Prevention Of Postoperative Intra-abdominal Adhesions Research Articles

Recombinant human lubricin for prevention of postoperative intra-abdominal adhesions in a rat model

BackgroundPostoperative intra-abdominal adhesions are a major cause of morbidity and mortality and contribute to a heavy burden on health care resources. At present, numerous introduced adhesion prevention products have demonstrated some benefit but none are consistently effective. The aim of this study was to examine the effectiveness of recombinant human lubricin in preventing intra-abdominal adhesion formation. Materials and methodsA total of 62 male Wistar Albino rats were randomly assigned to the study. Six rats were used to the initial pilot study and 56 rats were randomized into four groups: (1) control cecal abrasion; (2) treatment cecal abrasion with 0.5 mg/mL lubricin solution; (3) control cecal enterotomy and primary closure; and (4) treatment cecal enterotomy and primary closure with 0.5 mg/mL lubricin solution. Rats were sacrificed at 3 d and 21 d postoperatively for the pilot and main studies, respectively. Macroscopic and microscopic adhesion severity was graded by blinded investigators. ResultsFor the pilot study, all six rats successfully reached the end point indicating safety of the lubricin gel. In the main randomized study, adhesions in the treated cecal abrasion group were significantly reduced both macroscopically (P = 0.001) and microscopically (fibrosis P = 0.009, inflammation P < 0.0001), when compared with the control group. In the cecal enterotomy group, adhesions were reduced for the treatment group in macroscopic (P = 0.011) and microscopic grading (fibrosis P = 0.500, inflammation P = 0.206) compared with the control group. ConclusionsRecombinant human lubricin significantly reduced both macroscopic and microscopic intra-abdominal adhesions in the cecal abrasion group. The cecal enterotomy group showed modest macroscopic adhesion reduction. Future study using higher concentration of lubricin solution are needed to investigate its toxicity and more profound antiadhesion properties in significant operations.

Evaluation of ligustrazine on the prevention of experimentally induced abdominal adhesions in rats

ObjectiveTo determine the effects of ligustrazine on the prevention of postoperative intra-abdominal adhesions in rats. Materials and methodsAbdominal adhesions were induced by scraping the cecum of rats. Various dosages of ligustrazine were administered for 10 days after surgery. Grades of abdominal adhesions were ranked by macroscopic observation on the 11th day after surgery. Meanwhile, the levels of IL-1β, IL-6, TNF-a in blood serum and TGF-β1, CTGF in peritoneal fluid were determined by ELISA assay. In the cell experiment, the secretion of FN and CTGF undergoing stimulation with TGF β1 in the culture fluid of rat peritoneal mesothelial cells (RPMC) were measured by ELISA assay. And the expression of Smad7 and p-smad 2/3 in RPMC were evaluated by western blot analysis. ResultsLigustrazine remarkably alleviated the adhesions at the dose of 30 mg/kg and 60 mg/kg compared with the non-treated surgery group (p < 0.05). Ligustrazine decreased the levels of IL-1β, IL-6, TNF-α in blood serum and the expression of TGF-β1, CTGF in the peritoneal fluid in dose-dependent manner. In the cell experiment, ligustrazine markedly attenuated TGF-β1 induced upregulation of FN and CTGF in RPMC. Meanwhile, ligustrazine significantly inhibited the expression of pSmad 2/3 and increased the level of Smad7 in the RPMC. ConclusionsLigustrazine is a potent postoperative adhesion preventer by inhibiting inflammation and regulating the TGF/Smad signaling pathway.

Postoperatif İntraabdominal Adezyonların Önlenmesinde Hyaluronik Asit/Karboksimetilselüloz ve Fluniksin Meglumin Kombinasyonu’nun Etkisi: Tavşanlarda Deneysel Bir Çalışma

Postoperatif İntraabdominal Adezyonların Önlenmesinde Hyaluronik Asit/Karboksimetilselüloz ve Fluniksin Meglumin Kombinasyonu’nun Etkisi: Tavşanlarda Deneysel Bir Çalışma

Intra-abdominal Use of Phosphodiesterase Type 4 Inhibitor in Postoperative Adhesion Prevention

