Pirfenidone vs Sodium Hyaluronate/carboxymethyl cellulose as Prevention of the Formation of Intra-abdominal Adhesions After Colonic Surgery. A Randomized Study in an Experimental Model

Abstract

IntroductionUp to 93% of patients undergoing abdominal surgery will develop intra-abdominal adhesions with the subsequent morbidity that they represent. Various substances have been tested for the prevention of adhesions with controversial results; the aim of our study is to compare the capability of pirfenidone in adhesion prevention against sodium hyaluronate/carboxymethylcellulose. MethodsA randomized, prospective, longitudinal experimental study with Winstar rats. They were divided into 3 groups. The subjects underwent an exploratory laparotomy and they had a 4cm2 cecal abrasion. The first group received saline on the cecal abrasion, and groups 2 and 3 received pirfenidone and sodium hyaluronate/carboxymethylcellulose respectively. All rats were sacrificed on the 21st day after surgery and the presence of adhesions was evaluated with the modified Granat scale. Simple frequency, central tendency and dispersion measures were recorded. For the statistical analysis we used Fisher's test. ResultsTo evaluate adhesions we used the Granat's modified scale. The control group had a median adhesion formation of 3 (range 0–4). The pirfenidone group had 1.5 (range 0–3), and the sodium hyaluronate/carboxymethylcellulose group had 0 (range 0–1). There was a statistically significant difference to favour sodium hyaluronate/carboxymethylcellulose against saline and pirfenidone (P<.009 and P<.022 respectively). ConclusionsThe use of sodium hyaluronate/carboxymethylcellulose is effective for the prevention of intra-abdominal adhesions. More experimental studies are needed in search for the optimal adhesion prevention drug.