Postoperative Intra-abdominal Adhesions Research Articles

Comparison of the effect of Everolimus, Prednisolone, and a combination of both on experimentally induced peritoneal adhesions in rats

Postoperative intra-abdominal adhesions represent a significant post-surgical problem. Its complications can cause a considerable clinical and cost burden. Herein, our study aimed to investigate the effect of Everolimus on peritoneal adhesion formation after inducing adhesions in rats. In this experimental study, adhesion bands were induced by intraperitoneal injection of 3 ml of 10% sterile talc solution in 64 male albino rats. The first group served as the control group. The second one received oral Prednisolone (1 mg/kg/day), the third received Everolimus (0.1 mg/kg/day), and group four received both drugs with similar dosages for four consecutive weeks. The formation of adhesion bands was qualitatively graded according to the Nair classification. The rats in the control group had extensive adhesions between the abdominal wall and the organs. Regarding substantial adhesion formation, 50% (8/16) of animals in the control group had substantial adhesions, while this rate in the groups receiving Prednisolone, Everolimus, and combination treatment was 31%, 31%, and 31%, respectively. Also, 68.75% (5/11) of the Prednisolone recipients had insubstantial adhesions, the same as Everolimus recipients, while in the combination group, 66.66% (10/15) rats had insubstantial adhesions. Everolimus demonstrated satisfactory results in reducing the rates of induced peritoneal adhesion in an experimental model, similar to Prednisolone and superior to a combination regime.

Ovulation provides excessive coagulation and hepatocyte growth factor signals to cause postoperative intraabdominal adhesions

Postoperative adhesions show a higher occurrence in females aged 16-60, especially after pelvic surgeries. This study explores the role of ovulation in adhesion formation in mice. Ovarian surgery in mice with normal- or super-ovulation led to pronounced adhesions, whereas ovulation-defective Pgr-KO mice showed minimal adhesions. Specifically, exposure to ovulatory follicular fluid (FF) markedly increased the adhesion. The hazardous exposure time window was one day before to 2.5days after the surgery. Mechanistically, early FF exposure triggered adhesions via the blood coagulation cascade, while later exposure relied on the HGF/cMET signaling pathway. Prophylactic administration of a thrombin inhibitor pre-operatively or a cMET inhibitor postoperatively effectively mitigated FF-induced adhesions, while COX inhibitor treatment exhibited no discernible effect. These findings underscore ovulation as a pivotal factor in the development of pelvic wound adhesions and advocate for targeted preventive strategies such as c-MET inhibition, scheduling surgeries outside the ovulatory period, or employing oral contraceptive measures.

Ratlarda İntrabdominal Adezyonların Üzerine Trombositten Zengin Plazma’nın Etkisi

Cerrahi alanındaki teknolojik gelişmelere rağmen intraabdominal adezyonlar; kısırlık, abdominaopelvik ağrı ve bağırsak tıkanıklıklarının en önemli nedenlerinden biridir. Bu çalışmada; trombositten zengin plazma (PRP)’nin intraabdominal adezyonların önlenmesindeki etkinliğinin ortaya konulması amaçlandı. Çalışmada 4 aylık 25 adet erkek Spraque Dawley ırkı rat kullanıldı. Ratlar her grupta 10 rat olmak üzere iki eşit gruba ayrıldı. Beş rat ise donör olarak kullanıldı. Bu ratlardan elde edilen kanlardan RRP hazırlandı. Genel anestezi altında operasyonlar klasik cerrahi kurallar altında iliosekal bölge açığa çıkarıldı ve 1 cm2’lik bir bölge travmatize edildi. Birinci grup kontrol olarak değerlendirildi ve herhangi bir kimyasal uygulanmadı. İkinci gruptaki ratlara PRP 0.4 ml dozunda lokal olarak uygulandı. Postoperatif 14. günde relaparatomi yapıldı. Sonuçlar makroskopik ve histopatolojik olarak değerlendirildi. PRP grubunun adezyon derecesi ve fibrozis dereceleri kontrol grubu ile karşılaştırıldığında istatistiksel olarak anlamlı olduğu saptandı (p0.05). Sonuç olarak, PRP’nin intraabdominal adezyonları önlemede daha etkili olduğu saptandı.

