Prevention Of Intra-abdominal Adhesions Research Articles

Prevention of intra-abdominal adhesions by using Seprafilm in rats undergoing bowel resection and radiation therapy.

Intra-abdominal adhesions are an important surgical problem. Colorectal operations are a major cause of adhesive obstruction. Radiation therapy (RT) is frequently used as an adjuvant therapy to surgery for rectal cancer, though its value for colon carcinoma remains unclear. Peritoneal injuries including the surgical trauma, tissue ischaemia as well as RT are associated with peritoneal fibrinolytic activity. A sodium hyaluronate and carboxymethylcellulose bioresorbable membrane (Seprafilm) has been used to reduce intra-abdominal adhesion formation. We have investigated the effect of Seprafilm on intra-abdominal adhesion in rats receiving RT after the resection of the left colon. Thirty-two male Wistar rats were divided into two groups: group 1 (n=16), control (colon resection, no Seprafilm); group 2 (n=16), study group (colon resection and Seprafilm). All the rats received 50 Gy RT after left colon resection. Intra-abdominal adhesions were evaluated by grading and measurement of tissue-type plasminogen activator (tPA) as a tissue adhesion marker in peritoneal samples from the rats. tPA was determined using a commercially available ELISA kit. The levels of tPA were significantly increased in group 2 rats compared with those in the control group (P=0.0276). It was also seen that adhesions in the rats receiving Seprafilm were significantly less severe than those in the control group. Our findings suggest that the intraperitoneal administration of Seprafilm reduced the frequency and strength of adhesions.

Effect of streptokinase in the prevention of intra-abdominal adhesions in the rat

The objective of the present study was to assess the action of streptokinase, a streptococcal derivative with fibrinolytic capacity, in the prevention of intraperitoneal adhesions in rats. Eighty animals were divided into four groups of 20 each; group A (control) received isotonic saline by the intraperitoneal route, group B received streptokinase by the intraperitoneal route at the dose of 60.000 units/kg body weight diluted in 2 ml isotonic saline, group C received 60.000 streptokinase units diluted in 1 ml isotonic saline by the intravenous route, and group D received 30.000 streptokinase units in 2 ml isotonic saline by the intraperitoneal route and 30.000 streptokinase units diluted in 1 ml isotonic saline by the intravenous route. The animals were submitted at random to median laparotomy for the preparation of stitches inducing adhesions of the ischemic type according to the model of FERRAZ-NETO et al. (1991) modified, and sacrified with a lethal dose of sulfuric ether on the 3rd and 7th postoperative day. Streptokinase was found to be effective in the prevention of adhesions when used by the intraperitoneal route (p=0,0349) or when administered both intraperitoneal and intravenously (p=0,0073). Comparison of the 3rd and 7th posteperative day within the same group showed no significant difference, suggesting that the drug acts during the early period of the healing process. We conclude that streptokinase is effective in the prevention of adhesions formation when injected by the intraperitoneal route or by the combined intraperitoneal and intravenous routes at the dose employed in rats.

Effects of postoperative peritoneal lavage on pharmacokinetics of gentamicin in horses after celiotomy

Abstract Objective To evaluate the effect of peritoneal lavage on pharmacokinetics of gentamicin sulfate in healthy horses after experimental celiotomy. Animals 13 clinically normal horses. Procedure Horses were randomly assigned to control or experimental groups. All horses received gentamicin (6.6 mg/kg of body weight, IV, q 24 h) before surgery, underwent experimental abdominal surgery, and had abdominal drains placed percutaneously. Horses of the experimental group received postoperative peritoneal lavage; horses of the control group did not receive peritoneal lavage. The day after surgery, 24 hours after the preoperative dose of gentamicin, a second dose of gentamicin was administered. Three and 15 hours after this second dose of gentamicin, horses of the experimental group received peritoneal lavage. Venous blood was obtained, for determination of concentration of gentamicin, immediately before and at specified intervals during the 24-hour period after the second dose of gentamicin. Results There were no differences in any of the pharmacokinetic values of gentamicin between horses of the control and experimental groups. Conclusions Peritoneal lavage had no effect on pharmacokinetics of gentamicin in healthy horses after abdominal surgery, in which localized nonseptic peritonitis was induced. Clinical Relevance Peritoneal lavage in horses with localized nonseptic peritonitis or for the prevention of intra-abdominal adhesions should not necessitate alteration of the dosage of gentamicin to maintain predictable serum concentrations. (Am J Vet Res 1997;58:1166–1170)

Efficacy of tenoxicam on intra-abdominal adhesion prevention in a rat model.

