Uterine Horn Model Research Articles

The effect of platelet-rich plasma on intra-abdominal adhesions in rabbit uterine horn model

The effect of platelet-rich plasma on intra-abdominal adhesions in rabbit uterine horn model

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.

Two natural materials found to reduce adhesion formation in a rat uterine horn model

Background/Aim: Post-operative pelvic adhesions cause various problems in patients, pose surgical difficulties to clinicians, and an increase in health costs. We compared the effectiveness of two natural materials, Trehalose (TRZ), Human Amnion Fluid (HAF), with oxidized regenerated cellulose (ORC) in terms of adhesion prevention after gynecological operations. Methods: In this controlled experimental study, twenty-four female Wistar Hannover rats were divided into four groups: Control, TRZ, HAF, and ORC. The control group received medication used for the surgical procedure only. 3% TRZ, cell-free HAF, and 1 cm2 ORC (interceed®) were laid on the tissue on the antimesenteric side of each uterine horn damaged with a 10-Watt bipolar cautery. Adhesions were scored 30 days after the first surgical procedure. Results: The extent, severity, degree, total adhesion, inflammation, and fibrosis scores of the control group were significantly higher than those of the TRZ and HAF groups (P<0.05 for each). There was no significant difference between the Control and ORC groups in terms of inflammation (P=0.055), but all other parameters were significantly higher in the control group compared to the ORC group (P<0.05). The TRZ group had lower total adhesion scores (P=0.019) and histopathological scores (P=0.015, P=0.001) than the ORC group. Conclusions: TRZ and HAF may be useful in preventing pelvic adhesions.

Design, Manufacture, and In vivo Testing of a Tissue Scaffold for Permanent Female Sterilization by Tubal Occlusion.

Current FDA-approved permanent female sterilization procedures are invasive and/or require the implantation of non-biodegradable materials. These techniques pose risks and complications, such as device migration, fracture, and tubal perforation. We propose a safe, non-invasive biodegradable tissue scaffold to effectively occlude the Fallopian tubes within 30 days of implantation. Specifically, the Fallopian tubes are mechanically de-epithelialized, and a tissue scaffold is placed into each tube. It is anticipated that this procedure can be performed in less than 30 minutes by an experienced obstetrics and gynaecology practitioner. Advantages of this method include the use of a fully bio-resorbable polymer, low costs, lower risks, and the lack of general anaesthesia. The scaffold devices are freeze-cast allowing for the custom-design of structural, mechanical, and chemical cues through material composition, processing parameters, and functionalization. The performance of the biomaterial and de-epithelialization procedure was tested in an in vivo rat uterine horn model. The scaffold response and tissue-biomaterial interactions were characterized microscopically post-implantation. Overall, the study resulted in the successful fabrication of resilient, easy-to-handle devices with an anisotropic scaffold architecture that encouraged rapid bio-integration through notable angiogenesis, cell infiltration, and native collagen deposition. Successful tubal occlusion was demonstrated at 30 days, revealing the great promise of a sterilization biomaterial.

Hydrogen sulfide prevents postoperative adhesion in a rat uterine horn model

ObjectiveAbdominal adhesions are primarily severe postoperative complications that can cause gynecological problems such as infertility and chronic pelvic pain. Inflammatory mediators are significantly related to adhesion formation, and hydrogen sulfide plays a significant anti-inflammatory role in multiple physiological processes. Therefore, the effect of NaHS, a hydrogen sulfide donor, on postoperative adhesion formation was examined in a rat uterine horn model. Materials and methodsA rat uterine horn model was created to evaluate whether NaHS, a hydrogen sulfide donor, could decrease postoperative adhesion formation. Rats were randomly grouped and administrated with different doses of NaHS, where DL-propargylglycine and low-molecular-weight heparin acted as negative and positive controls, respectively. The extent and severity of adhesions were assessed on the 14th postoperative day. Serum of rats was sampled for the determination of 27 cytokines using a chip. ResultsThe severity and total scores of adhesion in rats given 112μM/kg and 56μM/kg NaHS were significantly less compared with those of the control group (p<0.01). Scores for the extent of adhesion re-formation in the DL-propargylglycine and control groups did not differ (p>0.05). At least six cytokines were involved in the procedures for the prevention of adhesion formation, as they varied significantly among different groups. ConclusionAdministration of NaHS could apparently reduce postoperative adhesion in the rat uterine horn model. This preventive effect may be associated with the variation of cytokine that is related to inflammatory.

