Comparison of 4 % Icodextrin and Omega 3 Fatty Acids in Prevention of Peritoneal Adhesions

Abstract

Postoperative peritoneal adhesions are major concerns in abdominal surgery. In this experimental study, the effects of 4 % icodextrin and omega-3 fatty acids (ω-3 FA) on prevention of postoperative peritoneal adhesions were evaluated. Twenty-four Wistar albino rats were divided into three groups. After laparotomy, serosal abrasion was carried out by cecal brushing. Intraperitoneally 3 cm 3 0.9 % NaCl, 3 cm 3 4 % icodextrin, and 200 mg/kg ω-3 FAs for each group were applied, and then the abdomen was closed. All subjects sacrificed 10 days postoperatively. Macroscopic and histopathological cellular reactions as a function of giant cell, lymphocyte/plasmocyte, neutrophil, histiocyte, intracellular adhesion molecule-1 (ICAM-1), and platelet endothelial cell adhesion molecule-1 (PECAM-1) were assessed and hydroxyproline levels were measured in all three groups and compared using Kruskal-Wallis and ANOVA tests when appropriate. Macroscopically, both ω-3 FAs and 4 % icodextrin reduced adhesion formation but the difference was not statistically significant (P00.253). Histopathological examination revealed that there was no statistical significance in terms of giant cell, lymphocyte/plasmocyte, neutrophil, ICAM-1, and PECAM-1 scores; however, both ω-3 FAs and 4 % icodextrin were found to be prone to reduce fibrosis (P00.047), whereas in the ω-3 FA group, histiocytic reaction was significantly increased (P00.001), and hydroxyproline levels were significantly lower than other groups (P00.044). In this study, ω-3 FAs were found to be superior to 4 % icodextrin with the lower hydroxyproline level and greater histiocytic reaction. Considering these results, ω-3 FAs can be a promising agent in the prevention of adhesion formation.

Anti-adhesive effects of argan oil on postoperative peritoneal adhesions

“…After abdominal skin shaving, antisepsis was provided by povidone iodine solution. All applications which could lead to adhesion were avoided [9,10].…”

“…100 mg/kg of paracetamol was injected subcutaneously for analgesia. The rats were allowed normal feeding, 6th hour postoperatively [9,10].…”

“…Barriers, surgical or non invasive strategies, cellular strategies, drugs and agents have been used at clinical or experimental studies [6]. Fatty acids contents such as soybean oil, ClinOleic, canola oil, omega 3 fatty acids and olive oil were studied for prevention of PPA experimentally in literature [7][8][9][10][11].…”

Comparing Lavage of the Peritoneal Cavity with Lidocaine, Bupivacaine and Normal Saline to Reduce the Formation of Abdominal Adhesion Bands in Rats

“…The fact that the severity of adhesions and adhesion scores were significantly lower in the lidocaine and bupivacaine groups shows that using local anaesthetic drugs can reduce the quality, quantity and severity of intra-abdominal adhesions, but cannot prevent their formation. One reason for this may be that inflammation intensity may be related to adhesion severity without being the cause of the formation of adhesion (14). Therefore, local anaesthetic drugs reduce the intensity of adhesion by reducing inflammation, but do not prevent their formation.…”

“…Hypothermia induction decreases postoperative intra-abdominal adhesion (12). Other factors such as orally administered simvastatin, omega 3 fatty acids (13,14), intraperitoneal administration of losartan plus atorvastatin (15), and using poly(lactic-co-glycolic acid) nanofibers between the abdominal wall and the peritoneum (16) reduces postoperative intra-abdominal adhesions. In one study, a non-steroidal antiinflammatory drug (NSAID) called Tenoxicam reduced the formation of fibrin and prevented the formation of adhesions following abdominal surgery in rats.…”