161.1 ± 21.6 mmHg) of double-layer adhesives-applied rat intestine at postoperative day 21 was far higher than those of the control (129.4 ± 5.7 mmHg) and the commercial anti-adhesives-applied group (120.8 ± 5.2 mmHg). In addition, adhesion score of double-layer adhesives-applied rat intestine was 3.6 ± 0.3 at postoperative day 21, which was similar to that of the commercial anti-adhesives-applied group (3.6 ± 0.3) and lower than that of the control group (4.9 ± 0.5). These findings indicate that the double-layer patch (CHI-G/cHA) has the potential to effectively prevent both postoperative adhesions and anastomotic leakage, offering a promising solution for gastrointestinal surgery.
预防胃肠道手术后的吻合口漏（AL）和术后粘连对于确保良好的手术预后至关重要。然而，使用组织粘合剂预防AL可能会意外导致不良粘连形成，而抗粘连剂可能会干扰伤口愈合并导致AL。在本研究中，我们开发了一种双层贴片，一侧为粘合剂层，使用没食子酸共轭壳聚糖（CHI-G），另一侧为抗粘连层，使用交联透明质酸（cHA）。这些CHI-G/cHA双层粘合剂通过形成CHI-G的物理屏障显著预防了AL，并通过cHA的抗粘连层减少了吻合口部位的术后粘连。术后第21天，应用双层粘合剂的大鼠肠道的爆破压力（161.1±21.6 mmHg）远高于对照组（129.4±5.7 mmHg）和应用商业抗粘连剂的组（120.8±5.2 mmHg）。此外，术后第21天，应用双层粘合剂的大鼠肠道的粘连评分是3.6±0.3，与应用商业抗粘连剂的组（3.6±0.3）相似，低于对照组（4.9±0.5）。这些发现表明，双层贴片（CHI-G/cHA）有潜力有效预防术后粘连和吻合口漏，为胃肠道手术提供了一个有前景的解决方案。
