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 (lowmolecular-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.
Forty male 5-month-old Wistar-Albino rats at Ankara University
Faculty of Medicine animal research laboratory, weighing 250 to
300 g, were acclimated to the new environment for 48 hours; they
were maintained on standard rat chow and water. None of the rats
was fasted before surgical intervention. The 40 rats were randomized
into four groups of 10 each. Each rat was anesthetized with
intramuscular ketamine (60 mg/kg) and xylazine (10 mg/kg). Each
animal was prepared with povidone-iodine and draped in a sterile
fashion. Using a lower midline incision, the cecum and terminal
ileum were mobilized and a 1 cm2 area of the cecum was rubbed
with gauze until subserosal hemorrhage developed.
Prior to abdominal closure, group 1 (control), group 2 (LMWH),
and group 3 (aprotinin) were given 1 ml of 0.9% NaCl 100 IU AXa
(anti factor X activity) nadroparine calcium, and 1800 IU aprotinin
intraperitoneally, respectively. In group 4, the area of cecal abrasion
was covered with an SCMC sheet before abdominal closure.
The abdomen was closed in running fashion with 4/0 polypropylene
sutures, and the skin was closed with interrupted 4/0 silk sutures.
Animals were allowed to feed ad libitum immediately after operation.