Effect of intra-abdominal boric acid in the experimental adhesion model.

The continuous advancement in medical and surgical techniques has led to a rise in the frequency of abdominal operations, subsequently increasing the incidence of intra-abdominal adhesions. Over 90% of laparotomies result in postoperative intra-abdominal adhesions. This study investigates the effect of a 5% boric acid solution on the development of intra-abdominal adhesions in rats, using an adhesion model. This study was conducted with two groups: a control group, in which the adhesion model was applied without any treatment, and a boric acid group, which was treated with a 5% boric acid solution. Each group comprised 16 rats. On the 14th postoperative day, the rats were sacrificed, re-explored, and the developed adhesions were evaluated both macroscopically and microscopically. The data from macroscopic and microscopic scoring were analyzed using the Mann-Whitney U test in the IBM Statistical Package for the Social Sciences (SPSS) Statistics 24 program. A p-value of less than 0.05 was considered statistically significant. This research was supported by the Manisa Celal Bayar University Scientific Research Projects Commission. A statistically significant difference was observed between the boric acid-treated group and the control group, with the boric acid group showing a significant decrease in adhesion development both macroscopically and microscopically (p<0.05). In the future, boron could play a significant role in reducing and preventing intra-abdominal adhesions after surgery. This investigation could pave the way for further research into the mechanism by which boric acid prevents the development of intra-abdominal adhesions. Moreover, it is imperative to explore the potential side effects of intra-abdominal boron application at the optimum concentration of the solution.

Effects of pioglitazone and metformin on abdominal adhesion formation in an experimental model.

This study evaluated the use of metformin or pioglitazone in preventing or reducing the development of post-operative intra-abdominal adhesion (PIAA) by employing histopathological, immunohistochemical, and biochemical analyses in an experimental adhesion model. Fifty Wistar-Albino rats were divided into five groups: Group I (Control), Group II (Sham Treatment), Group III (Hy-aluronic Acid), Group IV (Metformin), and Group V (Pioglitazone). Adhesions were induced in the experimental groups, except for the sham group, using the scraping method. After 10 days, rats were euthanized for evaluation. Macroscopic adhesion degrees were assessed using Nair's scoring system. Immunohistochemical and enzyme-linked immunosorbent assay (ELISA) methods were utilized to assess serum, peritoneal lavage, and intestinal tissue samples. Fructosamine, interleukin-6 (IL-6), transforming growth factor-beta (TGF-β), and fibronectin levels were measured in serum and peritoneal lavage samples. The groups exhibited similar Nair scores and Type I or Type III Collagen staining scores (all, p>0.05). Pioglitazone significantly reduced serum IL-6 and TGF-β levels compared to controls (p=0.002 and p=0.008, respectively). Both metformin and pioglitazone groups showed elevated IL-6 in peritoneal lavage relative to controls, while fibronectin levels in the lavage were lower in pioglitazone-treated rats compared to the sham group (all, p<0.005). Pioglitazone, but not metformin, demonstrated a positive biochemical impact on preventing PIAA formation in an experimental rat model, although histological impacts were not observed. Further experimental studies employing different dose/duration regimens of pioglitazone are needed to enhance our understanding of its effect on PIAA formation.

