Prevention Of Intra-abdominal Adhesions Research Articles

Evaluation of triacetin on mechanical strength and free surface energy of PHBHHx: The prevention of intra-abdominal adhesion

Several polymers are used for the preparation of biomaterials as membranes and films for tissue engineering applications. The most common plasticizer is PEG to obtain polymer-based biomaterials. On the other hand, triacetin is a non-toxic, FDA-approved plasticizer mostly used in the food industry. In this study, we used triacetin as a plasticizer to obtain hydrophobic membranes for the prevention of intra-abdominal adhesion. We selected a well-known polymer named PHBHHx which is a bacterial polyester generally used as supporting material for cell attachments in regenerative tissue applications. We evaluated the triacetin as a plasticizer and its effect on mechanical, thermal, surface area, pore size, and surface energy. The hydrophobic/hydrophilic contrast of a biomaterial surface determines the biological response. Surface hydrophobicity is critical for the cellular response. The contact angle tests of PHBHHx revealed that the hydrophilicity of the membrane was decreased following triacetin blending. Modification of the PHBHHx membrane by blending with triacetin caused a significant decrease in cell adhesion. The cell attachment rates of PHBHHx membranes were as 95 ± 5% on the first day, 34.5 ± 0.9% on third day, and 23 ± 1.5% on the fifth day, respectively. The rates of cell attachments on PHBHHx/triacetin membranes were determined as 79 ± 2.5% for the first day, 33 ± 2.7% for the third day, and 13 ± 2.1% for the fifth day, respectively. Besides, triacetin blending decreased the surface area from 38.790 to 32.379 m2/g. The elongation at breaks was observed as 128% for PHBHHx and 171% for PHBHHx/triacetin. Graphical abstract [Formula: see text]

Method of prevention of post-operative peritoneal adhesions.

The purpose of the research was to assess the performance of the method of prevention of post-operative peritoneal adhesions (PAs) (author's method) in patients of different age groups. Two hundred eighty-five patients were in total enrolled in the study. The patients of two age groups were divided into two groups: Group 1 (treatment group), where the author's method was used on 143 patients, and Group 2 (control group) 142 patients, where was used the standard approach of prevention of intra-abdominal adhesions. All patients were operated in an urgent order on adhesive intestinal obstruction (AIO). The patients previously had surgery on AIO one to 3 times. Within each group, sick children and adults were identified. The gender distribution was comparable in both groups. The recurrence of AIO was significantly less in Group 1 than in Group 2 (1.4% and 6.3%, respectively, p<0.05). A separate study of the results of treatment in the age aspect in groups showed some features. Among children the AIO relapse rate in study Groups 1 and 2: Early AIO-in 1 (0.86%) and 2 (1.8%) patients, respectively; late AIO-in 1 (0.86%) and 4 (3.5%), patients, respectively. Among adults who didn't have relapse AIO during the follow-up period in Group 1. The AIO relapse rate in Group 2: Early AIO - in 1 (3.5%) and late AIO-2 (6.9%) patients, respectively. The proposed author's method for preventing AIO recurrence has shown its effectiveness among patients with adhesive AIO. Besides, using this method in children to reduce the AIO relapse rate by more than thrice; in adult patients, to prevent the development of clinically significant signs of PA and normalize the patient's quality of life.

Prevention of Intra-Abdominal Adhesions Using the Combination of Mediclore® and a Statin

Purpose: This study investigated the antiadhesive effects of Mediclore®, rosuvastatin, and a combination of Mediclore and rosuvastatin in a rat adhesion model. Methods: The adhesion models (a total of 58 adult male rats) were divided into 4 groups. The control group (group C) received no special materials except for a saline. The experimental groups were treated with 5 mL of Mediclore (group M), rosuvastatin (group R), or rosuvastatin and Mediclore (group RM), and these materials were intraperitoneally placed under the incision. At postoperative day 14, the rats underwent re-laparotomy and adhesiolysis. Three investigators blinded to group assignment scored the extent of adhesion formation, the numbers of remote adhesions, and the extent of acute/chronic inflammation, fibrosis, edema, and congestion on resected specimens via histologic examination. Results: The macroscopic adhesion score in group RM (7.27 ± 3.51) was significantly lower than those in groups C (13.36 ± 2.24) and R (11.71 ± 1.98); group M (9.13 ± 4.09) had a significantly lower adhesion score than group C. The number of remote adhesions was significantly lower in groups R and RM than in group C. The acute inflammation score, chronic inflammation score, and fibrosis score in group RM; the acute inflammation score in group R; and the fibrosis score in group M were significantly lower than those in group C. Conclusion: The intraperitoneal application of Mediclore and a combination of Mediclore and rosuvastatin effectively reduced postoperative adhesions.

