Prevention of Pleural Adhesions Using a Membrane Containing Polyethylene Glycol in Rats

Abstract

Background: Recurrent thoracotomies regardless of the cause are not a rare occurrence. However, each thoracotomy results in adhesion to some extent. This adhesions increase morbidity and mortality presents a significant inconvenience for surgeons and prolongs the length of operations.Objective: We investigated the efficacy of Prevadh®, an anti-adhesion agent to prevent intrapleural adesions following thoracotomy in a rat model.Methods: Twenty male adult Wistar Albino rats were divided into a sham group (Group A, n = 4), a control group (Group B, n = 8), and a study group (Group C, n = 8). Only left thoracotomy was performed in Group A. Group B underwent left thoracotomy, induction of adhesion, and 1 ml saline solution was administered to the thoracic cavity. However, in Group C underwent left thoracotomy, induction of adhesion, and Prevadh® was placed between the pleura and the lung. The rats were sacrificed on day 21, and adhesions were analyzed using both macroscopic and histopathological methods. The results were statistically analyzed. A value of P<0.05 was considered statistically significant.Results: Mean lengths of adhesion differed statistically significantly among all three groups, while mean intensity of adhesion differed between Group A and Group B, and between Group B and Group C (P>0.05). There was also a statistically significant difference between Group A and Group C in mesothelium proliferation score (P>0.05). No statistically significant differences were found among the groups in terms of pleural thickness, macrophage and mononuclear cell infiltration (P>0.05).Conclusions: Prevadh® was shown in a rat model to effectively prevent post-thoracotomy adhesions.

Cloreto de sódio a 0,9%, adicionado ou não de dexametasona, intrapleural, na prevenção de aderências pulmonares após toracotomia intercostal em cães

“…Concorda-se com KARACAM et al (2011), que aderências pulmonares tenham um efeito benéfi co no pós-trauma ou pós-operatório imediato na tentativa de reparação das soluções de continuidade, no entanto, em reintervenções mais tardias, desfazê-las pode ser a causa de pneumotórax. Evidentemente, isso pode ocorrer em aderências organizadas em que haja presença de tecido colágeno, conforme descrevem NOISHIKI & SHINTANI (2010) e YANG et al (2012.…”

“…Na ausência de isquemia tecidual, ocorre fi brinólise sem formação de aderências. Quando ocorre lesão vascular, no entanto, a fi brina é infi ltrada por fi broblastos e produz aderências (KIRBY, 2003), condição que pode ser útil na prevenção do pneumotórax ou efusão pleural (KARACAM et al, 2011). As causas mais frequentes de aderências na cavidade abdominal são a isquemia, uso de fi os de sutura, dissecação da serosa, corpos estranhos e infecção (KIRBY, 2003).…”

Basic experiments of bioabsorbable materials in prevention of postoperative intrapleural adhesions following thoracotomy

“…From these, eight studies [8][9][10][11][12][13][14][15] with full-text available provided the best evidence. These studies are summarized in Table 1.…”

“…The type of a bioabsorbable material was a sheet in five studies (62.5 %) [8-10, 14, 15] and powder or spray in three studies (37.5 %) [11][12][13]. The material included a polymer in five studies (62.5 %) [10][11][12][13]15] and is commercially available in three studies (37.5 %) [8,14,15]. The material was placed on visceral pleura in five studies [8][9][10][11][12] and on parietal pleura in two studies [14,15], and on both in one study [14].…”

Pleural Lubrication

“…Considering that sialomucin is normally occurring in the glycocalyx of the mesothelial cells, the above finding suggests that it might be worthwhile to investigate whether sialomucin may be useful in the cases of thoracotomy that require prevention of pleural adhesion. Experiments in this field have been done in rats by using hyaluronate based bioresorbable membranes [57], hemostatic fleeces with a collagen matrix coated with fibrinogen and thrombin [58] or poly-ethylene glycol membranes [59]. Furthermore, peritoneal adhesions have been reduced by a peritoneal application of phospholipids in rats [60] or a peritoneal spray of phospholipids in rabbits [61].…”