Reduction of postsurgical adhesions in a rat model: a comparative study.
BACKGROUND
Adhesion formation after peritoneal surgery is a major cause of postoperative bowel obstruction, infertility, and chronic pelvic pain. In this study, we compared the possible individual effects of phosphatidylcholine (PC), Seprafilm II, and tissue plasminogen activator (t-PA) and the combined effects of phosphatidylcholine and t-PA on postoperative adhesion formation in a rat surgical model.


METHODS
A total of 50 Wistar male rats underwent median laparotomy and standardized abrasion of the visceral and parietal peritoneum. phosphatidylcholine, Seprafilm II, and t-PA alone and phosphatidylcholine and t-PA in combination were applied intraperitoneally at the end of the surgical procedure. Seven days after surgery, a relaparotomy was performed for adhesion grading and histopathological examination.


RESULTS
A comparison of adhesion stages demonstrated a significant difference between the control group and the study groups (p<0.001). The adhesion grade of the combined treatment group was statistically different from that of the other groups (p<0.05). In the t-PA group and the combined group, six and two rats, respectively, developed hematomas locally on the cecum.


CONCLUSIONS
PC, t-PA, and Seprafilm II used individually reduced the adhesion grade. The t-PA and phosphatidylcholine combination was most effective in reducing adhesion formation. On the other hand, usage of t-PA alone or in combination may increase risk of bleeding. More detailed studies are needed, and future studies on the efficacy of a material for decreasing adhesion formation should include a comparison of several control materials in the same model.
Irkorucu
Oktay
O
Department of General Surgery, Zonguldak Karaelmas University Medical School, Zonguldak, Turkey. oktaytip@yahoo.com
Ferahköşe
Zafer
Z
Memiş
Leyla
L
Ekinci
Ozgür
O
Akin
Murat
M
D000818:Animals; D004195:Disease Models, Animal; D004338:Drug Combinations; D004353:Drug Evaluation, Preclinical; D004359:Drug Therapy, Combination; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D008297:Male; D010532:Peritoneal Diseases / Q000188:drug therapy* / Q000517:prevention & control; D010713:Phosphatidylcholines / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy* / Q000517:prevention & control; D051381:Rats; D017208:Rats, Wistar; D000267:Tissue Adhesions / Q000188:drug therapy / Q000517:prevention & control; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D004338:Drug Combinations; D005343:Fibrinolytic Agents; D010713:Phosphatidylcholines; C118198:Seprafilm; D006820:Hyaluronic Acid; D010959:Tissue Plasminogen Activator