The Effects of Flunixin Meglumine and Amnion Fluid on the Prevention of Intraabdominal Adhesions

Abdominopelvik cerrahi sonrası oluşan karın içi yapışıklıkların, postoperatif devrede mortalite ve morbidite artışı-na neden oldukları bilinen bir gerçektir. Yapılan bu çalışmada fluniksin meglumin ve amniyon sıvısının intraabdominal adezyonların önlenmesindeki etkilerinin belirlenmesi amaçlanmıştır. Bu çalışmada 21 rat kullanıldı. Ratlar her grupta 7 adet olacak şekilde 3 gruba ayrıldı. Karın duvarı ve sekumda serozal kanama oluşuncaya kadar yapılan kazıma işlemi ile adezyon modeli oluşturuldu. Kontrol, fluniksin ve amniyon gruplarındaki ratlara 5 gün süreyle intraperitoneal olarak sırasıyla 0.5 ml serum fizyolojik, 2.5 mg/kg fluniksin meglumin ve 0.5 ml amniyon sıvısı enjekte edildi. On dört gün son-ra tüm ratlar sakrifiye edildi. Makroskopik değerlendirmede tedavi gruplarında adezyon oluşumu kontrol grubuna göre daha az olarak gözlendi (P&amp;lt;0.05). Yapılan histopatolojik kontrollerde gruplar arasında, yangı şiddeti ve fibrozis bakı-mından istatistiksel olarak fark görülmedi (P&amp;lt;0.05). İmmunohistokimyasal sonuçlar tablo halinde sunuldu. Sonuç olarak intraabdominal adezyonların önlenmesinde fluniksin meglumin ve amniyon sıvısının kullanılabileceği sonucuna varılmıştır.

Preventive effect of Rumex crispus L. on surgically induced intra-abdominal adhesion model in rats.

Rumex crispus L. (Polygonaceae), known as "Labada" in Turkey, was reported to be used for the treatment of gynecological diseases such as postpartum complications and infertility in folk medicine. Earlier studies on R. crispus have shown that leaf, fruit and root extracts have anti-inflammatory and antioxidant activities and are used for the treatment of tumors in the uterus. The hypothesis of this study is that R. crispus may generate potential anti-adhesive activity against complex factors such as inflammation, oxidation and fibrosis. We aimed to investigate the potential anti-adhesive activity of aqueous methanol extracts of leaves, fruits and roots of R. crispus. Abdominal adhesion model was performed in 72 female Wistar Albino rats. In the first step of the experiment, the rats were divided into six groups namely, Sham, Control, Reference and Experimental Groups (consisting of three sub-groups in which R. crispus leaf, fruit and root extracts were applied at 100mg/kg dose). The test samples were administered once to the peritoneal cavity and the rats were sacrificied at the end of the 14th day. Root extract showed prominent activity, therefore this extract was subjected to fractionation to obtain 3 fractions (30-60-100% methanol fractions) by using vacuum-liquid chromatography. In the second stage, animals were divided into 6 groups as Sham, Control, Reference and Experimental Groups (R30, R60, R100 at 100mg/kg dose). Adhesion scoring, tissue total antioxidant and oxidant levels, histopathological and immunohistochemical (TNF-α, IL-6 and IL-8) analyzes were performed. Adhesion scores, inflammatory cytokines and inflammation cells decreased by the application of R. crispus root extract. The fractions also showed similar anti-inflammatory effects, but R60 was found to be more effective in prevention of intra-abdominal adhesions and uterine fibrosis. R60 fraction, possessing potential bioactivity, was investigated in terms of phenolic composition by HPLC.

