# An Injectable Zwitterionic Hydrogels with Multiple Intermolecular Interactions for Effective Prevention of Abdominal Adhesions

## TL;DR

A new injectable hydrogel prevents abdominal adhesions after surgery by combining multiple molecular interactions and outperforms existing treatments.

## Contribution

An injectable hydrogel with multiple intermolecular interactions is developed to prevent abdominal adhesions and inflammation more effectively than current methods.

## Key findings

- The PSA-ZnO hydrogel reduced peritoneal adhesions in rats at 7 and 14 days post-surgery.
- The hydrogel showed >95% bacterial clearance and improved wound healing compared to commercial products.
- It prevents foreign body formation by inhibiting blood clot organization and fibrin accumulation.

## Abstract

Postoperative abdominal adhesions are the most common complication following abdominopelvic surgery, posing a significant burden on patients, clinicians, and society. However, current physical barriers often involve a tradeoff between preventing these adhesions and inhibiting inflammation. Herein, a one‐stone‐two‐birds strategy is presented to address this challenge through an injectable intertwined hydrogel containing sulfobetaine, modified aminocaproic acid (A6ACA), and ZnO nanoparticles (PSA‐ZnO hydrogel). This intertwined network is stabilized by multiple intermolecular coordination bonds, including hydrogen bonds and electrostatic interactions—enabling facile injection and resistance to abdominal creep stress. Experimental results demonstrate that PSA‐ZnO hydrogel fully reduce the severity of peritoneal adhesions in treated rats at both 7‐ and 14‐days post‐surgery, outperforming commercially available hyaluronic acid (HA) gel due to its superior antifouling, antibacterial (> 95% clearance of E. coli and S. aureus,), hemostatic (55 s), and wound healing properties (IL‐6 and TNF‐α decreased and VEGF increased). Unlike conventional barriers, PSA‐ZnO prevents foreign body formation by inhibiting blood clot organization and pathologic fibrin accumulation at wound sites. This integrated approach offers a clinically translatable solution for complete prevention of postoperative adhesions and inflammation, with the potential to improve patient outcomes and reduce healthcare burdens.

An injectable PSA‐ZnO through multiple intermolecular including hydrogen bonds and electrostatic interactions for effectively prevents abdominal adhesions. The PSA‐ZnO hydrogel demonstrates superior wound healing promotion (≥ 95%) and more effective inhibition of scar formation compared to the commercial 3M dressing (≈80%), and prevents post‐operative abdominal adhesions superiorly compared to commercial anti‐adhesion HA gel.