Abstract
BackgroundPostoperative peritoneal adhesion formation following abdominal surgery remains a relevant surgical problem. The application of soluble physico-chemical barriers like 4% icodextrin is one approach to protect the peritoneal surface from getting linked to adhesive scar. The aim of this study was to investigate the influence of 4% icodextrin on peritoneal tissue response both of visceral and parietal peritoneum, adhesion formation and wound healing.Methods40 rats were divided into two groups. After creation of an intraabdominal defect, either 4% icodextrin (Adept®) or sodium chloride was applied. Animals were sacrificed after 7 and 21 days. Adhesions were scored by an adhesion score. Furthermore, immunohistochemical investigations were conducted to determine the discrete influence of icodextrin on the parietal and visceral peritoneal tissue responses (CD68+ macrophages, CD3+ T-lymphocytes, vimentin for mesenchymal cells, HBME-1 for mesothelial cells, and as components of wound healing COX-2, C-myc, catenin).ResultsPostoperative peritoneal adhesions were predominantly present in the sodium chloride group as compared to the icodextrin group (14/19 (74%) vs. 9/19 (47%); p = 0.048). The adhesion score however did not reveal any significant differences, (p = 0.614). Furthermore, the expression of vimentin in both the parietal and visceral peritoneum after 21 days was significantly lower in the icodextrin group than in the sodium chloride group (p = 0.038 and p = 0.028, respectively). No significant differences were observed for macrophages, lymphocytes, reperitonealisation or the expression of COX-2, C-myc or Catenin.ConclusionsThe intraperitoneal application of 4% icodextrin reduces adhesion formation in comparison to sodium chloride. 4% icodextrin solution reduces the inflammatory and mesenchymal infiltrate in the wounded area, thus improving the ratio of mesothel cells to mesenchymal infiltrate. As demonstrated, icodextrin is able to ameliorate the local tissue response. Further experimental studies would be done to elaborate the impact on the early response of the adaptive immune system, which may then trigger the subsequent wound healing and tissue repair.
Highlights
Postoperative peritoneal adhesion formation following abdominal surgery remains a relevant surgical problem
The aim of this study was to determine the impact of icodextrin on the local tissue response of visceral and parietal peritoneum in comparison to sodium chloride in a rat model, and to analyse the potential inflammatory response markers (CD68, CD3 and COX-2), wound healing (C-myc, catenin), mesothelium regeneration and cell integrity
Two rats died during surgery because of anesthesia complications
Summary
Postoperative peritoneal adhesion formation following abdominal surgery remains a relevant surgical problem. The application of soluble physico-chemical barriers like 4% icodextrin is one approach to protect the peritoneal surface from getting linked to adhesive scar. The formation of postoperative peritoneal adhesions after abdominal surgery remains a major surgical problem causing complications like obstipation and ileus [1,2,3]. Peritoneal adhesion rates higher than 90% after abdominal surgery have previously been reported [4,5]. Intraabdominal application of various substances including hyaluronic of icodextrin on adhesion formation [9]. Tissue surfaces are kept apart by flotation offering a sufficient barrier for adhesion formation [11,12,13]. No local or systemic side-effects have been described during metabolism and degradation of icodextrin [12,14,15]
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