Preventing intraperitoneal adhesions with vitamin E and sodium hyaluronate/carboxymethylcellulose: a comparative study in rats

Abstract

Purpose:To compare the effectiveness of intraperitoneally administered vitamin E with the sodium hyaluronate/ carboxymethylcellulose membrane (HA/CBMC) in preventing postoperative intraperitoneal adhesion formation. Methods: Sixty Wistar rats underwent a laparotomy and adhesions were induced (IA). The animals were divided into four groups: group 1, control (IA); group 2 (IA + Vitamin E): group 3 (IA+HA/CBMC) and group 4 (IA+ Vitamin E + HA/CBMC). The Vitamin E (groups 2 and 4) and HA/CBMC (groups 3 and 4) were administered intraperitoneally before the abdominal wall was closed. After 30 days, adhesions were classified by an independent surgeon. Results: Three animals died; one from group 3 and two from group 4. All control animals had substantial adhesions compared with unsubstantial adhesions observed in 11/15 in group 2 (P = 0.000), 11/14 in group 3 (P = 0.001), and 10/13 in group 4 (P = 0.000). Conclusion: Vitamin E, administered intraperitoneally, is as effective as HA/CBMC in preventing postoperative adhesions.Key words: Adhesions. Vitamin E. Carboxymethylcellulose. Rats. RESUMOObjetivo: Comparar a efetividade da Vitamina E e da membrana de Carboximetilcelulose/Hialuronato de Sódio (CBMC/HA) na prevenção da formação de aderências intraperitoneais pós-operatórias. Métodos: Sessenta ratos Wistar foram submetidos à laparotomia para indução de aderências (IA) com abrasão do ceco seguido de aplicação de álcool absoluto e sutura com fio de seda no peritônio parietal. Os animais foram divididos em quatro grupos: 1 controle ( IA ); 2 ( IA + Vitamina E ); 3( IA + CBMC/HA ) e 4 ( IA + Vitamina E + CBMC/HA ). A Vitamina E ( grupos 2 e 4 ) e CBMC/HA ( grupos 3 e 4 ) foram administrados intraperitonealmente antes do fechamento da parede. Os ratos foram sacrificados em 30 dias e as aderências foram classificadas por cirurgião independente. Resultados: Três animais morreram, sendo um do grupo 3 e dois do grupo 4. Todos os animais do grupo controle ( 1 ) tiveram aderências substanciais, comparados com aderências insubstanciais em 11/15 no grupo 2 ( p = 0,000 ), 11/14 no grupo 3 ( p = 0,001 ) e 10/13 no grupo 4 ( p = 0,000 ). Conclusão: A Vitamina E administrada de maneira intraperitoneal é tão eficaz quanto a CBMC/HA na prevenção da formação de aderências pós-operatórias.

Abdominal Adhesions: Current and Novel Therapies

“…Increases cGMP leading to reduced collagen synthesis and increases in fibroblast apoptosis [276,277] Some efficacy in rat models (oral delivery) [278,279] Increased colonic bursting pressure and angiogenesis in rat model in the presence of infection [279] Methylene blue Inhibits NO synthase; reduces free radical oxygen but mechanism in preventing adhesions unknown [280] Some efficacy in rat models [280][281][282] May induce adhesions at high doses [280] Impairs anastomotic healing [282] Catalase Reduces oxidative stress Some efficacy in rat model [283] Vitamin E Antioxidant Efficacy comparable to Seprafilm in rat model [284] Opioids (opium, morphine) Unknown mechanism; postulated that opium receptor decreases inflammation [285] Some efficacy in rat model (reduced length, thickness, and severity) [285] (Continued ) WARD AND PANITCH: ABDOMINAL ADHESIONS: PATHOGENESIS AND SOLUTIONS May reduce oxidative stress [286] Some efficacy in rat bacterial peritonitis model [286] Mixture of lidocaine and prilocaine more effective than lidocaine alone [286] Honey Unknown mechanism; may reduce oxidative stress [287] Some efficacy in rat model (oral delivery [288] and peritoneal delivery [287]) Improved histology and anastomotic busting pressure in rats [288] Sphingosine kinase 1 delivered by adenovirus Enhances mesothelial cell migration accelerating wound healing [289] Some efficacy in rat model [289] neurokinin-1 receptor antagonist (aprepitant, CJ-12-255]…”

Visceral mobilization can lyse and prevent peritoneal adhesions in a rat model

“…Prevention is a far more desirable goal (Gomel et al, 1996;Mettler, 2003;Scott-Coombes et al, 1993), and much effort has been expended on adhesion prevention using various chemical compounds and barriers (Corrales et al, 2008;Guo et al, 2009;Ilbay et al, 2004;Kutlay et al, 2004;Mettler et al, 2003;Oncel et al, 2004). Systematic reviews of these treatments have reported that none consistently prevent adhesion formation (Kumar et al, 2009;Metwally et al, 2006).…”

The comparison of methylene blue and vitamin E in prevention of abdominal postoperative adhesion formation in rat uterine horn models: Biochemical and histopathologic evaluation

“…Vitamin E presents interesting biological properties and activities for preventing intraperitoneal adhesions. In vitro studies have reported that it has antioxidant, anti-inflammatory, anticoagulant and antifibroblastic effects, and playing a role in diminishing the production of collagen [3][4][5] . In recent studies, it has been suggested that intraperitoneal application of MB can be used as an effective agent in the prevention of postoperative adhesions 6 .…”