Double-layer adhesives for preventing anastomotic leakage and reducing post-surgical adhesion

Sung Il Kang; Hyun Ho Shin; Da Han Hyun; Ghilsuk Yoon; Jun Seok Park; Ji Hyun Ryu

doi:10.1016/j.mtbio.2023.100806

Double-layer adhesives for preventing anastomotic leakage and reducing post-surgical adhesion

Mater Today Bio. 2023 Sep 20:23:100806. doi: 10.1016/j.mtbio.2023.100806. eCollection 2023 Dec.

Authors

Sung Il Kang¹, Hyun Ho Shin², Da Han Hyun³, Ghilsuk Yoon⁴, Jun Seok Park⁵, Ji Hyun Ryu^{2

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Affiliations

¹ Department of Surgery, College of Medicine, Yeungnam University, Daegu, 42415, South Korea.
² Department of Chemical Engineering, Wonkwang University, Iksan, Jeonbuk, 54538, South Korea.
³ Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu, 41404, South Korea.
⁴ Department of Pathology, School of Medicine, Kyungpook National University, Daegu, 41566, South Korea.
⁵ Department of Surgery, School of Medicine, Kyungpook National University Hospital, Daegu, 41404, Republic of Korea.
⁶ Department of Carbon Convergence Engineering, Wonkwang University, Iksan, Jeonbuk, 54538, South Korea.
⁷ Smart Convergence Materials Analysis Center, Wonkwang University, Iksan, Jeonbuk, 54538, South Korea.

Abstract

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.

Keywords: Colorectal cancer; Crosslinked hyaluronic acid; Double layer; Gallic acid-conjugated chitosan; Intestinal anastomosis.