Effect of a new cross-linked hyaluronan gel on the staple line after sleeve gastrectomy in a rat model

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Abstract

Abstract Purpose: To evaluate the effect of a new cross-linked hyaluronan (NCHA) gel on healing of the staple line in an experimental sleeve gastrectomy. Methods: Eighteen rats were randomly divided into three groups. The control group (n = 6) received no medication. In the saline group (n = 6) and NCHA gel group (n = 6), saline and NCHA gel were respectively administered onto the staple line and intraperitoneally into the abdominal cavity after the standard stapling procedure. Results: The fibroblast activity and collagen deposition were significantly higher in the NCHA gel group than in the control group (p = 0.00, p = 0.017) and saline group (p = 0.004, p = 0.015). The tissue hydroxyproline protein level was significantly higher in the NCHA gel group than in the control group (p = 0.041). Adhesion formation was significantly lower in the NCHA gel group than in the control and saline groups (p = 0.015, p = 0.041). Conclusions: New cross-linked hyaluronan gel could be an effective approach to improve staple line wound healing and prevent potential leakage after sleeve gastrectomy. Moreover, NCHA gel helps to prevent adhesion formation without compromising healing of the staple line.

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Clinical Benefit of Gastric Staple Line Reinforcement (SLR) in Gastrointestinal Surgery: a Meta-analysis

Scott A Shikora, Christine B. Mahoney (2015)

Background The objective of this study was to assess whether the use of staple line reinforcement (SLR) reduces staple line complications (SLC). Mechanical staple lines are essential for gastrointestinal surgery such as bariatric surgery. However, SLC, such as bleeding and leakage, still occur. The purposes of this study were to provide quantitative evidence on the relative efficacy of gastric SLR and to compare the rates of effectiveness of three commonly used methods. Methods A search of the medical literature in English language journals identified studies from Jan 1, 2000, to Dec 31, 2013, using the following reinforcement types: (1) no reinforcement, (2) oversewing, (3) a biocompatible glycolide copolymer, and (4) bovine pericardium after gastric bypasses and sleeve gastrectomies. Types of reinforcement were compared using a random-effects model. Results This meta-analysis reviewed 16,967 articles, extracting data on 56,309 patients concerning leak and 41,864 patients concerning bleeding. Over 40 % of patients had no reinforcement, resulting in the highest leak rate (2.75 %) and bleed rate (3.45 %). Overall, reinforcing with bovine pericardium had the lowest leak (1.28 %) and bleed (1.23 %) rates. Suture oversewing was better than no reinforcement but not as effective as bovine pericardium for leak (2.45 %) and bleed (2.69 %) rates. Buttressing with a biocompatible glycolide copolymer resulted in the second highest leak rate (2.61 %) and a bleed rate of 2.48 % but had significantly lower bleed rates than no reinforcement. Conclusions SLR provided superior results for patients compared to no reinforcement for reducing SLC. Buttressing with bovine pericardium resulted in the most favorable outcomes. The effectiveness of different methods used to reinforce the staple line in gastric surgery does not appear to be equal.

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Effect of Crosslinking Agent Concentration on the Properties of Unmedicated Hydrogels †

Rachel Shet Hui Wong, Mark W Ashton, Kalliopi Dodou (2015)

Novel polyethylene oxide (PEO) hydrogel films were synthesized via UV crosslinking with varying concentrations of pentaerythritol tetra-acrylate (PETRA) as crosslinking agent. The aim was to study the effects of the crosslinking agent on the material properties of hydrogel films intended for dermatological applications. Fabricated film samples were characterized using swelling studies, scanning electron microscopy, tensile testing and rheometry. Films showed rapid swelling and high elasticity. The increase of PETRA concentration resulted in significant increase in the gel fraction and crosslinking density (ρc), while causing a significant decrease in the equilibrium water content (EWC), average molecular weight between crosslinks ( M ¯ c ), and mesh size (ζ) of films. From the scanning electron microscopy, cross-linked PEO hydrogel network appeared as cross-linked mesh-like structure with interconnected micropores. Rheological studies showed PEO films required a minimum of 2.5% w/w PETRA to form stable viscoelastic solid gels. Preliminary studies concluded that a minimum of 2.5% w/w PETRA is required to yield films with desirable properties for skin application.

