UNAIR NEWS – Intraperitoneal Adhesion in the abdominal cavity is one of serious cases for surgeon. In short word, adhesion intraperitoneal is an adhesion between the surface of the organs and the abdominal wall after surgery.

From a series of adhesion intraperitoneal problems and experimental trials in overcoming efforts, Universitas Airlangga students conducted research to find that hydrogels through a series of in vitro tests could inhibit intraperitoneal adhesion.

This research conducted by Wilda Kholida Annaqiyah, Ainia Rahmah Aisyah, Claudia  Yolanda Savira, Yolanda Citra Ayu Priskawati , and Titin Widya Anjar Sari. It been written on research proposal Student Creativity Program of Exacta Research (PKMPE), under supervision of Dr. Prihartini Widiyanti, drg., M.Kes., S.Bio,CCD., and succeeded get funding by Kemenristekdikti on PKM 2016 – 2017.

Wilda Kholida Annaqiyah, the leader of the team, said that according to etiology, intraperitoneal adhesion is a tissues formation or pathological bonding that occurs between omentum, the intestine and abdominal wall which is congenital or may be a post-inflammatory or postoperative reaction. This bond may be a thin connective tissue layer, a thick fibrous connection containing blood vessels and nerves, or direct adhesions between the two organs (Arung, 2011; Binda, 2004; Schoman, 2009).

Adhesion occurs to post-surgery person; even sometimes it occurs in open surgery or laparoscopy. Adhesion considered as serious case because it makes affects, includes, Intestinal obstruction, infertility (sterility), chronic abdominal pain, serious complications that require to more surgery and even lead to death.

Intraperitoneal Adhesion prevalence is up to 67-93% after laparotomy surgery and is up to 97% of gynecology surgery. Adhesion between injury and omentum occurs on 80% patient and 50% involving intestine. For more than 34% people with adhesion would be hospitalized due to complication with death rate 4,6 – 13% (hellebrekers et al, 2011)

According to Arlad based on Prasetyo (2012), In Indonesia the incidence of obstruction caused by peritoneal adhesion was in second position or third position after inguinal hernia and colonic malignancy. Intraperitoneal adhesion was also the common cause of obstructive ileus.

In Indonesia, recorded that 7.059 ileus paralytic obstruction cases and obstruction without hernia who been hospitalized, and 7.024 outpatient in 2004 (Bank Data of Health Department based on Romadhan, 2012). The obstruction caused by adhesion grows up to 5% from patient who had abdominal surgery in their life (Sabara in Romadhan, 2012)

To preventive intraperitoneal adhesion, they conducted several researches related to physical barrier to avoid adhesion by drugs/pharmacology agent, liquid barrier and solid barrier.  But chemical drugs such as corticosteroids, anticoagulants, antibiotics, fibrinolytics and hormones were considered inadequate and ineffective in treating intraperitoneal adhesion. Meanwhile, liquid barrier such as NaCl, ringer lactate and polymer solution N, O-carboxymethil chitosan (NOCC) carboxymethil cellulose (CMC), although, it used for in large quantities in its application absorbed too quickly (Grainger et al, 1991). The most used liquid is hypertonic solution 32% dextran 70, but, it gradually abandoned due to the serious complication (Dizerga, 2000)

Meanwhile, for solid barrier such as membrane and film in its application still remain practical complicated and only able to avoid particular areas, even, some of them could aggressively stick to surgeon’s gloves during the application (Attard et al, 2007)

In order to handle the drawbacks in treating intraperitoneal adhesion, so in this research, they formed physical barrier, it is hydrogel form to prevent adhesion occurs during healing process of injury tissues.

Hydrogel has the advantage of being able to cover the wound area and the entire surface of the organ with a complex geometry when injected into the body, so it could be a physical barrier or direct contact between the abdominal wall and inter-organ surfaces during tissue healing (Balakrishnan et al, 2005).

This hydrogel made with methylcellulose-based and hyaluronic acid materials and the addition of nano silver (AgNPs). Methylcellulose and hyaluronic acid were selected due to their biocompatible, biodegradable and non-toxic properties. In addition to that,  Hyaluronic acid is known to increase the proliferation of peritoneal mesothelial cells (Reijnen et al, 2000). While nano silver serves as an anti-bacterial agent because the prevalence of infection by bacteria in the sterile abdominal cavity is large enough.

To figure out the potential of hydrogel, it will pass several series of in vitro test, namely swelling test to discover the ability of inflating and absorbing body fluids. Then, Degradation test to see how long the sample persisted in the body meanwhile, cytotoxicity test to discover the toxic properties of the sample. Then antibacterial test to see the antibacterial ability of nano silver, and Fourier Transform Infra Red (FTIR) test to describe chemical bond of the material.

“So this hydrogel has been through a series of in vitro tests and meet as an anti-intraperitoneal adhesion barrier. We expect that the results of this research can serve as a reference in the medical field for the application of anti-intraperitoneal adhesion agents and can be continued in the in vivo test and clinical trials, “Wilda Kholida Annaqiyah said. (*)

Editor: Bambang Bes