Comparison of Substances Used for Prevention of Intra-Abdominal Adhesions: An Experimental Study in Rats

Abstract

Objective: Many substances have been used up to date in order to prevent postoperative adhesions. This problem is still a 'puzzle' for researchers. We aimed to compare various substances preventing adhesions in an experimental postoperative adhesion model. Material and Methods: A total of 35 female Sprague-Dawley rats were divided into five groups containing equal number of animals. After laparatomy, peritoneum and ceacum were brushed using a tooth brush until punctate hemorrhage was seen. Additional surgery was not applied in control group (group 1). In the other groups, polyethylene dioxide+sodium carboxymethyl cellulose (PEO+CMC) (group 2), hyaluronan. (HA) (group 3), octenidine dihydrochloride+fenoxyethanol 2% (ODH+FE) (group 4) and surfactant. (SFT) (group 5) were applied respectively, in order to prevent intra-abdominal adhesions. Rats were sacrificed on 10(th) day. Adhesion scores, fibroblastic activity and periserosal inflammation were determined and hydroxyproline (HP) levels were measured using HPLC method. Results: Adhesion and fibroblastic activity scores of group 1 (control) were found significantly higher than the other groups (except ODH+FE group). The lowest adhesion score and hydroxyproline level were found in PEO+CMC group (p<0.05). The lowest fibroblastic acitvity and periserosal inflammation were found in SET group, and it was significantly different from group 1. Periserosal inflammation was significantly higher in ODH group compared to the other groups (p<0.05). Adhesion score of PEO+CMC group was significantly lower than the other groups. Conclusion: All these substances have anti-adhesive effects to some extent. ODH+FE causes irritation to intestinal serosa and has mild anti-adhesive effect. SET was the least irritative among all the substances tested. PEO+CMC seems to be the strongest anti-adhesive substance. This study supports the positive reports on the clinical use of PME+CMS and HA. Particularly, SFT is found to be effective against intra-abdominal adhesions. However, ODH+FE should be further investigated in diluted concentrations.