Abstract
Infertility has been a common postoperative problem caused by peritoneal adhesions. Since several prophylactic agents have recently shown promising preliminary results, more complete studies comparing their real efficacy and safety are needed urgently. The aim of this study was to investigate and describe practical considerations of a porcine model that can be used to assess such prophylactic agents. First, 10 healthy 5½ months old female pigs (24.3–31.3 Kg) underwent a standardized laparoscopy to provoke peritubal adhesion formation without prophylactic agents. After 30 days, a second-look laparoscopy was performed to evaluate adhesions and perform adnexectomy for histopathological evaluation. Adhesions at different sites were classified by grade, for which the scores range from 0 (no adhesion) to 3 (very strong vascularized adhesions), and also by area, with scores ranging from 0 (no adhesion) to 4 (>75% of the injured area). The histopathological evaluation of the distal uterine horns, oviducts and ovaries were compared withthose from a control group of six healthy pigs with no previous surgery. Biological samples were collected to assess vitality, inflammation and renal, hepatic and hematopoietic systems. There were small (but significant) changes in serum albumin (P = 0.07), globulin (P = 0.07), C-reactive protein (P = 0.011), fibrinogen (P = 0.023) and bilirubin (P<0.01) after 30 days, but all values were within the normal range. No inflammation or abscess formation was observed, but different degrees of adhesion were identified. The estimated occurrence of adhesion (scores >0) and of strong / very strong adhesion (scores >1) was 75% (95% CI: 55–94.9) and 65% (95% CI: 45–85), respectively. The porcine model represents a useful animal platform that can be used to test the efficacy and safety of candidate prophylactic agents intended to prevent postoperative peritubal adhesions formation. We present several practical considerations and measures that can help to minimize animal suffering and avoid problems during such experiments.
Highlights
Abdominal intraperitoneal postoperative adhesions are fibrous bands that span two or more organs or the inner abdominal wall
Body mass index (BMI) and several preoperative inflammatory blood biomarkers have emerged as potential predictors of post-operative abdominal adhesion formation [2], recent reviews emphasize their shortcomings and affirm that optimal approaches to adhesion formation prevention still elude us
The estimated occurrence of adhesion and of strong / very strong adhesion was 75% and 65%, respectively
Summary
Abdominal intraperitoneal postoperative adhesions are fibrous bands that span two or more organs or the inner abdominal wall. Such adhesions usually develop as a consequence of the healing process in peritoneum that was injured during surgery, regardless of the surgical approach [1]. Several articles have suggested priorities for future research. Future studies, these authors say, should consider how adhesion prophylaxis can preserve fertility, include assessments of the safety of the prophylactic agents, assess adhesions in a uniform or standardized way, and present complete statistical analyses [10,11]. The authors call for non-industry funding so that the research is untainted by pharmaceutical manufacturers’ financial support [10,12]
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