Which Is Most Effective In Prevention Of Postoperative Intraperitoneal Adhesions - Methylene Blue, Low Molecular Weight Heparin Or Vitamin E: An Experimental Study In Rats

摘要

Background: Postoperative intraperitoneal adhesions and their complications are still serious problems, which are complicating abdominal surgery. Aim: To asses the effects of methylene blue, low molecular weight heparin (LMWH) and vitamin E in prevention of postoperative intraperitoneal adhesions. We also aimed to assess which one is the most effective one. Material and Method: 40 Wistar albino rats were divided into four groups. The first group was the control group; methylene blue was given intraperitoneally to the second group, LMWH to the third group and vitamin E to the fourth group. At the 7th postoperative day, the rats were sacrificed by an overdose of ether, and macroscopic staging for adhesions was performed blindly. Results: Adhesion formation in group 2, 3 and 4 was less than in the control group and a statistically significant difference was determined in comparison of those groups (p<0.005). No statistically significant difference was found at macromorphological staging between groups 2, 3 and 4, although some differences were noted (p>0.05).Conclusion: LMWH and vitamin E with their low prices, easy applications and no toxic and side effects may have an alternative clinical application field in prevention of adhesions. Introduction Abdominal surgery can cause adhesions between tissues and organs. Approximately 93% of the patients who had undergone one or more previous surgeries had intra-abdominal adhesions1. Postsurgical adhesions are a consequence resulting when injured tissue surfaces, following incision, cauterization, suturing or other means of trauma, fuse together to form scar tissue. Recently, it was found2 that all patients who had undergone at least one prior abdominal surgery developed one to more than ten adhesions. Postsurgical adhesions severely affect the quality of life of millions of people worldwide, causing small-bowel obstruction1, difficult reoperative surgery3, chronic abdominal and pelvic pain4, and female infertility5.Reoperating through a previous wound can be extremely difficult, risky, and potentially dangerous. Also, adhesiolysis extends operating time, anesthesia, and recovery time and causes additional risks to the patient such as blood loss, visceral damage including injury to the bladder, enterocutaneous fistulas, and resection of damaged bowel6.In this experimental study, we aspired to evaluate the effects of methylene blue (MB), low molecular weight heparin (LMWH) and vitamin E, which effect by different mechanisms but are applied from the same way, in prevention of postoperative intraperitoneal adhesions. All of these three substances are cheap and easy to apply; that is why we selected them. We also aimed to assess which one is the most effective one. Materials And Methods The Ethics Committee of our center approved the experimental procedures in this study. All of the guiding principles in the care and use of laboratory animals were strictly adhered to throughout the entire study.Forty Wistar female rats, weighing between 190 and 210g were housed in a climate controlled (relative humidity of 30-70% and temperature of 20°C to 24°C) animal-care facility, with a 12-hour light/dark cycle. The animals were provided with standard rodent chow and water ad libitum.The rats were anesthetized with intramuscular injection of ketamine hydrochlorur (40mg/kg). The surgical field was shaved and prepared with 1% antiseptic povidine-iodine solution and a 3cm incision was made along the abdominal midline. Punctate serosal hemorrhagies were created by scraping the anterior wall of the caecum with mesh gauze. This is a standard accepted procedure. Prior to closure of the abdominal incision, animals were randomly assigned to intraperitoneal administration of 2mL of either saline (n=10) (as control group), 1% Methylene blue solution (n=10), LMWH (100U a x a /kg) (Clexane?, Aventis Pharma – France) (n=10), or vitamin E (10mg/kg in 2ml sterilized pure olive oil) (n=10). The abdominal incision was sub