Effect of carboxymethyl cellulose, icodextrin and hyaluronic acid solutions on postoperative intraabdominal adhesion formation in rabbits and the role of cytokines in intraabdominal adhesion formation

In this study, the aim was to investigate the effects of 1% CMC, 4% ICO and 0.4% HA solutions in preventing postoperative IAs and their contribution to peritoneal wound healing, as well as the relationship of cytokines with the formation of postoperative IAs in rabbits. The material of the study consisted of 32 healthy rabbits. Rabbits underwent median laparotomy following general anesthesia. Serosal abraded was created at the antimesenteric border of the cecum. Next, a 3 × 2 cm peritoneum was excised on the right abdominal wall and the defect was closed using with a 2/0 silk suture. The rabbits were randomly assigned to either of the following four treatment groups: CNT (0.9% NaCl), ICO (4% icodextrin), HA (0.4% hyaluronic acid) and CMC (1% carboxymethyl cellulose). Both cecum and peritoneal surfaces were treated with 20 ml each of treatment solutions. On the 7th postoperative day, the rabbits were euthanized with a lethal dose of sodium pentobarbital and the degree of adhesion was evaluated. Samples taken from the peritoneal defect were examined histopathologically and tissue hydroxyproline levels were measured. Serum TNF-α, IL-1 and IL-6 levels were measured from blood samples taken before the surgery and at 1, 6, 24 and 48 hours after the surgery. It was observed that the adhesion grade in the HA group (p &lt; 0.05) and CMC group (p &lt; 0.01) was significantly lower than the control group. Although peritoneal tissue hydroxyproline levels were lower in the other groups compared to the control group, they were not statistically significant (p &gt; 0.05). In rabbits with adhesion formation, it was determined that TNF-α levels increased at the 6th postoperative hour (p &lt; 0.05), and IL-6 levels increased at the 6th, 24th and 48th postoperative hours (p &lt; 0.001) compared to preoperative. In this study, treating tissues with 0.4% HA and 1% CMC solutions suppressed peritoneal inflammation, and this resulted in an increase in the levels of proinflammatory cytokines TNF-α and IL-6. It has been determined that the application of these solutions reduces postoperative adhesion formation. It was concluded that TNF-α and especially IL-6, which are proinflammatory cytokines, can be a non-invasive biomarker in determining postoperative IA formation and evaluating the adhesive process.

What is the impact of intraperitoneal surfactant administration against postoperative intraabdominal adhesion formation? an experimental study.

Surfactant is a surface-active substance that, in addition to its detergent effect, also has effects that reduce inflammation and fibrosis. Because of these effects, it was aimed herein to investigate the effect of intraperitoneal surfactant application on preventing postoperative peritoneal adhesion formation in a uterine horn adhesion model. Twenty-one Wistar albino rats were randomly divided into 3 groups (G1-G3), as follows: G1 (n = 7): control group. The abdomen was opened and then closed; G2 (n = 7): adhesion group. The abdomen was opened. Then, a 2-cm linear incision was made over the right uterine horn, 2 mL of isotonic saline was administered intraperitoneally, and the abdomen was closed; and G3 (n = 7): treatment group. The abdomen was opened, a 2-cm linear incision was made over the right uterine horn, 2 mL (70 mg/kg) of surfactant was administered intraperitoneally, and the abdomen was closed. After 15 days, the rats were euthanized, the abdomens were reopened, and adhesion scoring was performed. After the right uterine horns were removed and fixed with 10% formalin, appropriate sections were taken from the traumatized tissue, stained with Masson's trichrome, and fibrosis and inflammation scoring were performed. The adhesion area and intensity were significantly higher in G2 than in G1 and G3 (p = 0.001) and were similar in G1 and G3 (p = 0.165). While fibrosis and inflammation were significantly higher in G2 than in G1 and G3 (p = 0.001), there was no difference between G1 and G3 (p = 0.5). Intraperitoneal surfactant administration at a dose of 70 mg/kg was found to be effective in preventing intraabdominal adhesion formation in a rat uterine horn model.

The effect of natural surfactants on the development of postoperative intraabdominal adhesion.