The study was designed to assess the value of intraperitoneal use of rolipram for adhesion prevention and to compare the results with placebo and a sodium hyaluronate/carboxymethylcellulose absorbable barrier (Seprafilm), in a murine cecal abrasion model. Twenty-four Balb/c mice were subjects of this study. Intra-abdominal adhesions were created with a multiple-abrasion model consisting of meticulous abrasion of the cecum and small-bowel segments with strokes of a dental toothbrush. Animals in groups R (n = 8) received 1 mL of rolipram intraperitoneally. Seprafilm was placed over the viscera under the incision in group S animals (n = 8). Group C animals (n = 8) were reserved as control and received nothing. Animals were killed on day 22. The adhesions were evaluated with 2 different observational scoring systems, the Majuzi System and the Linsky Scale. After completion of observational evaluation, the cecum and small bowel of the animals were excised and sent to the pathology laboratory for histopathologic examination. The extent of inflammatory response, the extent of the fibrotic reaction, the extent of the necrosis and abscess formation, and the extent of foreign body reaction were histologically evaluated. The mean Majuzi System scores of groups R and S were similar to each other and significantly less than control group. Also, all scores of the Linsky Scale in group R were similar to those in group S, and significantly less than those in the control group. Histologically, the mean score of inflammatory response in group R was less than both those in group C and group S. The mean score of fibrotic reaction in group R was significantly less than those in the control group. These results indicate that rolipram may be an effective material in prevention of postoperative intra-abdominal adhesions, but it is obvious that further studies are needed to validate the results of this limited initial study.

Efficacy of vitamin E and selenium for the prevention of intra-abdominal adhesions in rats: uterine horn models

OBJECTIVE:This study compares the efficacies of vitamin E and selenium, both individually and in combination, for the prevention of postoperative intra-abdominal adhesions in rats.METHODS:Forty-seven female rats were divided into five groups. The sham animals (S group, n = 7) were given only laparotomies and intraperitoneally received 0.9% NaCl (2 ml). In the 40 other rats, abrasions of the left uterine horn were performed, followed by intraperitoneal administration of either 2 ml 0.9% NaCl (C group), 10 mg vitamin E (vitamin E group), 0.2 mg/kg selenium (Se group) or 10 mg vitamin E with 0.2 mg/kg selenium (vitamin E + Se group), with 10 animals in each treatment group.RESULTS:Adhesion formation was significantly reduced in animals in the Se and vitamin E + Se groups (p<0.05). Tissue catalase and glutathione peroxidase activities did not significantly differ between the groups. However, catalase and glutathione peroxidase activities and reduced glutathione levels were slightly increased in the vitamin E, Se and vitamin E + Se groups. In the vitamin E group, malondialdehyde concentrations were significantly lower than in the C group (p<0.05), but no significant differences were present among the S, C, Se and vitamin E + Se groups. Levels of nitric oxide were significantly higher in the C group than in the other groups (p<0.01).CONCLUSION:Intraperitoneal administration of selenium or combined vitamin E and selenium appears to be effective in preventing intra-abdominal adhesion formation in rat models through the reduction of lipid peroxidation products.

Comparison of Intraperitoneal Honey and Sodium Hyaluronate-Carboxymethylcellulose (Seprafilm™) for the Prevention of Postoperative Intra-Abdominal Adhesions

BACKGROUND:Abdominal surgery can lead to postoperative intra-abdominal adhesions (PIAAs) with significant morbidity and mortality. This study compares the use of honey with a standard bioresorbable membrane (Seprafilm™) to prevent the formation of PIAAs in rats.METHODS:Thirty rats underwent laparotomy, and PIAAs were induced by scraping the cecum. The animals were divided into three groups, each containing ten rats. Group 1 (control) represented the cecal abrasion group, with no intraperitoneal administration of any substance. Group 2 (honey group) underwent cecal abrasion and intraperitoneal administration of honey. Group 3 (Seprafilm™ group) underwent cecal abrasion and intraperitoneal Seprafilm™ application.RESULTS:Group 1 exhibited higher adhesion scores for adhesions between the abdominal wall and the organs. Groups 2 and 3 had decreased adhesive attachments to the intra-abdominal structures. Compared to group 1, the incidence of adhesion formation was lower in both group 2 (p=0.001) and group 3 (p=0.001). The incidence of fibrosis was also lower in group 2 (p=0.016) and group 3 (p=0.063) compared to group 1. There was no significant difference between the histopathological fibrosis scores for the rats in group 2 and those in group 3 (p= 0.688).CONCLUSION:This study suggests that both honey and Seprafilm™ decrease the incidence of PIAAs in the rat cecal abrasion model. Although the mechanism of action is not clear, intraperitoneal administration of honey reduced PIAAs. The outcome of this study demonstrates that honey is as effective as Seprafilm™ in preventing PIAAs.

Use of methylene blue and N,O-carboxymethylchitosan to prevent postoperative adhesions in a rat uterine horn model

Objective To compare the anti-adhesion potential of 1% methylene blue (MB) solution and 2% N,O-carboxymethylchitosan (NOCC) gel in a rat uterine horn model. Design Experimental animal study. Setting University medical center. Animal(s) Forty female Wistar albino rats randomized into four groups. Intervention(s) We examined the effects of 1% MB solution and 2% NOCC gel to reduce the extent and severity of postoperative adhesions in a rat uterine horn model: no adjuvant therapy in control group, 2 mL of normal saline (NS) solution in NS group, 2 mL of 1% MB solution in MB group, and 2 mL of 2% NOCC gel in NOCC group was instilled onto uterine horns of the rats. Main outcome measure(s) Adhesions were scored according to their extent and severity. Result(s) The extent and severity scores of adhesions in MB and NOCC groups were significantly lower than those of control and NS groups. There was no statistically significant difference between the extent and severity scores of adhesions between MB and NOCC groups. Conclusion(s) These findings suggest that MB and 2% NOCC gel should be considered as an adjuvant in the prevention of postoperative intra-abdominal adhesions. Future experimental and clinical studies are required to find their optimal formulation and usage.