Effects of quercetin and surgicel for preventing adhesions after gynecological surgery: A rat uterine horn model.

Postoperative pelvic adhesions are significant health care problems causing chronic pelvic pain, infertility and intestinal obstruction after abdominal or pelvic surgery. We investigated the effects of quercetin and Surgicel for the prevention of adhesions after gynecological surgery. A double blind, randomized, controlled experimental study was designed. Forty female Wistar Hannover rats were divided into five groups: control, sham operated, quercetin, Surgicel, and quercetin + Surgicel. The control group received medication used for the surgical procedure only. The sham group received a laparotomy only. The quercetin group received 15 mg/kg quercetin in addition to undergoing the standard surgical procedure, and the injuries in the surgical group were covered with a single, 1 cm2 layer of Surgicel (oxidized regenerated cellulose). The quercetin + Surgicel group received both 15 mg/kg quercetin and a single, 1 cm2 layer of Surgicel. Adhesions were scored 14 days after the first surgical procedure. The extent, severity, degree, total adhesion, inflammation and fibrosis scores of the control group were significantly higher than those of the quercetin, Surgicel, and quercetin + Surgicel groups. There was no significant difference between the Surgicel and quercetin groups in degree, but all other parameters were significantly higher in the Surgicel than in the quercetin group. The quercetin + Surgicel group had lower adhesion scores than the quercetin group. Quercetin, Surgicel and quercetin + Surgicel treatment may be useful for preventing pelvic adhesions.

A randomized controlled experimental study of the efficacy of platelet-rich plasma and hyaluronic acid for the prevention of adhesion formation in a rat uterine horn model.

Platelet-rich plasma (PRP) has been known to possess an efficacy in tissue regeneration. The aim of this study was to determine the role of PRP on post-operative adhesion formation in an experimental rat study. Thirty Sprague-Dawley rats were randomly divided into control, hyaluronic acid, and PRP treatment groups and operated on for uterine horn adhesion modeling. Blood was collected to produce a PRP with platelet counts of 688×10(3)/μL, and 1ml of either hyaluronic acid gel or PRP was administered over the standard lesions, while the control group received no medication. The evaluation of post-operative adhesions was done on the 30th post-operative day. The location, extent, type, and tenacity of adhesions as well as total adhesion scores, tissue inflammation, fibrosis and transforming growth factor-1beta (TGF-1β) expressions were evaluated. The total adhesion score was significantly lower in the PRP group (3.2±1.5) compared with the hyaluronic acid (5.0±1.3) and control (8.1±1.7) groups. The extent of the adhesions was significantly lower in the PRP group. There was no significant difference in the type and tenacity of adhesions between the hyaluronic acid and the PRP group. The level of inflammation was significantly higher in the control group than the others, while there was no difference between the PRP and hyaluronic acid groups. TGF-1β expression was significantly lesser in the PRP group than the control and hyaluronic acid groups. PRP is more effective than hyaluronic acid treatment in preventing post-operative adhesion formation in an experimental rat uterine horn adhesion model.

Use of N,O-carboxymethyl chitosan to prevent postsurgical adhesions in a rabbit double uterine horn model: a randomized controlled design.