Prevention of intra-abdominal adhesions by a hyaluronic acid gel; an experimental study in rats.

In 80% to 90% of the patients intra-abdominal adhesions occur after abdominal surgery, which can cause small-bowel obstruction, chronic abdominal pain, female infertility and difficulty during reoperation. A novel crosslinked hyaluronic acid gel is evaluated regarding its anti-adhesive capacities in an ischemic button model in rats. 51 adult, male Wistar rats from a registered breeder, received eight ischemic buttons each and were treated with hyaluronic acid gel (HA, HyaRegen©), hyaluronic acid carboxymethylcellulose (HA-CMC, Seprafilm©) or no anti-adhesive barrier. After 14 days, the animals were sacrificed and adhesions were scored macroscopically. The number of buttons and organs involved in adhesions were recorded. Per animal, one button with adhesions and one without adhesions was explanted for qPCR analysis. Mann-Whitney U, Fisher's exact and Wilcoxon signed rank test were used for data analysis. A p-value of 0.05 was considered significant. Macroscopic evaluation of adhesion formation did not differ between the groups. The number of organs involved in adhesions in the HA gel group was significantly lower compared to HA-CMC (p = .041) and the control group (p = .012). A significantly, 1.36-fold higher clec10a (p = 0.25), 1.80-fold higher cd163 (p = 0.003) and 5.14-fold higher mmp1 expression (p = 0.028) was found in ischemic buttons with adhesions compared to buttons without adhesions. HA gel application reduces the number of organs involved in adhesions in an ischemic button model, but no overall reduction in adhesion formation was encountered. Macrophage subtype 2 polarization and high mmp1 expression are associated with adhesion formation. Further investigation is needed in the exact pathophysiologic process of adhesion formation and the role of macrophage polarization.

Prevention of Intra-abdominal Adhesions by Electrical Stimulation.

The study investigated the ability of transdermal electric stimulation to prevent the formation of intra-abdominal adhesions in the combination with Seprafilm® (anti-adhesive agent). One hundred and twenty-eight (128) rabbits were subjected to a surgical procedure to simulate the adhesion processes. After the simulation, the animals were divided into 4 groups (32 animals each), depending on the application of the methods of prevention: (1) control group (no anti-adhesives or electro-stimulation) (CG); (2) comparison group (applications of Seprafilm®) (SF); (3) comparison group 2 (transdermal electric stimulation of the abdominal muscles) TES; (4) group (transdermal electric stimulation + Seprafilm®) (TES + SF). We observed that the application of the Seprafilm® alone led to a significant decrease in the adhesive process compared to the control group (CG) (p < 0.01). The adhesion process in the group underwent transdermal electrical stimulation (TES) was significantly lower compared to the Seprafilm® group (SF) (p ≤ 0.05). The results demonstrated a significant decrease in the adhesion processes in the SF + TES group on days 1, 3, 7 and 14 in comparison with the CG group (p = 0.001), SF group (p = 0.001) and TES group (p = 0.01) group of animals. This study showed the efficacy of transdermal electrical muscle stimulation for the prevention of intra-abdominal adhesions. Moreover, the combination of Seprafilm® anti-adhesion agent and electrical muscle stimulation resulted in the complete absence of adhesions. Our findings indicate the potential of such strategy for further clinical application.

In vivo performance of a bilayer wrap to prevent abdominal adhesions

There is a high prevalence of intra-abdominal adhesions following bowel resection, which can result in chronic pain, bowel obstruction, and morbidity. Although commercial adhesion barriers have been widely utilized for colonic resections, these barriers do not prevent anastomotic leakage resulting from reduced healing of the anastomosis, which can result in long-term health problems. To address this limitation, we have developed an adhesive bilayer wrap with selective bioactivity to simultaneously prevent intra-abdominal adhesion formation and promote anastomotic healing. Reactive electrospinning was used to generate a crosslinked gelatin mesh to serve as a cell-instructive substrate to improve anastomotic healing. A coating of poly(ethylene glycol) (PEG) foam was applied to the bioactive mesh to generate an antifouling layer and prevent intra-abdominal adhesions. After in vitro confirmation of selective bioactivity, the composite wrap was compared after 2 weeks to a commercial product (InterceedⓇ) in an in vivo rat colonic abrasion model for prevention of intra-abdominal adhesions. The composite bilayer wrap was able to prevent intra-abdominal adhesions when clinical placement was maintained. The composite bilayer wrap was further modified to include tissue adhesive properties for improved efficacy. Preliminary studies indicated that the adhesive composite bilayer wrap maintained a maximum shear strength comparable to InterceedⓇ and greater than fibrin glue. Overall, this work resulted in an initial proof-of-concept device that was shown to effectively prevent intra-abdominal adhesion formation in vivo. The composite bilayer wrap studied here could lead to an improved technology for improved healing of intestinal anastomoses.

