Comparison of the effects of Mitomycin-C and sodium hyaluronate/carboxymethylcellulose [NH/CMC] (Seprafilm) on abdominal adhesions.

Ismail Hakkı Ozerhan,Funda Demirag,Aytekin Unlu,Nail Ersöz,Gokhan Yagci,Ulvi Mehmet Meral,Murat Urkan

doi:10.1186/s40064-016-2359-2

Abstract

IntroductionIntra-abdominal adhesions (IA) may occur after abdominal surgery and also may lead to complications such as infertility, intestinal obstruction and chronic pain. The aim of this study was to compare the effects of Mitomycin-C (MM-C) and sodium hyaluronate/carboxymethylcellulose [NH/CMC] on abdominal adhesions in a cecal abrasion model and to investigate the toxicity of MM-C on complete blood count (CBC) and bone marrow analyses.MethodsThe study comprised forty rats in four groups (Control, Sham, Cecal abrasion + MM-C, and Cecal abrasion + NH/CMC). On postoperative day 21, all rats except for the control (CBC + femur resection) group, were sacrificed. Macroscopical and histopathological evaluations of abdominal adhesions were performed. In order to elucidate the side effects of MM-C; CBC analyses and femur resections were performed to examine bone marrow cellularity.ResultsCBC analyses and bone marrow cellularity assessment revealed no statistically significant differences between MM-C, NH/CMC and control groups. No significant differences in inflammation scores were observed between the groups. The MM-C group had significantly lower fibrosis scores compared to the NH/CMC and sham groups. Although the adhesion scores were lower in the MM-C group, the differences were not statistically significant.ConclusionDespite its potential for systemic toxicity, MM-C may show some anti-fibrosis and anti-adhesive effects. MM-C is a promising agent for the prevention of IAs, and as such, further trials are warranted to study efficacy.

Highlights

Intra-abdominal adhesions (IA) may occur after abdominal surgery and may lead to complications such as infertility, intestinal obstruction and chronic pain
We hypothesized that the two agents would significantly reduce IAs
We investigated the toxicity of MM-C by complete blood count (CBC) analysis and examination of rat bone marrow specimens in the groups that received MM-C and in the control group

Summary

Introduction

Intra-abdominal adhesions (IA) may occur after abdominal surgery and may lead to complications such as infertility, intestinal obstruction and chronic pain. Intraabdominal adhesions (IAs) are among the leading causes of postoperative complications (Celebioglu et al 1999). Postoperative IAs have a significant impact on morbidity (chronic pain, infertility, partial or complete small bowel occlusion, etc.) rates and increase the workload in surgical units (Celebioglu et al 1999; Sulaiman et al 2001; Brüggmann et al 2010). It has been reported that up to 100 % of patients develop IA after surgical interventions (Sulaiman et al 2001; Brüggmann et al 2010) These patients frequently require a secondary adhesiolysis procedure and 8–32 % of these patients develop recurrent obstruction after the initial adhesiolysis procedure (Ellis 1997). Prevention of IAs have been addressed by numerous experimental studies, with limited success rates (Kamel 2010; Maciver et al 2011)

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