Auswirkungen der intraabdominellen Applikation von Phospholipiden auf Wundheilung und Adhäsionsbildung

Abstract

Background: Adjuvant therapy is needed to prevent adhesion formation as a major cause of postoperative morbidity and mortality. Previously published data proved the efficacy of phospholipids (PL) for this indication; however, additional information on drug safety was still outstanding. This study was designed to investigate the influence of phospholipids on three different types of healing tissue. Materials and Methods: A total of 48 Chinchilla rabbits underwent median laparotomy, standardized abrasion of the visceral and parietal peritoneum, jejunal anastomosis, and an electrocautery incision of the liver. The operation was completed by intraperitoneal administration of 10 ml/kg of either normal saline (NaCl, 0.9%) or phospholipids (PL, 12%). After intervals of 5 and 10 days, respectively, 50% of the surviving animals were sacrificed and adhesions were measured using a digitizer board. The fresh 10-cm long segment of the jejunum carrying the anastomosis was examined using a bursting experiment. Tensile strength of the midline laparotomy wound was assessed. Specimens of the scar tissue of liver, anastomosis, and abdominal wall were stained with Sirius red and Fast green to determine the collagen protein ratio. Results: After 5 (NaCl 691 mm2 vs. PL 192 mm2 ) and after 10 days (NaCl 625 mm2 vs. PL 88 mm2) the control group presented with significantly larger adhesion areas (p < 0.05). The bursting pressure of the anastomosis on the fifth (NaCl 16.1 kPa vs. PL 18.2 kPa) and tenth (NaCl 19.7 kPa vs. PL 18.6 kPa) postoperative day showed no statistically significant difference. The tensile strength of the laparotomy wound measured after intervals of 5 (NaCl 8.5 N cm-1 vs. PL 6.8 N cm-1) and 10 days (NaCl 23.0 N cm-1 vs. PL 20.2 N cm-1) was not statistically different either. The collagen protein ratio of anastomoses, laparotomy wounds, and liver incisions, as well as the inflammatory reparative response of the different tissues, were not affected by PL. Conclusions: These results prove the efficacy of phospholipids in adhesion prevention. The findings of uncompromised healing of anastomoses, laparotomy wounds, and liver incisions reveal the safety of this agent. Further data may qualify phospholipids for a clinical trial.