In Situ Forming Injectable Gelatin-Based Antibacterial Bioadhesives for Preventing Postoperative Leakage and Abdominal Adhesions

Postoperative anastomotic leakage (AL) and abdominal adhesions are two major complications after intestinal surgery, with an incidence of 2-25% for AL and 93% for adhesion. Until now, there is no method addressing AL and abdominal adhesions simultaneously. In this work, Bi-PEG-succinimidyl succinate (PEG-NHS), amino-gelatin (Agel) is combined with cefoperazone-sulbactam (SCF) to prepare a multifunctional bioadhesive (SCF/SEAgel) for the postoperative leakage and adhesion prevention. SCF/SEAgel possesses a great sealing capability for tissue, with a bursting pressure of 54 kPa. The loaded SCF endows the systems with good antibacterial properties. The in vivo antiadhesion experiments show that SCF/SEAgel possesses better anti-adhesion properties than the commercially used sodium hyaluronate gel. In the cecum leakage model, the SCF/SEAgel effectively seals the leakage with a survival rate of 100%, superior to commercial products (Sainaoning). Meanwhile, it significantly reduces tissue adhesion. Finally, the laparoscopic surgery with dogs shows that the SCF/SEAgel can be injected through minimally invasive surgery, demonstrating its ease of use. Combined with its great biocompatibility, SCF/SEAgel is very promising in intestinal surgery.