Prevention of postoperative peritoneal adhesions: effects of lysozyme, polylysine and polyglutamate versus hyaluronic acid.
OBJECTIVE
Intraperitoneal adhesions are an important cause of postoperative intestinal obstruction, abdominal discomfort and infertility. In the present study we hypothesized that a combination of polypeptides with different surface properties, resulting in fine disperse low-soluble complexes, could be of benefit in the prevention of abdominal adhesions.


METHODS
Various polypeptides including lysozyme, polyglutamate, polylysine and combinations of all three were evaluated as compared to hyaluronic acid. A standard wound on the parietal peritoneum in mice was used and the evaluated agents were administered immediately postoperatively. The extent of peritoneal adhesions to the injured area was measured and expressed as a percentage of the wound length as evaluated after 7 days. Flow cytometry was performed to evaluate the effect on peritoneal macrophage survival and phagocytic function and the Pick test was used to determine peroxide production in order to estimate toxicity and potential impairment of macrophage function caused by the chemicals.


RESULTS
Significant differences were seen among the treatment groups (p<0.001). Both polyglutamate and lysozyme, and polyglutamate together with polylysine significantly decreased adhesion formation as compared to hyaluronic acid. The polylysine-polyglutamate combination was still visible macroscopically on the peritoneal surface after 1 week, though not after 1 month. The polyglutamate-lysozyme mixture was less effective than these individual components alone. The chemicals did not show any toxic effects or altered function in macrophage cell culture.


CONCLUSIONS
Lysozyme, polyglutamate and, most effectively, a polyglutamate-polylysine combination significantly decreased experimental abdominal adhesion formation. A strong mechanical connection to the wound and prolonged attendance in the surface were noted. Peritoneal phagocyte function did not seem to be influenced by the chemicals.
Nehéz
László
L
Department of Surgery, Lund University, Sweden.
Vödrös
Dalma
D
Axelsson
Jakob
J
Tingstedt
Bobby
B
Lindman
Björn
B
Andersson
Roland
R
D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000818:Animals; D000890:Anti-Infective Agents / Q000627:therapeutic use; D004195:Disease Models, Animal; D005260:Female; D005434:Flow Cytometry; D005500:Follow-Up Studies; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D017737:Macrophages, Peritoneal / Q000187:drug effects / Q000473:pathology; D051379:Mice; D008815:Mice, Inbred Strains; D009113:Muramidase / Q000627:therapeutic use*; D010532:Peritoneal Diseases / Q000473:pathology / Q000517:prevention & control*; D011099:Polyglutamic Acid / Q000627:therapeutic use*; D011107:Polylysine / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control*; D000267:Tissue Adhesions / Q000473:pathology / Q000517:prevention & control; D014945:Wound Healing / Q000187:drug effects
D000276:Adjuvants, Immunologic; D000890:Anti-Infective Agents; D011107:Polylysine; D011099:Polyglutamic Acid; D006820:Hyaluronic Acid; D009113:Muramidase