Investigating the effect of human amniotic membrane gel to minimize adhesions in endometriosis: findings from an experimental study using a rat model.

OBJECTIVE

Postoperative adhesions and inflammation remain major challenges following endometriosis surgery. Human amniotic membrane gel (HAG) has emerged as a potential therapeutic strategy with both anti-adhesive and anti-inflammatory properties. This study aimed to evaluate the efficacy of intraperitoneal HAG in reducing adhesion severity, lesion persistence, and inflammatory cytokine levels in an experimental rat model of endometriosis.

METHODS

Forty-four adult female Wistar rats underwent surgical induction of endometriosis through autotransplantation of uterine horn tissue. After 3 weeks, the animals were randomized into two groups (n=22 each): one receiving intraperitoneal HAG and the other receiving normal saline during a second laparotomy. Adhesion severity was evaluated using the Hoffmann and Lauder scoring systems. Two weeks after the intervention, endometriotic lesion size was measured. Serum levels of interleukin (IL)-6 and IL-1β were assessed at three time points. Histopathological examination was conducted to evaluate the presence of endometriotic tissue, fibrosis, abscess formation, and adipose tissue remodeling.

RESULTS

Rats treated with HAG showed a significant reduction in lesion size (6.8 mm² vs. 81 mm², p<0.001) and significantly lower adhesion scores (p<0.001). Persistent endometriosis was observed in only 36% of animals in the HAG group compared with 95.5% in the control group (p<0.001). Histological analysis demonstrated fewer fibrotic and purulent reactions and a shift toward adipose tissue remodeling in the HAG-treated animals. Serum IL-6 and IL-1β levels decreased significantly in the HAG group, whereas both cytokines increased in the control group (p<0.001 for both).

CONCLUSION

HAG significantly improved macroscopic, histological, and biochemical outcomes in this experimental model. These findings suggest that HAG may serve as a biologically active adjunct for reducing postoperative adhesion formation and inflammation in endometriosis.