Increasing anastomosis safety and preventing abdominal adhesion formation by the use of polypeptides in the rat.
OBJECTIVE
Postoperative adhesions can potentially be reduced using different anti-adhesive agents, though these drugs tend to compromise healing of an intestinal anastomosis. No method that significantly increases anastomosis safety is known at present. The aim of the study was to develop a concept of preventing postoperative adhesions using differently charged bioactive polypeptides, also considering healing and safety of an intestinal anastomosis.


METHODS
An ileocolic anastomosis was performed under both "clean" and "septic" conditions in the rat. The treatment group received intraperitoneal poly-L-lysine and poly-L-glutamate, while controls received sodium chloride. Abdominal adhesions, anastomosis leakage and burst pressure were analysed after 1, 3, 5 and 7 days in the clean anastomosis model and after 7 days in the septic model.


RESULTS
A significant decrease (p<0.01) in the amount of adhesions was seen in animals treated with polypeptides after 1, 3 and 5 days, while no difference was seen after 7 days. The anastomosis demonstrated a significantly higher burst pressure as evaluated at days 1 and 3 (p<0.05 and p<0.01, respectively) in the polypeptide-treated animals, while no difference was seen between the groups at day 5 or 7.


CONCLUSIONS
The use of differently charged polypeptides administered intraperitoneally after surgery resulted in a significant decrease in the extent of postoperative adhesions. Furthermore, an increase in intestinal anastomosis safety, based on improved burst pressure during the first 3 days, i.e. the critical period during the healing process, was noted. No adverse effects were seen in surgery during septic conditions.
Tingstedt
Bobby
B
Department of Surgery, Centre of Chemistry and Clinical Engineering, Lund University, Lund, Sweden. bobby.tingstedt@med.lu.se
Nehéz
László
L
Axelsson
Jakob
J
Lindman
Björn
B
Andersson
Roland
R
D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D003125:Colostomy / Q000009:adverse effects*; D004195:Disease Models, Animal; D007081:Ileostomy / Q000009:adverse effects*; D008297:Male; D008856:Microscopy, Fluorescence; D010455:Peptides / Q000627:therapeutic use*; D010865:Pilot Projects; D011183:Postoperative Complications / Q000473:pathology / Q000517:prevention & control*; D051381:Rats; D017207:Rats, Sprague-Dawley; D000267:Tissue Adhesions / Q000473:pathology / Q000517:prevention & control
D010455:Peptides