title: Bromelain: a natural proteolytic for intra-abdominal adhesion prevention.
abstract: BACKGROUND
  Peritoneal adhesions are pathological fibrous connections between peritoneal surfaces resulting from incomplete peritoneal repair. Adhesions cause various health problems ranging from pelvic pain and bowel obstruction to infertility. To date, no effective agent exists for intra-abdominal adhesion prevention. Bromelain is the crude extract of the pineapple and it has fibrinolytic, antithrombotic, and anti-inflammatory properties. Bromelain has been shown to be effective for removing necrotic tissues and has been found to be effective for treating various wounds, inflammatory conditions, and thrombotic pathologies. In the present study, we evaluated bromelain as a novel agent for preventing intra-abdominal adhesions.
  
  
  METHODS
  Group 1 (control group): Adhesions were produced by cecal abrasion method, and no treatment was applied. Group 2 (i.p. bromelain-treated group): After adhesion formation, 10 mg/kg/BW of bromelain dissolved in 1 mL saline solution was applied intraperitoneally for 10 days. Group 3 (i.p. saline-treated group): After adhesion formation, 1 mL saline solution was applied intraperitoneally for 10 days. On postoperative day 10, all animals were sacrificed.
  
  
  RESULTS
  All 30 rats survived surgery. Throughout the follow-up period, no complications were observed. Statistically significant differences were found between the groups with regards to macroscopic adhesion scores, inflammation, fibrosis and neo-vascularization (p < 0.001, <0.001, p = 0.001, p = 0.002, respectively). Macroscopic and histopathologic (inflammation, fibrosis, neo-vascularization) adhesion scores were lowest in the bromelain-treated group.
  
  
  CONCLUSIONS
  Bromelain, acting through its barrier, anti-inflammatory, antioxidant, and proteolytic effects and without increasing bleeding tendency or having any adverse effects on wound healing, may be a suitable agent for intra-abdominal adhesion prevention.
authors.affiliation: Zonguldak Bulent Ecevit University, School of Medicine, Department of Obstetrics and Gynecology, Kozlu, Zonguldak, Turkey. Electronic address: drsahbazahmet@yahoo.com.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Sahbaz
authors.affiliation: Zonguldak Bulent Ecevit University, School of Medicine, Department of Obstetrics and Gynecology, Kozlu, Zonguldak, Turkey. Electronic address: o.aynoglu@yahoo.com.
authors.forename: Oner
authors.initials: O
authors.lastname: Aynioglu
authors.affiliation: Zonguldak Bulent Ecevit University, School of Medicine, Department of Obstetrics and Gynecology, Kozlu, Zonguldak, Turkey. Electronic address: k.hgonbe@gmail.com.
authors.forename: Hatice
authors.initials: H
authors.lastname: Isik
authors.affiliation: Zonguldak Bulent Ecevit University, School of Medicine, Department of Obstetrics and Gynecology, Kozlu, Zonguldak, Turkey. Electronic address: ozmenulk@yahoo.com.tr.
authors.forename: Ulku
authors.initials: U
authors.lastname: Ozmen
authors.affiliation: Zonguldak Bulent Ecevit University, School of Medicine, Experimental Animal Research Laboratory, Kozlu, Zonguldak, Turkey. Electronic address: osmancengil@gmail.com.
authors.forename: Osman
authors.initials: O
authors.lastname: Cengil
authors.affiliation: Zonguldak Bulent Ecevit University, School of Medicine, Department of Pathology, Kozlu, Zonguldak, Turkey. Electronic address: banudogangun@yahoo.com.
authors.forename: Banu Dogan
authors.initials: BD
authors.lastname: Gun
authors.affiliation: Izmir Tepecik Education and Research Hospital, Department of Gynecological Oncology, Izmir, Turkey. Electronic address: maidenkemal@yahoo.com.
authors.forename: Kemal
authors.initials: K
authors.lastname: Gungorduk
mesh_terms: D000818:Animals; D001963:Bromelains / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D010532:Peritoneal Diseases / Q000517:prevention & control*; D008517:Phytotherapy; D010936:Plant Extracts / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control; D017208:Rats, Wistar; D000267:Tissue Adhesions / Q000517:prevention & control; D014945:Wound Healing / Q000187:drug effects
chemical_list: D010936:Plant Extracts; D001963:Bromelains
keywords: Abdominal surgery; Adhesion; Bromelain; Prevention; Proteolytic