In previous studies, N,O-carboxymethyl chitosan has been shown to decrease the incidence and intensity of abdominal adhesions. In the present study, adhesions were induced in 220 rabbits using a double uterine horn model. Rabbits were randomized to receive an operation only or an operation+medical chitosan intraperitoneally. Twenty-two rabbits from each group were euthanized at one of five different times (Day 3, 7, 14, 28, or 42), and adhesion formation was given gross and histopathological scores. Reductions were observed in adhesion extent (P=0.0337) and tenacity (P=0.0271) as well as inflammation (P<0.0001) on Day 3 when medical chitosan was applied. Prior to Day 14, fibrosis was less obvious in the medical chitosan group (P< 0.0005). The tenacity scores were significantly lower in the medical chitosan group following Day 14 (P<.05), while the type scores were lower in the medical chitosan group following Day 28 (P<.03). Thus, medical chitosan decreased both the gross and the histopathological scores of the induced adhesions.

A systemic review of randomized controlled studies about prevention with pharmacologic agents of adhesion formation in the rat uterine horn model.

IntroductionEvaluation of treatment attempts in postoperative adhesion formation is pivotal for the prevention of several morbidities including infertility, pelvic pain, bowel obstruction, and subsequent intraoperative complications. The purpose of this systemic review was to assess the literature on the rat uterine horn model for adhesion formation and treatment modalities to prevent adhesion in the most frequently used experimental animal model.Material and methodsWe performed a systemic review of publications from January 1st 2000 to December 31st 2013 via a PubMed search. A high number of agents were evaluated for the prevention of postoperative adhesion formation in the rat uterine horn model.ResultsAccording to most of the studies, adjuvants such as antiinflamatuars, antiestrogens, antioxidants were effective to prevent adhesion formation.ConclusionsPrevention of adhesion formation is pivotal and numerous types of agents were described in the literature were summarized in this review.

Evaluation of vitamin C and vitamin E for prevention of postoperative adhesion: A rat uterine horn model study

To investigate the effectiveness of intraperitoneal vitamin C (VC) and vitamin E (VE) in the prevention of postoperative adhesion formation in a rat uterine horn model. Twenty-eight Wistar albino rats were divided into four groups in which: control group, the abdomen was opened and closed without any intervention; adhesion group, a 2-cm linear incision was performed on the uterine horn and closed; VC group, VC was administrated i.p., and 15 min later a 2-cm incision was performed on the uterine horn and closed; and VE group, VE was administrated i.p., and 15 min later a 2-cm incision was performed on the uterine horn and closed. Re-laparotomy was performed 15 days later. Right uterine horn adhesions were evaluated according to macromorphological characteristics and tissue sections were further examined for fibrosis, angiogenesis and vascular endothelial growth factor (VEGF), type I collagen and malondialdehyde (MDA) scoring. Kruskal-Wallis anova and Mann-Whitney U-test were utilized for statistical analysis. Adhesion area and also strength were significantly lower in the VC group and the VE group compared with the adhesion group. Fibrosis and angiogenesis scores were observed to be significantly higher in the adhesion group compared with the VC group and the VE group. MDA and VEGF immunoreactivity were also found to be significantly lower in the VC group and the VE group compared with the adhesion group. However, there was no significant difference between the VC group and the VE group with respect to all the above parameters. Administration of VC or VE i.p. was observed to be effective in the prevention of postoperative adhesion formation in an experimental model.

Increased adhesion formation after gelatin-thrombin matrix application in a rat model.

To evaluate the effects of gelatin matrix and thrombin-based hemostatic sealant agents (gelatin-thrombin matrix) on postoperative adhesion formation in the rat uterine horn model. A total of fourteen female Wistar-Albino rats were used in our postoperative adhesion formation model. Both uterine horns were exposed by midline incision with sterile technique and each uterine horn was traumatized by bipolar electrocautery. Before closure of the abdomen, 0.9% NaCl solution was administered intraperitoneally in the control group and the gelatin-thrombin matrix was applied on the traumatized areas on the uterine horns of the rats in the study group. At day 21 after the first surgery, the intraperitoneal macroscopic adhesion scores and the extent of fibrosis, inflammation scores, inflammatory cell activities, inflammation types of adhesion tissues, and the level of free oxygen radicals [malondialdehyde (MDA)] and antioxidant enzyme activity [superoxide dismutase (SOD) and glutathione S-transferase (GST)] in the uterine horn tissue were measured. There was no statistically significant difference between the two groups in terms of macroscopic adhesion scores (p=0.064), MDA levels (p=0.121), and GST activity (p=0.360). However, there was statistically significant difference between the two groups in terms of the extent of fibrosis (p<0.001), inflammation score (p=0.001), inflammatory cell activity (p=0.002), and SOD activity (p<0.001). Gelatin-thrombin matrix was found to have increased the extent of fibrosis, inflammatory cell activity, and inflammation score, and reduced the activity of SOD, which acts to prevent cell damage.