Evaluation of the efficacy of platelet-rich plasma in preventing postoperative intraabdominal adhesions.

Postoperative intraabdominal adhesions still maintain their currency as serious causes of morbidity and mortality. This study aimed at evaluating the role of platelet-rich plasma (PRP) in the prevention of intraabdominal adhesions. A total of 16 healthy rabbits were used within the scope of the study. The animals were allocated into two groups as Group 1 (control group) and Group 2 (study group). In all subjects, cecal abrasion was formed by laparotomy. In the study group, platelet rich plasma was administered intraabdominally. At the end of the study, the adhesions were evaluated by Nair's Score. Total adhesion score in Group 1 was 8, while the mean score was 1. On the other hand, total adhesion score in Group 2 was 12, while the mean score was 1.5. There was no statistical difference between both groups by total adhesion score and mean fibrosis score. However, mean scores for inflammatory cell infiltration and angiogenesis were higher in Group 2 and the differences were statistically significant (p= 0.021). We were not able to report the positive results of PRP; however, we believe that we shed an important light for future studies which might be conducted using the combination of different methods.

Topical Application of High-Dose Mesna Prevents Adhesion Formation: An Experimental Animal Study

BackgroundAdhesion formation is a common complication of abdominal surgeries. Mesna is a drug with fibrinolytic properties which has been used in surgical field to facilitate tissue dissection. The aim of this experimental animal study was to investigate the effect of mesna on prevention of intra-abdominal adhesion in rats. Materials and methodsTwenty-eight Wistar albino rats were used in the study. To create abdominal adhesion, cecum was abraded in all rats. No additional surgical procedure was performed other than adhesion in group 1 (only adhesion). In the other groups, rats were treated topically by administering 0.9% saline (group 2), 40 mg/kg mesna (group 3), and 400 mg/kg mesna (group 4). All rats were sacrificed on postoperative 21st day. Histopathological and macroscopic evaluations of adhesion formation were performed. ResultsQuantity of adhesion scores (P = 0.022), severity of adhesion scores (P = 0.041), total adhesion scores (P = 0.023), and histopathological adhesion grading scores (P < 0.001) were reduced by 400 mg/kg mesna. ConclusionsThis is the first study for mesna on prevention of abdominal adhesion formation in rats. We concluded that dose-dependent reduction of adhesion was achieved by mesna. With future studies, topical administration of mesna during open abdominal surgeries may be used to prevent adhesion formation.

Comparing Five New Polymer Barriers for the Prevention of Intra-abdominal Adhesions in a Rat Model

BackgroundIntra-abdominal adhesions affect up to 93% of the patients after abdominal surgery, causing small-bowel obstruction, infertility, chronic abdominal pain, and iatrogenic bowel injury at reoperation. The efficacy of five new polymer antiadhesive barriers to avoid adhesion formation is evaluated in an ischemic button model in rats. Materials and methodsFive new, biodegradable polyurethane and copolyester-based, antiadhesive barriers (A1, A2, A3, B1, and B2) were evaluated in separate experimental groups and compared with two control groups (hyaluronate carboxymethylcellulose barrier and no antiadhesive barrier) in an ischemic button model (n = 11 per group operated). After 14 d, the quantity and quality of the adhesions were scored macroscopically. The Kruskal–Wallis with Mann–Whitney U post hoc and the Fisher's exact tests were used for data analysis. The Bonferroni correction method was applied, and a P-value <0.007 was considered significant. ResultsTwo animals died during surgery and follow-up. A significant reduction of adhesions to ischemic buttons was found in the A2 group (median, 3.5; interquartile range, 2.25) compared with no adhesive barrier (median, 8.0; interquartile range, 2.0) (P = 0.001). The remaining groups did not differ significantly regarding adhesion quantity or quality. Adverse events were observed in the A2, A3, and B2 groups. ConclusionsThe A2 antiadhesive barrier reduced the adhesion formation significantly compared with no anti-adhesive barrier, but applicability is questionable because of extensive adverse events observed due to implantation of the anti-adhesive barrier. The Nair score appears not to be sensitive enough to detect differences in adhesion formation in this model. Future research should focus on anti-adhesive barriers that are self-adhering.

