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Published on: August 11, 2018
Addition of nimesulide to small intestinal submucosa biomaterial inhibits postsurgical adhesiogenesis in rats
Mark A Suckow1, Jason P Hodde, William R Wolter
1Freimann Life Science Center, University of Notre Dame, Notre Dame, IN 46556, USA. suckow.1@nd.edu
Abstract:
Adhesion formation is a common complication in abdominal surgery with incidence as high as 93% and small bowel obstruction a common complication. Because the extracellular matrix material, small intestinal submucosa (SIS), is commonly used in various surgical procedures, methods to inhibit adhesiogenesis are of great interest. This study was undertaken to determine if incorporation of nimesulide (NM), a selective cyclooxygenase (COX)-2 inhibitor, could reduce the extent and tenacity of intraabdominal adhesion formation associated with SIS implantation. Female Sprague-Dawley rats underwent a cecal abrasion surgical procedure to induce adhesiogenesis. Rats were either left untreated or treated by direct application over the injured cecum with polypropylene mesh (PPM); SIS; SIS containing a low dose of NM; or SIS containing a high dose of NM. Rats were euthanized 21 days later, and adhesion extent and tenacity were evaluated using standard scales (0 = minimal adhesiogenesis; 4 = severe adhesiogenesis). Addition of NM to SIS resulted in a significant (p < 0.05) reduction in adhesion extent and in a similar reduction in adhesion tenacity for SIS containing a low dose of NM. Adhesions typically extended from the abraded cecal surface to the body wall and were characterized histologically by fibrous tissue adherent to the cecal wall. In conclusion, addition of the nonsteroidal anti-inflammatory, COX-2 selective drug, NM, to SIS attenuates adhesion extent and tenacity when compared with surgical placement of SIS or PPM alone.
Insights
Incorporating nimesulide (NM) into small intestinal submucosa (SIS) significantly reduces intra-abdominal adhesion formation and tenacity after abdominal surgery. This finding offers a promising strategy to mitigate surgical complications like small bowel obstruction.
Area of Science:
- Surgical Innovation
- Biomaterials Science
- Pharmacology
Background:
- Adhesions are a frequent surgical complication, affecting up to 93% of patients and potentially causing small bowel obstruction.
- Small intestinal submucosa (SIS) is a widely used biomaterial in surgery, but its use can be associated with adhesion formation.
- Inhibiting adhesion formation (adhesiogenesis) is crucial for improving surgical outcomes.
Purpose of the Study:
- To investigate the efficacy of nimesulide (NM), a selective cyclooxygenase (COX)-2 inhibitor, in reducing intra-abdominal adhesions.
- To evaluate the impact of incorporating NM into SIS on adhesion extent and tenacity.
- To compare the anti-adhesion effects of NM-loaded SIS with untreated controls, polypropylene mesh (PPM), and plain SIS.
Main Methods:
- A rat model of intra-abdominal adhesion was induced using a cecal abrasion procedure.
- Rats were treated with either no treatment, PPM, SIS, SIS with low-dose NM, or SIS with high-dose NM applied directly to the injured site.
- Adhesion extent and tenacity were quantitatively assessed 21 days post-surgery using established scales.
Main Results:
- Direct application of SIS containing nimesulide (NM) led to a statistically significant reduction (p < 0.05) in both the extent and tenacity of intra-abdominal adhesions.
- A low dose of NM incorporated into SIS demonstrated a notable decrease in adhesion formation and strength.
- Histological analysis revealed reduced fibrous tissue adherence to the cecal wall in NM-treated groups.
Conclusions:
- The addition of nimesulide (NM) to small intestinal submucosa (SIS) effectively attenuates the formation and reduces the tenacity of intra-abdominal adhesions.
- NM-loaded SIS presents a promising therapeutic approach to mitigate adhesion-related complications following abdominal surgery.
- This study highlights the potential of targeted COX-2 inhibition using NM within a surgical biomaterial to improve patient outcomes.
