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Postoperative adhesion is a serious and frequent complication, but there is currently no reliable anti-adhesive barrier available due to low tissue adhesiveness, undesirable chemical reactions, and poor operability. To overcome these problems, we report a single-syringe hotmelt tissue adhesive that dissolves upon warming over 40 °C and coheres at 37 °C as a postoperative barrier. Tendon-derived gelatin was conjugated with the ureidopyrimidinone unit to supramolecularly control the sol-gel transition behavior. This functionalization improved bulk mechanical strength, tissue-adhesive properties, and stability under physiological conditions through the augmentation of intermolecular hydrogen bonding by ureidopyrimidinone unit. This biocompatible adhesive prevented postoperative adhesion between cecum and abdominal wall in adhesion models of rats. This hotmelt tissue adhesive has enormous potential to prevent postoperative complications and may contribute to minimally invasive surgery. STATEMENT OF SIGNIFICANCE: There is a strong need to develop medical tissue adhesives with high biocompatibility, tissue adhesiveness, and operatability to prevent postoperative complications. In this report, single syringe, hotmelt-type tissue adhesive was developed by controlling sol-gel transition behavior of gelatin through supramolecular approach. The functionalization of gelatin with quadruple hydrogen bonding improved key features necessary for anti-adhesive barrier including bulk mechanical strength, tissue adhesive property, stability under physiological conditions, and anti-adhesive property. The hotmelt tissue adhesive can be used for a sealant, hemostatic reagent, and wound dressing to prevent postoperative complications including delayed bleeding, perforation, and inflammation and contribute to minimally invasive surgery.

Aortic anastomotic leak is a potentially fatal complication that can occur after treatment of aortic dissection or aneurysm. Several surgical adhesives have been used to prevent this complication, but all have problems with regard to tissue adhesion or biocompatibility. In the present study, we developed a surgical adhesive composed of boric acid-protected catechol groups-modified Alaska pollock-derived gelatin (Cat-ApGltn) and a poly(ethylene glycol)-based crosslinker (4S-PEG). By avoiding oxidation of catechol groups using boric acid, resulting Cat-ApGltn adhesive formed a strong hydrogel by double crosslinking: chemical crosslinking by 4S-PEG, and chemical and physical crosslinking by the catechol groups. The catechol groups modification contributed to increased bulk strength and decreased gelation time/swelling ratios. The Cat-ApGltn adhesive, in which 7.8 mol% of the amino groups of the original ApGltn (Org-ApGltn) were modified with catechol groups, demonstrated 2.3 times higher burst strength compared with the Org-ApGltn adhesive, and 3.9 times higher burst strength compared with a commercial fibrin adhesive. When the Cat-ApGltn adhesive was implanted subcutaneously into rats, it induced only weak inflammation similar to that induced by the Org-ApGltn adhesive, and was completely degraded within 2 months. Therefore, the Cat-ApGltn adhesive has great potential for use in the field of cardiovascular surgery.