The effects of an absorbable hemostat produced from oxidized regenerated cellulose on adhesion formation in a rat model

Abstract

Objective: This study aimed to analyze the effect of an absorbable hemostat produced from oxidized regenerated cellulose (ORC) on pelvic adhesion formation in a rat model using an adhesion scoring system and immunohistochemical staining. Methods: This randomized, controlled experimental study included 20 female Wistar-Albino rats that were equally divided into the following groups: control and absorbable hemostat groups. The uterine horns of all the rats were exposed by laparotomy and using 10 W bipolar cautery. Five standard lesions were applied to the antimesenteric areas of each uterine horn. The experimental group received an absorbable hemostat to the traumatized uterine surfaces, whereas the control group did not. After a 28-day follow-up period, a relaparotomy was performed, and adhesions were evaluated based on an adhesion scoring system, and histological sections from areas with adhesion were obtained for immunohistochemical staining. Immunohistochemical staining included analysis of Ki-67 (proliferation index), CD-31 (neovascularization index), and Masson Trichrome [(MTC) fibrosis and collagen formation index]. Additionally, acute and chronic inflammation indices were determined via polymorphonuclear leukocytes (PMNL) and mononuclear leukocytes (MNL), respectively. Results: The intensity and scope of adhesion and overall adhesion ratings were substantially higher in the absorbable hemostat group than the control group (2.8±0.85 vs. 2.2±0.53, 0.92±0.26 vs. 0.61±0.25, and 3.72±0.96 vs. 2.81±0.75, respectively). Staining results for Ki-67, CD-31, MTC, PMNL, and MNL were also significantly higher in the absorbable hemostat group than in the control group (p<0.05 for all). Conclusion: The obtained results suggest that the use of ORC-based absorbable hemostats in pelvic surgery may increase adhesion formation on peritoneal surfaces by increasing inflammation, vascularity, and collagen formation.