The role of aerosolized intraperitoneal heparin and hyaluronic acid in the prevention of postoperative abdominal adhesions

Abstract

Intraperitoneal adhesions are a common and serious problem following abdominal surgery. Significant research has been performed to investigate the mechanisms involved; however, this has not influenced the incidence; it is still the leading cause of intestinal obstruction, pelvic pain, and infertility in women. The purpose of this study was to evaluate the ability of aerosolized heparin and hyaluronic acid for the prevention of postoperative adhesions. A survival pig model was employed (N = 40). The pigs underwent laparoscopic insertion of polypropylene mesh to create intraperitoneal adhesions. The animals were randomized into four groups: control (n = 10), aerosolized heparin (n = 10), aerosolized hyaluronic acid (n = 10), and aerosolized mixture of both agents (n = 10). After a 2-week recovery period, the animals were killed and intraperitoneal adhesions were assessed. All of the animals in the control group suffered postoperative adhesions (10/10) compared with three in the heparin group, two in the hyaluronic group, and one in the mixed group. The number of adhesions per animal and the severity was higher in the control group compared with the therapeutic groups. The mean number of adhesions in the affected pigs also was higher in the control group compared with the therapeutic groups: 3.3 versus 0.4 in heparin group (range 0-2) versus 0.3 in hyaluronic acid group versus 0.1 in the mixed group (p = 0.002). This study has shown that aerosolised heparin and hyaluronic acid is an effective method to prevent postoperative adhesions whether they were used independently or in synergism. However, the best result was when both agents mixed together compared with the control. A human-based study will be the next step to confirm the success of these agents.