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J Biomed Mater Res B Appl Biomater. 2018 Feb;106(2):598-609. doi: 10.1002/jbm.b.33835. Epub 2017 Mar 6.

Tissue response to five commercially available peritoneal adhesion barriers-A systematic histological evaluation.

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Cardiology I, Centre for Cardiology, University Medical Centre, Johannes Gutenberg University of Mainz, Mainz, Germany.
REPAIR-lab, European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Institute of Pathology, University of Regensburg, Regensburg, Germany.
Department of Internal Medicine, St. Vincenz and Elisabeth Hospital of Mainz (KKM), Mainz, Germany.
Department of Gynaecology and Obstetrics, University of Tuebingen, Tuebingen, Germany.
German Centre of Biomaterials and Artificial Organs e.V. Denkendorf, Germany.
Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, Germany.
Institute of Textile Technology and Process Engineering, Denkendorf, Germany.
Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.


Separating wounded serosa by physical barriers is the only clinically approved adjunct for postoperative adhesion prevention. Since the optimal adhesion barrier has not been found, it is essential to improve our pathogenic understanding of adhesion formation and to compare the effects of different barrier materials on tissue and cells. Wistar rats underwent standardized peritoneal damage and were treated either with Seprafilm, Adept, Intercoat, Spraygel, SupraSeal or remained untreated as a control. 14 days postoperatively, the lesions were explanted and histomorphologically analyzed using the European ISO score to evaluate material implants. Striking differences between the material groups were present regarding the inflammation, fibrosis, and foreign body reaction. According to the ISO score, Intercoat and Spraygel were considered as nonirritating to tissue. Adept, Seprafilm, and SupraSeal were assessed as mild-irritating materials. Interestingly, the most effective material in adhesion prevention revealed moderate inflammation accompanied by minor fibrosis. The degree of inflammation to barrier materials does not predict the efficacy in the prevention of adhesions. Histopathological investigations are crucial to improve our understanding of the cellular mechanisms during adhesion formation and elucidate the tissue response to material approaches used in adhesion prevention. This will lead to improved antiadhesive strategies and the development of functional barrier biomaterials.


adhesion prevention; barrier materials; histomorphology; mesothelial cells; peritoneal adhesion


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