The development of postoperative adhesion after abdominal surgery is sometimes a severe problem. Our study investigates the effectiveness of exogenous surfactant application in preventing adhesion development in the experimental adhesion model. This randomized-controlled interventional study was carried out in the animal laboratory of Kahramanmaraş Sütçü İmam University between March 1 and March 31, 2020. An experimental intra-abdominal adhesion model was established in 24 adult female rats by cecal abrasion. Rats were randomly divided into four groups. Groups I, II, and III were taken intraperitoneally as beractant, poractant, and calfactant applied groups, respectively. Group IV was the control group. Relaparotomy was performed in all groups on the 15th postoperative day, and intra-abdominal adhesions were scored macroscopically according to the Canbaz scoring system. In addition, the cecal regions were evaluated microscopically and scored according to the Zühlke microscopic classification system. The scores of the groups were compared statistically. The Zühlke adhesion development score was significantly lower in the exogenous surfactant applied groups. In addition, when the surfactant-applied groups were compared among themselves, it was seen that the adhesion score in the beractant group was significantly better than the other surfactant types (p < 0.01). Our study results showed that prophylactic intraperitoneal surfactant application significantly reduced postoperative adhesion development, particularly beractant.

Can serum tumor necrosis factor-alpha predict peritoneal adhesions prior to secondary laparoscopic procedures?

This study aimed to investigate the incidence and degree of postoperative intra-abdominal adhesions(POAs) in secondary laparoscopic procedures and assess the power of the preoperative levels of tumor necrosis factor-alpha(TNF-α) and interleukin-1 beta(IL-1β) and selected peripheral inflammatory biomarkers(PIBs) in the prediction of the development and extent of POA. This prospective study enrolled 103 patients who had previously undergone at least one or more laparoscopic abdominal or gynecological operations. We examined TNF-α, IL-1β, and PIBs, namely C-reactive protein, white blood cell count, neutrophil-to-lymphocyte ratio(NLR), platelet-to-lymphocyte ratio, and systemic immune-inflammation index(SII) according to the presence, location, and score of adhesions determined during secondary laparoscopic procedures. Only age, postoperative adhesion index(PAI) score, NLR, SII, TNF-α, and IL-1β resulted in a significant difference in the existence of adhesion(P<0.05). The correlation analysis of TNF-α with variables showed that the PAI score and IL 1β levels had a significantly positive correlation. The presence and extent of POA could be predicted by examining the preoperative TNF-α level in patients who had laparoscopic abdominal surgery previously. We could overcome adverse events during secondary laparoscopic procedures by assessing high-risk patients and integrating a personalized surgical approach to managing selected patients.

English

This study aims to investigate the protective efficacy of fresh (FG) and aged (AG) Taşköprü Garlic (Allium sativum L.) macerated oils prepared in safflower oil at different concentrations against post-operative (PO) intra-abdominal adhesions (PIA). No commercial garlic product was used in the study. AG was produced from Taşköprü Garlic, which is one of the geographically indicated products of the European Union. Then FG and AG were kept at two different concentrations (1.5 g/mL &amp; 2.0 g/mL) in safflower (Carthamus tinctorius L.) oil to get macerated oils of FG15, FG20, AG15 and AG20. After spectrophotometric and chromatographic analyzes of the oils, in vivo experiments were made on rats. A cecal abrasion model was applied to six study groups viz FG15, FG20, AG15, AG20, serum physiologic control and oil control. Their preventive activities against PIA were examined macroscopically and histopathologically at different time points (7th‑14th‑21st days PO). The safflower oil did not give successful results in preventing PIA when used alone. The AG macerated oils, especially AG20, caused negative effects on the injured tissue/organ surfaces due to their high ratio of 2,4‑decadienal content. The macerated oils prepared with fresh Taşköprü Garlic in safflower oil (FG15 and FG20) at the rate of 0.1 mL were found successful agents to prevent PIA by intra-abdominal route without any irritant effect in rats. These oils are considered as low cost clinical/laboratory preparations and can be used in laparotomy/laparoscopy to prevent PIA

Effect of anti-adhesion agents on cytokine profile in an experimental model of postoperative intra-abdominal adhesions