Influence of the Platelet-Activating Factor Receptor Antagonist BB-882 on Intra-Abdominal Adhesion Formation in Rats

Postoperative intra-abdominal adhesion formation is a major clinical problem. We aimed to examine the preventive effect of treatment with the platelet-activating factor (PAF) antagonist (lexipafant, BB-882) on experimentally induced intra-abdominal adhesion formation in rats. Twenty male Sprague-Dawley rats weighing 250 and 290 g were studied. Generation of adhesions in rats by brushing a 1-cm² area of the cecum and the peritoneum on the right side of the abdominal wall was followed by intra-abdominal administration of saline and 5 mg/kg in a volume of 0.2 ml PAF receptor antagonist BB-882. After 45 days, formation of adhesions was graded and histological evaluation was processed. The severity of adhesions was significantly less in the BB-882 group than in the control group (p < 0.001, p < 0.05). The average adhesion scores in the control and BB-882 groups were 3.2 ± 0.6 and 0.6 ± 0.6, respectively, and the difference between both groups was found to be significant (p < 0.0001). The number of polymorphonuclear leukocytes and fibrotic areas was significantly decreased in the BB-882 group when compared to the control group (p < 0.001, p < 0.002). In conclusion, this study confirms the efficacy of BB-882 in the prevention of postoperative intra-abdominal adhesions in a rat model.

An Experimental Study Evaluating the Effect of Mitomycin C on the Prevention of Postoperative Intraabdominal Adhesions

Background. Fibroblast proliferation is one of the well-known mechanisms for postoperative intraabdominal adhesion formation. Inhibition of fibroblast proliferation is an attractive field of investigation in the prevention of adhesions. Mitomycin C (MMC) is a cytotoxic agent that alkylates and crosslinks DNA and also inhibits fibroblast proliferation up to a few weeks. We aimed to determine the effect of MMC on the prevention of adhesions.Materials and methods. Generation of adhesions in rats by brushing a 1-cm2 area of the cecum and the peritoneum on the right side of the abdominal wall was followed by intraperitoneal administration of saline, 1 mg/kg MMC, and 0.5 mg/kg MMC in saline. After 45 days, formation of adhesions was graded.Results. The average adhesion scores of the control, and MMC (1 mg/kg), MMC (0.5 mg/kg) groups were 3.2 ± 0.7, 0.8 ± 0.6, and 0.7 ± 0.8, respectively. Adhesion scores of the two MMC-treated groups were significantly lower than that of the control group (P < 0.001). There was no difference between the two MMC groups (P > 0.05). No side effect of MMC was observed.Conclusion. MMC was found to be very effective in the prevention of postoperative intraabdominal adhesions.

An animal study of different treatments to prevent postoperative pelvic adhesions

A study was designed to test various high-molecular-weight solutions in the prevention of postoperative intraabdominal adhesions. The bicornuate rat uterus was used as the surgical model, and 80 mature white female rats underwent surgical injury of the right uterine horn. The rats were randomly divided into 5 groups: groups A, B, and C received 5 ml intraperitoneally of chondroitin sulfate, sodium carboxymethylcellulose, and 32% dextran 70, respectively; group D was treated with microsurgical repair; and group E, the control, received no therapy. The animals were killed postoperatively, and the adhesions were scored. Significantly better results in adhesion prevention were demonstrated in the sodium carboxymethylcellulose group vs. the other groups, except in group A where the difference was not significant.

Dextran and adhesions in guinea-pigs

This prospective, randomized, 'blind' study with guinea-pigs was performed to assess the possible benefit of 6% dextran 70 (molecular weight 70 000) in the prevention of post-operative intra-abdominal adhesions and recurrent adhesions after adhesiolysis. In 50 guinea-pigs lesions for inducing adhesions were applied at the end of the uterine horn. On the right side a strip lesion was made and on the left side an end-to-end anastomosis was performed after section. Before closing the peritoneum 20 ml 6% dextran 70 (N = 25) or saline (N = 25) were introduced into the peritoneal cavity. A second laparotomy 4 weeks later showed no differences in adhesion formation in the animals treated with 6% dextran 70 and saline. In the animals with adhesions adhesiolysis was performed and 6% dextran 70 or saline was left in the peritoneal cavity. Again no beneficial effect of dextran was seen. The end-to-end procedure appeared to be far more suitable for producing adhesions than was the strip lesion.