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A model for the role of hyaluronic acid and fibrin in the early events during the inflammatory response and wound healing.

Paul Weigel, Gerald Fuller, Robert D. LeBoeuf (1986)

A model is presented outlining the molecular and cellular events that occur during the early stages of the wound healing process. The underlying theme is that there is a specific binding interaction between fibrin, the major clot protein, and hyaluronic acid (HA), a constituent of the wound extracellular matrix. This binding interaction, which could also be stabilized by other cross-linking components, provides the driving force to organize a three-dimensional HA matrix attached to and interdigitated with the initial fibrin matrix. The HA-fibrin matrix plays a major role in the subsequent tissue reconstruction processes. We suggest that HA and fibrin have both structural and regulatory functions at different times during the wound healing process. The concentration of HA in blood and in the initial clot is very low. This is consistent with the proposed interaction between HA and fibrin(ogen), which could interfere with either fibrinogen activation or fibrin assembly and cross-linking. We propose that an activator (e.g. derived from a plasma precursor, platelets or surrounding cells) is produced during the clotting reaction and then stimulates one or more blood cell types to synthesize and secrete HA into the fibrin matrix of the clot. We predict that HA controls the stability of the matrix by regulating the degradation of fibrin. The new HA-fibrin matrix increases or stabilizes the volume and porosity of the clot and then serves as a physical support, a scaffold through which cells trapped in the clot or cells infiltrating from the peripheral edge of the wound can migrate. The HA-fibrin matrix also actively stimulates or induces cell motility and activates and regulates many functions of blood cells, which are involved in the inflammatory response, including phagocytosis and chemotaxis. The secondary HA-fibrin matrix itself is then modified as cells continue to migrate into the wound, secreting hyaluronidase and plasminogen activator to degrade the HA and fibrin. At the same time these cells secrete collagen and glycosaminoglycans to make a more differentiated matrix. The degradation products derived from both fibrin and HA are, in turn, important regulatory molecules which control cellular functions involved in the inflammatory response and new blood vessel formation in the healing wound. The proposed model generates a number of testable experimental predictions.

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Author and article information

Contributors

Nurullah Bülbüller: Role: ND

Barış Rafet Karakaş: Role: ND

Hülya Tosun Yıldırım: Role: ND

Muhittin Yaprak: Role: ND

Veli Vural: Role: ND

Sadıka Halide Akbaş: Role: ND

Arzu Karaveli: Role: ND

Cem Sezer: Role: ND

Journal

Journal ID (publisher-id): acb

Title: Acta Cirurgica Brasileira

Abbreviated Title: Acta Cir. Bras.

Publisher: Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia (São Paulo, SP, Brazil )

ISSN (Print): 0102-8650

ISSN (Electronic): 1678-2674

Publication date (Print and electronic): February 2018

Volume: 33

Issue: 2

Pages: 163-174

Affiliations

[5] Antalya orgnameAkdeniz University orgdiv1Faculty of Medicine orgdiv2Department of General Surgery Turkey

[8] Antalya orgnameHealth Sciences University orgdiv1Antalya Training and Research Hospital orgdiv2Department of Pathology Turkey

[4] Antalya orgnameAkdeniz University orgdiv1Faculty of Medicine orgdiv2Department of General Surgery Turkey

[1] orgnameAkdeniz University orgdiv1Faculty of Medicine orgdiv2Department of General Surgery Turkey

[7] Antalya orgnameHealth Sciences University orgdiv1Antalya Training and Research Hospital orgdiv2Department of Anesthesiology and Reanimation Turkey

[2] Antalya orgnameHealth Sciences University orgdiv1Antalya Training and Research Hospital orgdiv2Department of General Surgery Turkey

[6] Antalya orgnameAkdeniz University orgdiv1Faculty of Medicine orgdiv2Department of Biochemistry Turkey

[3] Antalya orgnameHealth Sciences University orgdiv1Antalya Training and Research Hospital orgdiv2Department of Pathology Turkey