A randomized controlled study of the efficacy of misoprostol and hyaluronic acid in preventing adhesion formation after gynecological surgery: a rat uterine horn model

ObjectiveTo investigate the effect of misoprostol in the reduction of adhesion formation after gynecological surgery. Study designA double blind, randomized controlled experimental study was designed. Twenty-one female Wistar Hannover rats were divided into three groups as control, misoprostol and Hyalobarrier® groups. A uterine horn adhesion model was created. After anesthesia induction, 1.5–2cm injuries were made to the each uterine horn by cautery. The control group received no special medications except for the standard surgical procedure. The misoprostol group received 10μcg/kg misoprostol in addition to the standard surgical procedure, and the Hyalobarrier® group received 1cm3 ready-for-use Hyalobarrier® gel intraperitoneally in addition to the standard surgical procedure. After 14 days from the first surgical procedure, adhesion scores were evaluated. ResultsThe extent (p<0.001), severity (p<0.001), degree (p<0.001) and total adhesion score (p<0.001) values of the control group were statistically higher than the values of misoprostol and Hyalobarrier® groups. The inflammation score value of misoprostol group was statistically lower than control and Hyalobarrier® groups (p<0.001). ConclusionIn this study, we have found a new therapeutic potential of misoprostol that may be useful in preventing pelvic adhesion and reducing inflammation scores.

Tranexamic acid and hyaluronate/carboxymethylcellulose create cell injury.

Background and Objectives:Postoperative pelvic adhesions are associated with chronic pelvic pain, dyspareunia, and infertility. The aim of this study was to evaluate the adhesion prevention effects of tranexamic acid (TA) and hyaluronate/carboxymethylcellulose (HA/CMC) barrier in the rat uterine horn models on the basis of macroscopic and microscopic adhesion scores and histopathological as well as biochemical parameters of inflammation.Methods:Twenty-one Wistar rats were randomly divided into 3 groups. Ten lesions were created on the antimesenteric surface of both uterine horns by bipolar cautery. Three milliliters of 0.9% sodium chloride solution were administered in the control group. A single layer of 2 × 2 cm HA/CMC was plated in group 2. Two milliliters of TA was applied in the last group. All rats were sacrificed at postoperative day 21.Results:No significant difference was found among the control group, the HA/CMC group, and the TA group in terms of macro-adhesion score (P = .206) and microadhesion score (P = .056). No significant difference was found among the 3 groups in terms of inflammation score (P = .815) and inflammatory cell activity (P = .835). Malondialdehyde levels were significantly lower in the control group than in the TA group and HA/CMC group (P = .028). Superoxide dismutase and glutathione S-transferase activities were found to be higher in the control group than in the TA group (P = .005) and HA/CMC group (P = .009).Conclusions:TA and HA/CMC had no efficacy in preventing macroscopic or microscopic adhesion formation and decreasing inflammatory cell activity or inflammation score in our rat models. TA and HA/CMC increased the levels of free radicals and reduced the activities of superoxide dismutase and glutathione S-transferase enzymes, which act to reduce tissue injury.