Many attempts have been made to prevent peritoneal adhesions using anti-adhesion agents, barriers and other therapeutic approaches, but their efficacy has not been widely accepted. Purpose – to determine the effects of mezogel, a mixture of metronidazole, dextran, and contrykal enriched with oxygen based on the pro- and anti-inflammatory cytokine concentration in rats with simulated postoperative peritoneal adhesions. Materials and methods. A total of 90 outbred white rats, divided into three groups of 30 animals each, underwent laparotomy and mechanical injury of the small bowel wall until a drop of blood appeared. After mechanical injury of the small bowel wall, the abdominal wound in group 1 animals (control) was closed with a layered suture technique; group 2 animals (comparison) were administered one mL of mezogel into the abdominal cavity before layer-by-layer suturing; group 3 animals (experimental) were introduced one mL of a specially prepared mixture of metronidazole, dextran, and contrykal (in a ratio of 1:1:0.1, respectively) enriched with oxygen into the abdominal cavity before the laparotomy wound was closed. Each surgical intervention lasted 15–20 minutes. On days 5, 10 and 21 of the experiment interleukin (IL) 4, IL-6, IL-10 and tumour necrosis factor alpha (TNF-α) were determined in the blood by enzyme immunoassay using corresponding test kits manufactured by Bender Medsystems (Austria). Results. The levels of the anti-inflammatory cytokines IL-4 and IL-10 increased dynamically in groups 2 and 3, while group 1 showed their decrease. The proinflammatory cytokine IL-6 and TNF-α concentration decreased in the experimental and comparison groups during the study period. On day 5 in groups 2 and 3, compared to group 1, the IL-6 concentration was reduced by 28.4% (p=0.029) and 41.0% (p=0.006), respectively. Group 3 animals had a 17.6% (p=0.043) lower IL-6 level compared to group 2 animals. On days 10 and 21 a dynamic decrease in IL-6 was observed in the animals of groups 2 and 3. Group 3 animals had the lowest TNF-α, 41.9 % (p=0.001) lower than in group 1, and 31.7 % (p=0.118) lower than in group 2. There were significant strong relationships detected between IL-10 and IL-6 in all groups on day 5 of the study. Conclusions. The administration of anti-adhesion agents, mezogel and an oxygen-enriched mixture of metronidazole, dextran, and contrykal, inhibits inflammation, which is expressed as a decrease in the concentrations of IL-6 and TNF-α. These agents lead to a negative interaction of anti-inflammatory cytokines with pro-inflammatory cytokines, in particular IL-4 with IL-6 and IL-10 with IL-6, indicating a greater prophylactic effect. The experiments with laboratory animals were provided in accordance with all bioethical norms and guidelines. No conflict of interests was declared by the authors.

An Overview of Postoperative Intraabdominal Adhesions and Their Role on Female Infertility: A Narrative Review

Postoperative intraabdominal adhesions can occur after more than 90% of gynecologic surgeries. They not only cause chronic pelvic pain and small bowel obstruction, but are also one of the main reasons for infertility. Adhesions are not only a burden for the affected patients, but are also a burden for the healthcare system, since the treatment of adhesion-associated complications costs a considerable amount of money. The gold standard for the diagnosis of adhesions is by laparoscopy, although other methods, such as transvaginal hydro-laparoscopy, are being discussed as better alternatives. Ideally, adhesions are avoided inherently, by operating carefully and by using microsurgical principles. If this is not possible, gel barriers have been shown to be successful in reducing postoperative adhesions.

Multifunctional Microgel-Based Cream Hydrogels for Postoperative Abdominal Adhesion Prevention.