Efficacy of an antiadhesive agent for the prevention of intra-abdominal adhesions after radical gastrectomy: A prospective randomized, multicenter trial.

Background:Guardix-SG is a poloxamer-based antiadhesive agent. The aim of this study was to investigate its efficacy in preventing abdominal adhesions in gastric cancer patients undergoing gastrectomy. Few clinical studies have reported that antiadhesive agent reduces the incidence of adhesion after gastrectomy.Methods:We conducted a multicenter trial from June 2013 and August 2015 in patients with gastric adenocarcinoma undergoing radical gastrectomy. Patients were randomly assigned to the Guardix treatment or control group. Postoperative adhesions were diagnosed based on postoperative symptoms, plain x-ray films, and computed tomography. The primary endpoint of the study was the incidence of small bowel obstruction in the first postoperative year. The secondary end-point was the safety of Guardix-SG.Results:The study included 109 patients in the Guardix group and 105 patients in the control group. The groups were similarly matched with pathological stage, operation type, anastomosis method, midline incision length, and the extent of lymph node dissection. Eight in the Guardix group and 21 in the control group experienced intestinal obstruction during the 1-year follow-up period. The cumulative incidence of small bowel obstruction was significantly lower in the Guardix group compared to that seen in the control group (4.7% vs 8.6% at 6 months and 7.3% vs 20% at 1 year; P = .007, log-rank test). There were no differences in postoperative complications and adverse events.Conclusion:Guardix-SG significantly decreased the incidence of intestinal obstruction without affecting the incidence of postoperative complications.

Application of anti-adhesive barrier for recurrent acute adhesive intestinal obstruction

Surgical treatment of a patient with recurrent acute adhesive intestinal obstruction is described. Seven plates of anti-adhesive barrier agent made from oxidized regenerated cellulose were applied to small bowel in order to prevent adhesions. Control examination did not reveal viscero-parietal adhesions between hollow organs and delayed passage through the gastrointestinal tract. Long-term results indicate the need for intraoperative prevention of intra-abdominal adhesions in patients with abdominal adhesive disease.

Effect of xanthan gum on the prevention of intra-abdominal adhesion in rats

Postoperative adhesions remain a significant concern following abdominal surgery. Polymer barriers are widely used to prevent adhesions, although none have been able to completely prevent adhesions in all situations. Therefore, it is still crucial to develop new products that are effective in a variety of surgical applications. In this study, XG with different concentrations (0.5%–2%, w/v) and molecular weight (Mw) (2.5 × 106 Da–6.9 × 106 Da) were prepared to estimate their potential application as an injectable tissue adhesion barrier. The results showed that XG exerts an anti-adhesion effect in the rat abdominal cavity. For XG with Mw of 5.5 × 106 Da, a 1% or greater concentration was needed to form a gel with required effect as an anti-adhesion agent. The 1% XG gel with high Mw (6.9 × 106 Da) was more effective for the prevention of adhesions compared to a commercially available gel (1.2% sodium hyaluronate). Histological and cytotoxic evaluation demonstrated that XG gel showed no side effect during wound healing, and had no in vitro cytotoxicity to L929 cells. Moreover, rheological analysis was conducted to correlate the anti-adhesion effect with the rheological behavior of XG gels. This investigation suggests that XG has good potential value in intra-abdominal adhesion prevention.