Sıçan uterin horn modelinde enoksaparin ve rapamisinin adezyon oluşumuna etkilerinin karşılaştırılması

Aim. Several studies have demonstrated that low molecular weight heparins (LMWHs) decreased postoperative adhesion formation. Also, a few studies have noted that immunosuppressive agent rapamycin decreased postoperative adhesion formation. In this experimental study, we aimed to investigate the effect of enoxaparin and rapamycin alone and in combination on the adhesion formation in a rat uterine horn model. Methods. Our study included 40 Wistar-Albino rats weighing between 200-250 g. Control and three study groups were formed including 10 rats. In sterile condition, we performed 3-cm midline incision of abdominal wall under general anesthesia. On the antimesenteric surface of both uterine horns, 8-10 unipolar electrocauterization were applied. Later these antimesenteric surfaces were sutured to abdominal sidewalls with 4.0 polydioxanone. In the control group, no therapy was applied after surgery and incision was closed according to general surgical rules. In the enoxaparin group, enoxaparin 50 U/kg was applied intraperitoneally for 14 days. In the rapamycin group, rapamycin 0.8 mg/kg was applied orally with feeding tube for 14 days. In the enoxaparin plus rapamycin group, enoxaparin 50 U/kg was applied intraperitoneally and rapamycin 0.8 mg/kg orally with the feeding tube for 14 days. The animals were sacrificed by lethal dose pentobarbital 14 days after surgery and a midline laparatomy was carried out and abdominal cavity was inspected for the presence of adhesion and adhesion samples were obtained for histopathological examination. Results. According to the findings of macroscopic and microscopic evaluation, the scores of adhesion severity were found comparable among the enoxaparin, rapamycin and enoxaparin plus rapamycin groups (p>0.05); however, the scores of adhesion extent and total adhesion scores were significantly lower in the drug groups compared to the control group (p 0.05). Conclusion. Enoxaparine and rapamycin prevent total adhesion similarly, however, this effect is considerable on the extent of adhesion rather than the severity of adhesion. Combination of enoxaparin and rapamycin did not show synergistic effect on adhesion formation.

Comparison of effects of enoxaparin and rapamycin on adhesion formation in a rat uterine horn model

Comparison of effects of enoxaparin and rapamycin on adhesion formation in a rat uterine horn model

Lipoic acid decreases peritoneal adhesion formation in a rat uterine scar model

To investigate the effects of lipoic acid in the prevention of postoperative pelvic adhesions by a visual scoring system and immunohistochemistry in a rat uterine horn model with full thickness injury. Twenty-eight female Wistar albino rats were randomised into four groups: uterine trauma control, 15 days and 30 days, and uterine trauma + lipoic acid, 15 days and 30 days. A full thickness defect was established by incising a segment of approximately 1.0 cm in length from each uterine horn, leaving the mesometrium intact. Extension and severity of the adhesions in each group were scored by a visual scoring system and evaluated immunohistochemically. Adhesion scores were 2.00±0.81, 2.14±0.69 0.71±0.75, and 0.85±0.69 for extent and 2.28±0.48, 2.14±0.69, 0.85±0.69, and 1.14±0.69 for severity in Groups 1, 2, 3 and 4, respectively. Adhesion extent and severity were significantly less for groups treated by lipoic acid but no difference was observed between long and short administration. Both Vitronectin and u-PAR staining were significantly increased in treatment groups when compared to the control group. Lipoic acid was found to be effective in reducing postoperative adhesion formation in a rat model.

The aromatase inhibitor letrozole reduces adhesion formation after intraperitoneal surgery in a rat uterine horn model

To investigate, in an experimental animal study, the effects of letrozole and tamoxifen in the reduction of adhesion formation following abdominopelvic surgery. Thirty female Wistar albino rats were included and divided into three groups. One group received 500 μg/d tamoxifen and a second group received 1 mg/kg/d letrozole through an enteric tube. A third group did not receive any drugs and served as the control group. On the fifth day, a laparotomy was performed and the right uterine horn was injured by monopolar cautery. The left uterine horn was incised with a scalpel and sutured. The preventive therapy protocols were continued for 7 days after surgery. On the 14th day after first surgery the animals were sacrificed, and the intraperitoneal macroscopic adhesion formation and microscopic adhesion features were evaluated. The Kruskal-Wallis test was used to compare the scores of the macroscopic adhesion scores and histologic features among the three groups, followed by a post hoc Mann-Whitney test. The total histological score was analyzed with a one-way ANOVA, followed by post hoc Bonferroni correction tests. p values ≤0.05 were considered statistically significant. The level of significance was set at p≤0.016 for the post hoc tests. The letrozole and tamoxifen groups had significantly lower adhesion scores for the right uterine horn than the control group (p=0.005 and p=0.013, respectively). For the left horn, however, only the letrozole group had a lower macroscopic adhesion score than the controls (p=0.011). The total histological score was significantly lower in the letrozole group than in the control group (p=0.014), but no differences were found between the tamoxifen group and the control group (p=0.954). Inflammation, fibroblastic activity, collagen formation and vascular proliferation were significantly lower in the letrozole group compared with the control group (p<0.05). The foreign body reactions were similar among the three groups (p>0.05). Tamoxifen administration did not result in any significant effects on the histological scores (p>0.05). Letrozole resulted in a significant decrease in postoperative macroscopic adhesion formation and the total histological scores, but tamoxifen did not demonstrate a similar effect on the histological scores.

