Postoperative adhesions are considered a risk
factor for redo surgeries.[19] After surgeries in which
the solid organs are not covered by the peritoneum
or pericardium, adhesions from the previous surgery
increase the complexity of the surgical procedure and
are associated with increased mortality/morbidity
when a new surgery is required. Adhesions seen after
any surgery are one of the most important factors
affecting the course of redo abdominal surgery.[
20,
21]
The main mechanism of adhesion formation is the
migration of inflammatory cells to the surgical site
in the acute and chronic phases. Essentially, this
migration takes place to speed up recovery, but when
surgery is required again, it complicates the surgical process of the patient. Our study was designed based
on abdominal adhesions.
Adhesion barriers are currently used to eliminate
or minimize the risk of postsurgical adhesion. These
barriers prevent the inflammatory cascade or fibrin
formation and form a mechanical barrier by preventing
the approach and contact between the affected tissues
that cause adhesion formation. Abdominal adhesions
are associated with significant comorbidities, such
as chronic pelvic pain, dyspareunia, infertility, and
intestinal obstruction. Adhesions can also cause issues
in other specialties, such as gynecology, oncology,
or pediatric surgery. There are large financial and
public health repercussions associated with hospital
readmission costs, and they represent a real public
health problem.
There are many products produced to prevent
adhesions.[19,22] It has been shown that the use of
polyethylene glycol/polylactic acid membrane
containing barriers, alone or with other barriers,
prevent adhesion to a significant extent.[23] However,
polylactide film barrier was found to be ineffective
in preventing adhesions.[24] An ideal adhesion barrier prevents the formation of adhesions by allowing
the damaged tissue surfaces to separate and heal
freely. In addition, the barrier must be nonreactive,
antibacterial, biocompatible, biodegradable, and
effective in vivo.[20,21] In this study, gold nanoparticle/
hyaluronic acid nanocomposite was synthesized in situ
without the use of toxic chemicals and the purification
step by green synthesis.
This study evaluated the effectiveness of the
adhesion barrier, mainly targeting the acute, subacute,
and chronic processes. When the acute period effects
were examined, no significant difference was observed
between the groups with and without the application
of the adhesion barrier in terms of both the density of
inflammatory cells and the formation of fibrous tissue.
As the process lengthened and the subacute and chronic
periods were reached, there was a significant decrease
in inflammatory cell and fibrous tissue density in favor
of the adhesion barrier group. Furthermore, in terms
of edema and vascularization, there was a significant
decrease in favor of the adhesion barrier group.
It was shown that the application of an adhesion
barrier prevents cellular activities that will cause
adhesion in rats. This is promising for patients who
will need surgery again. These findings suggest
that a gold nanocomposite hyaluronic acid-based
adhesion barrier can be successfully applied to prevent
postsurgical adhesions. However, clinical studies with
long-term follow-up are needed.
There are several limitations in our study. The first
of these only conducted research on the The research
was only conducted on the laparotomic approach.
In addition, the study being an animal experiment
limited the chance of long-term follow-up. The study
was only tested on peritoneal adhesions. Further
studies are needed to investigate its effects on other
membranes, such as the pericardium.
In conclusion, the application of the adhesion
barrier will cause adhesions in the subacute and
chronic periods. It was observed that the adhesion
barrier minimizes inflammatory cells, edema,
vascularity, and fibrous tissue formation. In terms
of these parameters, no statistically significant
difference was observed between the two groups in
the early period, suggesting that the antibacterial
gold nanocomposite hyaluronic acid-based adhesion
barrier can be successfully applied to prevent subacute
and chronic adhesions. Further clinical studies with
long-term follow-up are needed.
Ethics Committee Approval: The study was initiated
after the ethics committee decision numbered 65202830-
050.04.04-524 of Sivas Cumhuriyet University Animal
Experiments Local Ethics Committee. The study was
conducted in accordance with the principles of the Declaration
of Helsinki.
Data Sharing Statement: The data that support the
findings of this study are available from the corresponding
author upon reasonable request.
Author Contributions: Idea/concept, critical review:
F.K.; Control/supervision, data collection, literature review,
writing the article, critical review, references: F.A.; Analysis
and/or interpretation, literature review: M.Ö.; Analysis and/
or interpretation: A.S.M.
Conflict of Interest: The authors declared no conflicts
of interest with respect to the authorship and/or publication
of this article.
Funding: This study was supported by TÜBİTAK 1507
program with project number 7201426.