Postoperative abdominal adhesions are a common problem after surgery and can produce serious complications. Current antiadhesive strategies focus mostly on physical barriers and are unsatisfactory and inefficient. In this study, we designed and synthesized advanced injectable cream-like hydrogels with multiple functionalities, including rapid gelation, self-healing, antioxidation, anti-inflammation, and anti-cell adhesion. The multifunctional hydrogels were facilely formed by the conjugation reaction of epigallocatechin-3-gallate (EGCG) and hyaluronic acid (HA)-based microgels and poly(vinyl alcohol) (PVA) based on the dynamic boronic ester bond. The physicochemical properties of the hydrogels including antioxidative and anti-inflammatory activities were systematically characterized. A mouse cecum-abdominal wall adhesion model was implemented to investigate the efficacy of our microgel-based hydrogels in preventing postoperative abdominal adhesions. The hydrogels, with a high molecular weight HA, significantly decreased the inflammation, oxidative stress, and fibrosis and reduced the abdominal adhesion formation, compared to the commercial Seprafilm group or Injury-only group. Label-free quantitative proteomics analysis demonstrated that S100A8 and S100A9 expressions were associated with adhesion formation; the microgel-containing hydrogels inhibited these expressions. The microgel-containing hydrogels with multifunctionality decreased the formation of postoperative intra-abdominal adhesions in a murine model, demonstrating promise for clinical applications.

Effect of intra-peritoneal induction of ascites fluid on the rate of postoperative intraabdominal adhesion in a rat model

IntroductionIntra-abdominal adhesions (IAAs) are secondary to peritoneal injuries such as previous surgery or intra-abdominal infections (IAIs). Accordingly, it is crucial to employ fitting techniques to minimize the likelihood of adhesions in any surgery. Due to a paucity of similar data available, this study sought to explore the effects of induced high serum ascites albumin gradient (SAAG) and low serum ascites albumin gradient (SAAG) on the rate of post-operative microscopic and macroscopic adhesion in a mouse model. Material and methodsSixty mice were compared in six groups of ten each. Control groups (1 &4) received normal saline, groups 2&5 received high SAAG ascites fluid, and groups 3&6 received low SAAG ascites fluid intraperitoneally. These groups underwent exploratory laparotomy on day zero, followed by the same procedure on the 10th (groups 1,2,3) and the 30th (Groups 4,5,6) day of surgery. Then, microscopic and macroscopic IAAs were evaluated. Data were analyzed in SPSS software and compared with a p-value less than 0.05. ResultsBy comparison, the least microscopic and macroscopic IAAs after 10 and 30 days were found in the low SAAG ascites group. Revealing a statistically significant difference compared to the other two groups (P = 0.01). After 10 days of surgery, macroscopic IAA in the high SAAG group was significantly lower compared to the control and Low SAAG ascites groups. ConclusionIntraabdominal low SAAG ascites fluid can significantly decrease the probability of postoperative fibrosis and adhesion band formation. Protocol numberIR. BUMS.REC.1399.503.

Lipid emulsions prevent postoperative abdominal adhesions

IntroductionAdhesions are the most common cause of long-term morbidity after abdominal surgery and most often cause various forms of intestinal passage disorders ranging from partial obstruction to complete, life-threatening intestinal obstruction. The aim of the present study was to evaluate the protective effect of intraperitoneally administered lipid emulsions on the formation of adhesions in larger animal model, as the lubricating effect of phospholipids and the mechanical barrier of the lipid component are combined with the anti-inflammatory effect of fish oil. MethodsThirty-one female domestic pigs were randomly divided into three groups. At the end of the surgical procedure, a lipid emulsion or saline solution was applied intraperitoneally. After 14 days, an independent macroscopic, histological and immunohistochemical evaluation of the adhesions were performed. ResultsIntraperitoneal administration of lipid emulsions significantly reduced the incidence of intra-abdominal adhesions. Microscopic examination demonstrated a significant reduction in the number of inflammatory elements and the amount of collagen in the adhesions, especially after administration of the fish oil-based emulsion. A simultaneous decrease in neovascularization was observed in the adhesions. Evaluation of the intestinal anastomosis did not reveal significant differences in healing between the groups. ConclusionIntraperitoneal administration of lipid emulsions can reduce the development of postoperative intra-abdominal adhesions by the combined action of phospholipids as important lubricants and lipids as a mechanical barrier. Their effect is caused by a reduction in proinflammatory and profibrotic mediators. At the same time, intraperitoneal administration of lipid emulsions does not impair healing of the anastomosis in larger animal model.

