Chemical Scalpel: An Experimental Collagenase-Based Treatment for Peritoneal Adhesions

SIMPLE SUMMARY: Intraperitoneal adhesions are bands of scar tissue that occur frequently after abdominal surgery. These scars bind the abdominal organs together, producing symptoms such as intestinal obstruction, infertility, chronic pain, and a greater risk of injury in subsequent surgery. Currently, the only treatment approach for this disease is a risky surgical intervention that may cause additional adhesions or other complications. In this article we propose the use of collagenase in the peritoneal cavity to facilitate adhesion disruption. Using a simple experimental rat model, we produced an array of adhesions resembling those presented in humans. We demonstrate that the application of collagenase at the concentration and time described is safe and facilitates the disruption of adhesions with no organ damage due to contact with collagenase. The further development of this therapy and application route, published for the first time in this article, may improve the quality of life of patients with this disease. ABSTRACT: (1) Background: Abdominal adhesions are a common disease appearing after any type of abdominal surgery and may prolong surgical time and cause intestinal obstruction, infertility, or chronic pain. We propose the use of intraperitoneal collagenase to perform chemical adhesiolysis based on the pathophysiology and histology of adhesions. (2) Methods: We generated an adhesion model with intraperitoneal polypropylene meshes. Four months later, we evaluated the efficacy of the treatment in blinded form, i.e., 0.05% collagenase vs. placebo at 37 °C for 20 min. Protocol 1: Ten rats with ten mesh fragments, in which an attempt was made to remove the maximum number of meshes in a 5-min period. Protocol 2: Six rats with four mesh fragments in the sides of the abdominal cavity in which adhesiolysis was performed using a device that measures burst pressure. (3) Results: Protocol 1: 42% efficacy in the collagenase group versus 8% in the control group (p < 0.013). Protocol 2: 188.25 mmHg (SD 69.65) in the collagenase group vs. 325.76 mmHg (SD 50.25) in the control group (p < 0.001). (4) Conclusions: Collagenase allows for the safe and effective chemical adhesiolysis in this experimental model of adhesions.