The aim of this study was to investigate the effect of tenoxicam as a non-steroidal anti-inflammatory drug (NSAID) on intra-abdominal adhesion prevention in a rat model. Altogether 50 Wistar-Albino rats weighing 220-280 g were assigned to five groups, each of which was made up of 10 rats. All the rats were anaesthetized and prepared for sterile surgery. After a mid-line laparotomy was performed, a 1 cm area of the caecum was rubbed with gauze until subserosal haemorrhage developed, and then a 5 mm-diameter part of the peritoneum on the right side of the abdominal wall was removed. Prior to complete closure, 3 ml of the test material was placed into the abdominal cavity. On the eighth day the rats were killed and the adhesion score was determined. The groups and their mean adhesion scores were as follows: control group (normal saline), 2.5; group of dilution buffer, 1.8; tenoxicam (0.125 mg/kg), 1.3; tenoxicam (0.25 mg/kg), 1.3; and tenoxicam (0.5 mg/kg), 0.9. The differences between the adhesion scores among all the groups (P < 0.05, Kruskal-Wallis test), and those between the tenoxicam groups and control group (P < 0.05, Mann-Whitney U-test), were significant. Thus a single instillation of tenoxicam into the peritoneal cavity at the time of surgery reduced adhesion formation effectively in this model, irrespective of dosage.

Heparin: a review of its pharmacology and therapeutic use in horses.

Heparin is used clinically in horses to treat hemostatic abnormalities associated with severe gastrointestinal disease, septicemia, and endotoxemia. The primary anticoagulant effect of heparin is through the suppression of thrombin-dependent amplification of the coagulation cascade, and inhibition of thrombin-mediated conversion of fibrinogen to fibrin. Heparin may be of benefit in preventing the complications associated with hypercoagulable states such as jugular vein thrombosis, laminitis, and organ failure. Heparin may also be beneficial in the prevention of intraabdominal adhesions after gastrointestinal surgery, and in amelioration of hemodynamic abnormalities associated with endotoxic shock. Because a sequential rise in serum heparin concentration occurs during a uniform dosage regimen, a decreasing dosage regimen is recommended. The initial dose recommended is 150 U heparin/kg body weight subcutaneously, followed by 125 U heparin/kg body weight subcutaneously, every 12 hours for six doses. The dose should be decreased to 100 U heparin/kg body weight subcutaneously, every 12 hours, after the seventh dose. Anemia, hemorrhage, thrombocytopenia, and painful swelling at injection sites are complications of heparin administration in horses.

Dose dependency and wound healing aspects of the use of tissue plasminogen activator in the prevention of intra-abdominal adhesions

Intra-abdominal adhesions have been shown to result from the impairment of peritoneal fibrinolysis by inhibitors present in ischemic tissue. A reproducible model for the formation of intra-abdominal adhesions was utilized for the evaluation of the effectiveness of intraperitoneal applications of recombinant tissue plasminogen activator (rtPA) in adhesion prevention. Concentrations of rtPA required to overcome the inhibition of fibrinolysis in this model were estimated by titration of that amount of rtPA required to lyse blood clot in the presence of a measured amount of ischemic tissue. Adhesions were graded, and the hydroxyproline content of the abdominal wounds was analyzed. The effect of intraperitoneal administration of rtPA on adhesion formation was strongly dose related. Levels of rtPA of 0.01 mg/mL showed no effect (p < 0.75) on adhesion formation, whereas levels of 0.1 mg/mL either prevented or significantly modified the formation of intra-abdominal adhesions (p < 0.05). Concomitantly, wound hydroxyproline content was significantly reduced (p = 0.004). Prior investigations have shown a strong correlation between wound bursting strength and hydroxyproline content. The results of this study indicated that the levels of rtPA required to alter or prevent intra-abdominal adhesion formation also produce a significant impairment of the early phase of wound healing as measured by the wound content of hydroxyproline.

Prevention of intraabdominal adhesions in ponies by low-dose heparin therapy.

An ischemic bowel model was used to stimulate adhesion formation in eight ponies. Heparin (40 USP u/kg) or saline was administered intravenously at surgery and was continued subcutaneously every 12 hours for 48 hours to evaluate the efficacy of heparin in preventing intraabdominal adhesions. Ponies were euthanatized after 6 weeks, and postmortem examinations were performed. A statistically significant difference was found between the heparin-treated and the control groups. Adhesions developed in three of four control ponies, and adhesions did not develop in three of four heparin-treated ponies. None of the adhesions resulted in clinical disease. In this study, heparin decreased the formation of adhesions in ponies after experimentally induced intestinal ischemia.

Foreign material and postoperative adhesions.

A PROBLEM of major importance in abdominal surgery is the prevention of intra-abdominal adhesions with their sequelae. It has been estimated that approximately 10 per cent of repeat laparotomies ar...