Intraperitoneal Triamcinolone Reduces Postoperative Adhesions, Possibly through Alteration of Mitochondrial Function.

Neeraja Purandare,Paige Minchella,Sarah Ottum,Jessica Rausch,Conrad R Chao,Siddhesh Aras,Maurice-Andre Recanati,Lawrence I Grossman,Christopher Walker,Katherine J Kramer

doi:10.3390/jcm11020301

Abstract

Adhesions frequently occur postoperatively, causing morbidity. In this noninterventional observational cohort study, we enrolled patients who presented for repeat abdominal surgery, after a history of previous abdominal myomectomy, from March 1998 to June 20210 at St. Vincent’s Catholic Medical Centers. The primary outcome of this pilot study was to compare adhesion rates, extent, and severity in patients who were treated with intraperitoneal triamcinolone acetonide during the initial abdominal myomectomy (n = 31) with those who did not receive any antiadhesion interventions (n = 21), as documented on retrospective chart review. Adhesions were blindly scored using a standard scoring system. About 32% of patients were found to have adhesions in the triamcinolone group compared to 71% in the untreated group (p < 0.01). Compared to controls, adhesions were significantly less in number (0.71 vs. 2.09, p < 0.005), severity (0.54 vs. 1.38, p < 0.004), and extent (0.45 vs. 1.28, p < 0.003). To understand the molecular mechanisms, human fibroblasts were incubated in hypoxic conditions and treated with triamcinolone or vehicle. In vitro studies showed that triamcinolone directly prevents the surge of reactive oxygen species triggered by 2% hypoxia and prevents the increase in TGF-β1 that leads to the irreversible conversion of fibroblasts to an adhesion phenotype. Triamcinolone prevents the increase in reactive oxygen species through alterations in mitochondrial function that are HIF-1α-independent. Controlling mitochondrial function may thus allow for adhesion-free surgery and reduced postoperative complications.

Highlights

Introduction distributed under the terms andThe development of adhesions is a commonly documented finding in patients with a history of abdominal surgery
We found that 2% hypoxia alone significantly increased TGF-β1 levels relative to controls, but in cells treated with triamcinolone, the TGF-β1 levels did not increase
We found that 2% hypoxia alone significantly increased TGF-β1 levels r to controls, but in cells treated with triamcinolone, the TGF-β1 levels did not increa re-exposed the cells that had been hypoxic (2% oxygen for 24 h) back to 20% o

Summary

Introduction

The development of adhesions is a commonly documented finding in patients with a history of abdominal surgery. These fibrous bands can lead to bowel obstruction, chronic pain, dyspareunia, infertility, fistulas, and complications at the time of reoperation [1,2,3]. Adhesions occur regardless of surgical route [8,9,10] and frequently occur after Cesarian sections [11,12] or gynecological surgery [13]. Myomectomy is an important cause of abdominal adhesions [14,15]. Leiomyomas are common benign tumors with a prevalence of 20–40%

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Discussion

Conclusion