A Comparative Study of Tissue Response to Implantation of Two-Component Hemostatic Sodium Salt of Carboxymethyl Cellulose Sponges in a Chronic in Vivo Test

Abstract

Background. Currently, cases of damage to parenchymal organs for various reasons remain widespread. Most often, damage results from trauma and various surgical interventions. In modern surgical practice, a wide range of application hemostatic agents is increasingly used to stop bleeding from parenchymal organs. Hemostatic sponges are most widely used for these purposes. The advantage of this technique to stop bleeding is that the porous structure provides a high degree of adhesion to the wound surface without additional fixation and trauma to surrounding tissues.The aim of research was to comparatively study the body tissue response to implantation of two-component hemostatic sodium salt of carboxymethyl cellulose (Na-CMC) sponges in a chronic in vivo test.Materials and methods. The study materials included: a two-component sponge hemostatic Na-CMC-based agent (No. 1) (an experimental sample developed in KSMU, Russia), a collagen hemostatic sponge (No. 2) (JSC "Zelenaya Dubrava", Russia), "TachoComb" ( No. 3) (Takeda, Austria), Surgicel Fibrillar (No. 4) (Johnson Johnson, USA). Rabbits were subjected to a median laparotomy under inhaled anesthesia in the laboratory of experimental surgery and oncology at the Scientific Research Institute of Emergency Medicine, Federal State Budgetary Educational Institution of Higher Education KSMU, Ministry of Health of Russia; the animals were also simulated a superficial liver injury. This was followed by the application of tested samples of hemostatic products. In 1, 3, 7, 14 days after surgery, each animal underwent control-dynamic laparoscopy with the macroscopic assessment of the following parameters: the presence/absence and nature of pathological changes in the abdominal cavity (signs of inflammation, effusion, its nature and quantity), the severity of the adhesive process, the prevalence of adhesions, and the morphology of adhesions.Results. The lowest prevalence and severity of the adhesive process were observed under hemostatic Na-CMC sponge application. Statistically significant differences were obtained when comparing the prototype with all the study groups.Conclusion. After interventions two-component Na-CMC-based sponge application results in minimal manifestations of adhesions in the abdominal cavity of laboratory animals (1.3 times lower than in all comparison groups, p0.05). In all cases, the authors detected cord-like adhesions; their morphological substrate was a strand of the greater omentum. However, in spite of the presence of adhesions in the abdominal cavity, there were no clinically supported data on the development of adhesive intestinal obstruction. No signs of local or widespread peritonitis were detected in any of the animals.