Can minimally invasive surgical techniques reduce the incidence of postoperative adhesions?

&lt;br&gt;&lt;b&gt;Introduction:&lt;/b&gt; Postoperative intra-abdominal adhesions are a clinical condition that may develop after any abdominal surgery and constitute the leading cause of mechanical small bowel obstructions.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Aim:&lt;/b&gt; This study investigates factors which influence the formation of postoperative adhesion and evaluates the efficiency of applying minimally invasive surgical techniques in reducing adhesion.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Material and methods:&lt;/b&gt; Patients who underwent surgery to diagnose obstructive ileus in our clinic between January 2015 and January 2020 were analyzed retrospectively. Demographic data of the patients, operation details time between the operations and history of hospitalizations, postoperative mortality and morbidity, as well as the severity of complications were recorded. The patients included in the study were divided into groups according to the surgical technique applied in the first operation (laparoscopy/ laparotomy), the abdominal incision line (upper/lower/total), and the etiology of the primarily operated lesion (benign/malignant).&lt;/br&gt; &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; One hundred eighteen (118) patients were included in the study. The mean age of patients was 61.2 ± 10.8 (39-82) years. Age, ileus history, time to the onset of ileus, length of hospital stay and the number of complications were shorter in the laparoscopy group as compared to the laparotomy group and the difference was found to be statistically significant. In addition, when patients were categorized according to the abdominal incision line, fewer hospitalizations and more frequent postoperative complications due to ileus were observed in the sub-umbilical incision group (p &lt; 0.05).&lt;/br&gt; &lt;br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; Postoperative adhesion formation is currently one of the clinical conditions which pose a challenge to both the patient and the clinician due to its incidence and recurrence. However, adhesion formation can be reduced by applying minimally invasive surgical methods, especially laparoscopic surgery and precise maneuvers during surgery.&lt;/br&gt.

Comparison of the effect of PerClot® powder and a chitosan derivative on postoperative intra-abdominal adhesions in rat animal models.

&lt;b&gt;Aim:&lt;/b&gt; Centered on the significance of postoperative intra-abdominal adhesions and provided that few studies have been conducted on the role of chitosan and hemostatic derivatives in postoperative intra-abdominal adhesions, the objective of this research was to measure the effect of PerClot® (a starch-derived hemostatic compound) and ParsBand (a chitosan derivative) on postoperative intra-abdominal adhesions in the rat animal model. &lt;/br&gt;&lt;/br&gt; &lt;b&gt; Methods:&lt;/b&gt; Median laparotomy and standardized abrasion of the visceral and parietal peritoneum were conducted on a total of 27 Wistar male rats. These rats were randomly classified into 3 groups: PerClot® powder, a chitosan derivative, and a laparotomy-only control group. A relaparotomy for adhesion categorization was implemented seven days after surgery. &lt;/br&gt;&lt;/br&gt; &lt;b&gt; Results:&lt;/b&gt; The mean adhesion degree score in 3 groups was 2 ± 0.87, 2.11 ± 0.78 and 1.67 ± 0.87, respectively. There was no significant disparity between 3 groups in the mean adhesion score (P = 0.571). In comparison, there was no meaningful difference between two groups (group 1 and group 3), (group 2 and 3) and (group 1 and 2) in terms of the mean degree of adhesion (P &gt; 0.05). &lt;/br&gt;&lt;/br&gt; &lt;b&gt; Conclusions:&lt;/b&gt; While the results of most of the studies suggest the anti-adhesive properties of chitosan and hemostatic compounds, these findings have not been met in this study. It suggests, however, that a possible explanation for the discrepancy between the experiments could be due to the use of various derivatives or the different dosage of these compounds.

