Balance of antiperitoneal adhesion, hemostasis, and operability of compressed bilayer ultrapure alginate sponges

In surgery, both antiperitoneal adhesion barriers and hemostats with high efficiency and excellent handling are necessary. However, antiadhesion and hemostasis have been examined separately. In this study, six different ultrapure alginate bilayer sponges with thicknesses of 10, 50, 100, 200, 300, and 500 μm were fabricated via lyophilization and subsequent mechanical compression. Compression significantly enhanced mechanical strength and improved handling. Furthermore, it had a complex effect on dissolution time and contact angle. Therefore, the 100 μm compressed sponge showed the highest hemostatic activity in the liver bleeding model in mice, whereas the 200 μm sponge demonstrated the highest antiadhesion efficacy among the compressed sponges in a Pean crush hepatectomy-induced adhesion model in rats. For the first time, we systematically evaluated the effect of sponge compression on foldability, fluid absorption, mechanical strength, hemostatic effect, and antiadhesion properties. The optimum thickness of an alginate bilayer sponge by compression balances antiperitoneal adhesion and hemostasis simultaneously.