Effects of Streptokinase and Normal Saline on the Incidence of Intra-abdominal Adhesion 1 Week and 1 Month after Laparotomy in Rats

Background:Intra-abdominal adhesions after surgery are usually in the form of bands and can annoy the patient throughout life causing repeated surgical procedures. Therefore, any action to prevent adhesions after surgery can increase longevity and quality of life. For this aim, this study investigates the effect of streptokinase and normal saline on the 7th day and 1 month after laparotomy.Materials and Methods:Experimental study was conducted on thirty healthy male Wistar rats weighing 200–250 g with age of 3 months divided into three groups of 10. Group I: No treatment, Group II: Received normal saline, and Group III: Received normal saline and streptokinase at the same time. One week and 1 month after laparotomy, the frequency of the presence or absence of adhesion bands was performed by a person who was unaware of the sample grouping. The collected information was analyzed with the SPSS software (version 16; SPSS Inc., Chicago, IL, USA).Results:Adhesion frequency was found to be 20% on the 7th day (early) and 1 month after laparotomy (late) for Group 1, and it was 40% on early and late for Group II, while 0% on the early and late for Group III. Hence, in the group receiving streptokinase, no early or late adhesion was observed; therefore, it had a significant role in the prevention of intra-abdominal adhesions (P < 0.05). However, adhesions in the group receiving normal saline had no remarkable difference with the group receiving no drug (P > 0.05).Conclusion:According to the results of our study, we believe that streptokinase could be a good antiadhesive agent considering its effectiveness.

In situ cross-linking carbodiimide-modified chitosan hydrogel for postoperative adhesion prevention in a rat model

BackgroundPostoperative intra-abdominal adhesion often causes many complications. Chitosan fluid has been used in clinic to prevent intra-abdominal adhesion. However, fluid can be easily diluted and cannot stay on the wound site. As hydrogel is able to form stable physical barrier to separate injured tissues, we developed a chitosan hydrogel for better prevention of intra-abdominal adhesion in this study. MethodsWe synthesized a carbodiimide-derivatized chitosan gelatin (cd-CS-gelatin) hydrogel and investigated its rheological properties. A rat model was used to compare the anti-adhesion effect of chitosan hydrogel and fluid. The wounds were created with damage of the underlying muscle of the abdominal wall and the serosal layer of the cecum. They were coated with chitosan fluid or cd-CS-gelatin hydrogel. At day 14 after surgery, the animals were euthanized and intra-abdominal adhesion was assessed. ResultsThe cd-CS-gelatin hydrogel solidified within 3min after the mixing of the reagents. The cecum-abdomen adhesion occurred in all rats without anti-adhesion treatment. The application of cd-CS-gelatin significantly reduced the adhesion rate from 100% to 50%, compared the chitosan fluid only to 88%. The decrease of adhesion breaking strength also manifested that cd-CS-gelatin was more effective than chitosan fluid to reduce postsurgical intra-abdominal adhesion formation. ConclusionsChitosan hydrogel is more effective than chitosan fluid to prevent postoperative cecum-abdomen adhesion. It indicates that hydrogel could be a more promising state than liquid to prevent postoperative intra-abdominal adhesion.

Separate and synergistic effects of taurolidine and icodextrin in intra-abdominal adhesion prevention.

In our present study, we aimed to evaluate the effects of taurolidine, a blocking agent of fibrin deposition, and icodextrin, a colloid osmotic material that also inhibits fibrin accumulation, and the effect of their application separately and concomittantly in intra-abdominal adhesion prevention. Forty BALB/c male mice, weighing 30-35 g and 11-12 weeks old were divided into four groups as follows: group 1: control group, group 2: taurolidine group, group 3: icodextrin group, and group 4: taurolidine and icodextrin group. Animals were sacrificed by cervical dislocation after 14 days. The adhesions were classified and scored by two blinded researchers according to Nair's macroscopic adhesion staging system and microscopically evaluated using Zuhlke classification system. In group 2 there was no mice with score 4. In group 3, scores 3 and 4 were absent. Scores 2, 3, and 4 were not detected in group 4. The mean value of adhesion scores decreased from groups 1 to 4. There was a significant statistical difference between all the groups and group 1. There was no change between the study groups on macroscopic examination, whereas histopathological examination revealed statistically significance between group 4 and other groups. Taurolidine and icodextrin, when used alone or together, decrease postoperative intra-abdominal adhesion formation. Macroscopic appearence was not supportive of statistical difference between group 4 and other groups. Microscopic evaluation paves the road for future studies for determining significance when taurolidine and icodextrin are applied concomittantly. Additional experimental studies are required for dose adjustment.