The effect of lipoic acid on wound healing in a full thickness uterine injury model in rats

Aim of this study was to investigate the effects of lipoic acid on uterine wound healing by immunohistochemical and biochemical assay in a rat uterine horn model with full thickness injury. Thirty-two female Wistar albino rats were randomised into five groups: Control group, with no intervention; uterine scar group 15days (US15d), uterine scar group 15days+alpha lipoic acid (ALA) (US15d+ALA), uterine scar group 30days (US30d) and uterine scar group 30days+ALA (US30days+ALA). After uterine incision 100mg/kg of ALA was administered by oral gavage for either 15 or 30days. Vascular endothelial growth factor (VEGF) and alpha smooth muscle actin (α-SMA) distribution were evaluated by immunohistochemical methods in tissue and ELISA methods in tissue homogenate. The percentage of α-SMA positive area in US15d+ALA and US30d+ALA groups was significantly higher than US15 and US30d groups. The percentage of VEGF positive area in US15d+ALA group was significantly higher than US15d group and US30d+ALA group was significantly higher than US30d group. Biochemically, α-SMA was significantly higher in the US15d+ALA group when compared to US15d group and higher in US30d+ALA group when compared to US30d group. VEGF was significantly higher in US15d+ALA and US30d+ALA groups when compared to US15 and US30d groups. In conclusion, ALA was found to be effective in enhancing wound healing in uterine full thickness injury.

Effect of Human Amniotic Fluid on Prevention of Postoperative Peritoneal Adhesion Formation in a Rat Uterine Horn Model

Effect of Human Amniotic Fluid on Prevention of Postoperative Peritoneal Adhesion Formation in a Rat Uterine Horn Model

Creation of an animal model for post-operative adhesion prevention

To establish a rabbit double uterine horn model for assessing the time-course of pelvic adhesions and evaluating the effectiveness of different anti-adhesive materials in reducing adhesions. A total of 330 Japanese white rabbits underwent laparotomy, followed by uterine horn incision. Animals were euthanized after 3, 7, 14, 28, and 42 days, respectively. The surgical procedure was smooth. Rabbit double uterine horn model was applied for the evaluation of pelvic adhesions in a three-dimension fashion. Each of the three means-gauze abrasion, needle holder clamping, and direct uterine incision induced postoperative pelvic adhesions, among which direct uterine incision was the best to mimic conditions after gynecological operations. Under normal circumstances, degradation of filmy fibrinous adhesions by locally released proteases of the fibrinolytic system occurred within 3 days of injury. The regeneration of the mesothelium was completed within 7 days. Collagen reached its peak by day 14. Anti-adhesive materials were supposed to be completely absorbed by day 28, and their effectiveness in preventing pelvic adhesions was confirmed at this time point. Whether their effect can be maintained after the absorption of the anti-adhesive materials was investigated in 42 days. The animal model was successfully established. It well mimics the postoperative pelvic adhesions after direct uterine horn injury and thus is a suitable model for studying site-specific adhesions. Observations on the 3rd, 7th, 14th, 28th, and 42nd post-operative days provided a full picture of the adhesion formation process.