Prevention of post-surgical adhesion bands by local administration of frankincense n-hexane extract

Backgroundand purpose: The formation of postoperative intra-abdominal adhesion band formation may lead to severe complications. This study aimed to evaluate the preventive effect of local administration of frankincense n-hexane extract (FHE) on the formation of postsurgical adhesion bands. Materials and methodsFHE was extracted from the resin of a Boswellia sacra tree and its components were identified by gas chromatography-mass spectrometry (GC-MS). In an animal model, the expression levels of TNF-α and TGF-β1 cytokines after application of FHE were assessed to check the inflammatory and fibrotic cues, respectively. ResultsFollowing FHE compound analysis, in vivo experiments demonstrated that intraoperative local administration of FHE resulted in the prevention of adhesion band formation. The adhesion grades in the FHE-treated group were significantly lower than those in the negative control (NC) and the positive control (Interceed). The infiltration of inflammatory cells observed by histopathology revealed a significant anti-inflammatory potential of FHE. Furthermore, the gene expression results proved that significant suppression of TNF-α and TGF-β1 was responsible for its antiadhesion properties. ConclusionsThe study reported the potential of FHE as an ointment for the prevention of adhesion bands.

Effect of Sirolimus on Intra-Abdominal adhesion development in a rat model

Objective: Postoperative intraabdominal adhesions still cause significant morbidity in surgical patients. This study aims to evaluate the effects of an immunosuppressor known as Sirolimus and an antiadhesive membrane which is formed with sodium hyaluronate carboxymethylcellulose-based bioresorbable membrane (Seprafilm™) to the intraabdominal adhesion formation in a rat model.&#x0D; Materials and Methods: This experimental study was performed at an experimental research center, Yeditepe University Faculty of Medicine, Istanbul. Spraque-Dawley Rats, at a weight of about 250±20 gr, were used. Group 1 (n=8): Abdomen was closed after applying cecal abrasion (control group), group 2 (n=8): 10 x 30 mm Seprafilm™ was applied under the abdominal wall after cecal abrasion ( Seprafilm™ group ). Group 3 (n =8): Sirolimus (0,5 mg/kg) was applied (Sirolimus group). Adhesions quantitatively evaluated by a blinded assessor according to the classification of Nair and his colleagues.&#x0D; Results: Statistically significant difference in terms of adhesion severity scores according to the Nair classification was found between the Sirolimus and the control group (p=0,03). Whereas, no statistically significant difference was found between the Seprafilm™ and the control group (p=0,17). Similarly, no statistically significant difference was found between Seprafilm™ and sirolimus group (p=0,64).&#x0D; Conclusion: Although there was no statistically significant difference between intraperitoneal application of Sirolimus and Seprafilm™ group (p = 0.57), a statistically significant difference was found when each group compared with the control group (p=0,03). Combined anti-adhesive effect of Sirolimus and Seprafilm™ can be evaluated in future studies.

Effects of heparin and prednisolone on postoperative intra-abdominal adhesions in Wistar rats

Aim: Postoperative intra-abdominal adhesions are one of the complications surgeons want to avoid. It was aimed to compare the effects of physiological saline, heparin, Ringer’s lactate, and prednisolone, which have been commonly used for surgical adhesions, with repeated lavage on postoperative adhesions.Methods: Upon the approval of the Ethics Committee of Fırat University, Faculty of Medicine, 35 Wistar Albino (female) rats were randomized into 5 groups (Heparin BID, Heparin QD, Prednisolone QD, Prednisolone BID, and Control) of 7 rats, and adhesion was created with peritoneal injury model in all rats. The differences in the adhesions created between groups were compared using the macroscopic adhesion scoring system of Linsky.Results: No significant differences were found between physiological saline-heparin and Ringer's lactate-prednisolone groups in terms of adhesion scores (P=0.06). There was a difference in adhesion severity on the left only in the groups receiving heparin QD and prednisolone QD (P=0.04). Conclusion: We demonstrated that none of the agents (Physiological saline, Heparin, Ringer's lactate, and prednisolone) we used in our study model reduced adhesions. It is thought that no difference was detected because of the adhesion model we established. Advanced technology-based studies are still needed to prevent postoperative intra-abdominal adhesions that are globally observed to reduce a huge economic burden and decrease mortality and morbidity.