Evaluation of botulinum toxin type A effectiveness in preventing postoperative intraperitoneal adhesions.

PurposePostoperative intraperitoneal adhesions (PIAs) are one of the most important problems surgeons have to face after laparotomies. In this study, we aimed to evaluate the effectiveness of local application of botulinum toxin type A (BoNT-A) in various dosages on the prevention of intra-abdominal adhesions in rats with experimental intra-abdominal adhesions.MethodsForty Wistar Albino female rats were randomly separated into 4 groups. The 4 groups were determined as follows: Control (group 1, n = 10); Sham (group 2, n = 10); 10-µg/kg low-dose BoNT-A (group 3, n = 10) and 30-µg/kg high-dose BoNT-A (group 4, n = 10). Subserosal injuries were created on the caecum of all rats. Laparotomy was performed on the fifth day. Adhesion scores, histopathological examination, and E-cadherin expression levels were evaluated.ResultsGeneral adhesion scores for groups 1 and 2 were determined to be significantly high when compared to group 4 (P < 0.001). A significant difference was also determined between groups 3 and 4 in terms of general adhesion scores (P < 0.05). In pair comparisons, a significant decrease in high-dose BoNT-A group (group 4) when compared to groups 1 and 2 in terms of neovascularization, fibroblast density, collagen deposition and inflammatory cell count was determined (P < 0.05).ConclusionA significant decrease was observed only in postoperative PIAs in the high-dose BoNT-A group between all 4 rat-groups with experimentally created postoperative PIAs. In this study, high-dose BoNT-A is determined to be an effective agent in preventing postoperative PIAs.

Effect of Resveratrol on the Prevention of Intra-Abdominal Adhesion Formation in a Rat Model

Background: Intra-abdominal adhesions are a very common complication following abdominal surgery. Our previous studies have demonstrated that the inhibition of inflammation at the sites of peritoneal injury can prevent the formation of intra-abdominal adhesions. Resveratrol is a natural extract with a broad range of anti-inflammatory effects. Therefore, we propose that resveratrol can reduce the formation of intra-abdominal adhesions after surgery. The aim of this study was to investigate the effect of resveratrol on intra-abdominal adhesion prevention in a rat model with surgery-induced peritoneal adhesions. Materials and Methods: The cecum wall and its opposite parietal peritoneum were abraded following laparotomy to induce intra-abdominal adhesion formation. Varying doses of resveratrol were administered to the animals. On the eighth day after surgery, the adhesion score was assessed using a visual scoring system. Picrosirius red staining and a hydroxyproline assay were used to assess the amount of collagen deposition in the adhesion tissues. The levels of serum interleukin-6 (IL-6), tumor necrosis factor (TNF-α), and transforming growth factor beta-1 (TGF-β1) were determined by an enzyme-linked immunosorbent assay (ELISA). Western blotting was performed to determine the protein expression of TGF-β1, fibrinogen, and α-smooth muscle actin (α-SMA) in rat peritoneal adhesion tissue. Real-time RT-PCR was performed to quantify the mRNA expression of TGF-β1, fibrinogen, and α-SMA. Results: Resveratrol significantly reduced intra-abdominal adhesion formation and fibrin deposition in the rat model. Furthermore, resveratrol significantly reduced the serum levels of IL-6, TNF-α, and TGF-β1. The protein and mRNA expression of TGF-β1, fibrinogen, and α-SMA in the rat peritoneum and adhesion tissues were also down-regulated due to resveratrol intervention. Conclusion: Resveratrol can effectively prevent the formation of postoperative intra-abdominal adhesions in a rat model. This effect may be related to the suppression of inflammatory cytokine expression in the injured peritoneum by resveratrol. This study suggests that resveratrol may be a new and effective anti-adhesive agent that is worthy of further study and has potential application value.

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

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.