Comparative Effectiveness of Several Agents for Preventing Postoperative Adhesions

Abstract

Postoperative adhesions (PAs) are usually clinically asymptomatic. Symptomatic cases, however, may present with chronic abdominal and pelvic pain, infertility, and intestinal obstruction; and they may require intensive, costly therapeutic modalities. Various agents have been used to prevent PAs, but the results indicate general suboptimal effectiveness. Our objective was to evaluate the comparative effectiveness of two pharmacologic agents for preventing PA: nadroparine calcium (low-molecular-weight heparin, or LMWH) and aprotinin, as well as a barrier agent, sodium hyaluronate/carboxymethycellulose (SCMC). Our subjects were 40 male Wistar-Albino rats divided into four groups, each consisting of 10 rats, which underwent standard cecal abrasion preceding midline laparotomy. In the control group (group 1) 1 ml of 0.9% NaCl was administered intraperitoneally before abdominal closure. In the three preventive groups, 100 U AXa (anti factor X activity) LMWH, 1800 IU aprotinin, and SCMC were administered intraperitoneally to groups 2, 3, and 4, respectively. Relaparotomy was performed on the 14th postoperative day. Visceral and abdominal wall adhesions were scored in a blinded fashion. The adhesion scores (mean +/- SD) for groups 1, 2, 3, and 4 were 2.00 +/- 0.67, 0.6.00 +/- 0.84, 1.10 +/- 0.74, and 0.20 +/- 0.42, respectively. The differences in the adhesion scores among all three preventive groups (groups 2, 3, 4) were statistically significant when compared with the control group ( p < 0.001, p = 0.017, p < 0.001, respectively). Intraperitoneal SCMC and administration of LMWH were more effective than giving aprotinin.

Development of a Novel, Nearly Insoluble Antiadhesive Membrane

“…However, when the fibrin also contains cellular elements, it may undergo organization into adhesion. Some researchers have studied antiadhesive agents, which stimulate fibrinolysis or prevent organization of the fibrin matrix [23,24]. However, barriers between the two surfaces are thought to be the most effective method for preventing postoperative adhesion.…”

“…Rats in the control group received no barrier. On the 14th day after surgery, all rats in each group underwent repeat laparotomy under anesthesia and the extent of adhesion formation was evaluated according to our modified scale [21]. Adhesion severity was scored as follows: 0 = no adhesion; 1 = thin and easily separated adhesion; 2 = narrow range weak adhesion, but able to withstand mild traction; 3 = adhesion present in two locations or fairly firm adhesion, and 4 = adhesion present in three or more locations (fig.…”

Analysis of the effects of heparin and enoxaparin on degloving injuries

“…Standard heparin and LMWH's inhibit thrombin formation that is effective in the coagulation phase of the phases of wound healing. It has been reported that heparin and derivatives fasten wound healing by decreasing the destruction in tissues and cells, and increasing neoangiogenesis, thus, supporting revascularization, granulation, and epithelisation (12,13). In addition, heparin and derivatives positively affect wound healing by increasing the cellular aggregation and new vessel formation, and by decreasing cellular destruction (14)(15)(16).…”

Effects of Saline and Other Peritoneal Lavage Solutions on the Morphology and Function of in Vitro Mesothelial Cells

“…In the light of these results, the weak spot of many studies on peritoneal lavage is use of 0.9% saline as a control fluid for other tested substances (7,15,16). Many investigators and clinicians simply denote this solution as a standard fluid for lavage of inflamed peritoneal cavities (17), and there is still no convincing evidence concerning the biocompatibility of this peritoneal lavage solution.…”