Reduction of Postoperative Adhesions by Perfluorocarbons: An Experimental Study in a Rat Model

Abstract

Peritoneal adhesions are a well-known and frequently occurring postoperative complication. Many published studies have looked into the prophylaxis of adhesions following abdominal surgery, but only few clinically relevant agents have been reported. Most publications refer to adult patients and not to paediatric patient collectives. This experimental study in a rat model compares the effect of perfluorocarbons as adhesion prophylaxis with those of a well-known anti-adhesive agent Adept^® and with an untreated control group. We hypothesized that PFC might have a double effect: initially it could suppress the accumulation of monocytes and neutrophilic granulocytes, and subsequently it would work as a barrier to prevent contact between the visceral and parietal layers of the peritoneum. After a standardised operation, PFC was injected into the abdominal cavity of rats in the study group. Macroscopically, the PFC group did not fare significantly better, but nevertheless a clear tendency towards fewer adhesions after the application of PFC could be ascertained.

peritoneal adhesions - experimental study in a rat model - perfluorocarbons (PFC, FC-77)

References

• 1 Bolen JW, Hammar SP, MacNutt MA. Reactive and neoplastic serosal tissue. A light-microscopic, ultrastructural, and immunocytochemical study.  Am J Surg Pathol. 1986;  10 34-47
• 2 Calderwood HW, Ruiz BC, Tham MK. et al . Residual levels and biochemical changes after ventilation with perfluorinated liquid.  J Appl Physiol. 1975;  39 603-607
• 3 diZerega GS. Contemporary adhesion prevention.  Fertil Steril. 1994;  61 219-235
• 4 diZerega GS. Biochemical events in peritoneal tissue repair.  Eur J Surg Suppl. 1997;  577 10-16
• 5 diZerega GS, Campeau JD. Peritoneal repair and post-surgical adhesion formation.  Hum Reprod Update. 2001;  7 547-555
• 6 diZerega GS. Peritoneal repair and post-surgical adhesion formation.  Hum Reprod Update. 2001;  7 ((6)) 547-555
• 7 diZerega GS, Verco SJ, Young P. et al . A randomized, controlled pilot study of the safety and efficacy of 4% icodextrin solution in the reduction of adhesions following laparoscopic gynaecological surgery.  Hum Reprod. 2002;  17 1031-1038
• 8 Duffy DM, diZerega GS. Adhesion controversies: pelvic pain as a cause of adhesions, crystalloids in preventing them.  J Reprod Med. 1996;  41 19-26
• 9 Duron JJ, Ellian N, Olivier O. Post-operative peritoneal adhesions and foreign bodies.  Eur J Surg Suppl. 1997;  163 ((579)) 15
• 10 Ellis H. Intestinal adhesions.  Ann Chir Gynaecol. 1983;  72 237-238
• 11 Frantzen C, Schlosser HW. Microsurgery and postinfectious tubal infertility.  Fertil Steril. 1982;  38 397-420
• 12 Gauger PG, Pranikoff T, Schreiner RJ. et al . Initial experience with partial liquid ventilation in pediatric patients with the acute respiratory distress syndrome.  Crit Care Med. 1996;  24 16-22
• 13 Hirschl RB, Pranikoff T, Wise C. et al . Initial experience with partial liquid ventilation in adult patients with the acute respiratory distress syndrome.  JAMA. 1996;  275 383-389
• 14 Hirschl RB, Croce M, Gore D. et al . Prospective, randomized, controlled pilot study of partial liquid ventilation in adult acute respiratory distress syndrome.  Am J Respir Crit Care Med. 2002;  165 781-787
• 15 Holaday DA, Fiserova-Bergerova V, Modell JH. Uptake, distribution, and excretion of fluorocarbon FX-80 (perfluorobutyl perfluorotetrahydrofuran) during liquid breathing in the dog.  Anesthesiology. 1972;  37 387-394
• 16 Hosie K, Gilbert JA, Kerr D. et al . Fluid dynamics in man of an intraperitoneal drug delivery solution: 4% icodextrin.  Drug Deliv. 2001;  8 9-12
• 17 Koch T, Ragaller M, Haufe D. et al . Perfluorohexane attenuates proinflammatory and procoagulatory response of activated monocytes and alveolar macrophages.  Anesthesiology. 2001;  94 101-109
• 18 Leach CL, Greenspan JS, Rubenstein SD. et al . Partial liquid ventilation with perflubron in premature infants with severe respiratory distress syndrome. The LiquiVent Study Group.  N Engl J Med. 1996;  335 761-767
• 19 Lowe KC. Perfluorochemicals and hyperbaric oxygen in radiation therapy: a cautionary note.  Int J Radiat Oncol Biol Phys. 1987;  13 291-292
• 20 Lowe KC. Perfluorocarbons as oxygen-transport fluids.  Comp Biochem Physiol A. 1987;  87 825-838
• 21 Luijendijk RW, de Lange DC, Wauters CC. et al . Foreign material in postoperative adhesions.  Ann Surg. 1996;  223 242-248
• 22 Lundorff P, van Geldorp H, Tronstad SE. et al . Reduction of post-surgical adhesions with ferric hyaluronate gel: a European study.  Hum Reprod. 2001;  16 1982-1988
• 23 Menzies D. Peritoneal adhesions – Incidence, cause, and prevention.  Surg Annu. 1992;  24 27-45
• 24 Mettler L, Audebert A, Lehmann-Willenbrock E. et al . Prospective clinical trial of SprayGel as a barrier to adhesion formation: an interim analysis.  J Am Assoc Gynecol Laparosc. 2003;  10 339-344
• 25 Monk BJ. Adhesion related complications of radical hystorectomy. Proc 24th Annu Meet of the Felix Rutheledge Society. Laguna Beach 1994
• 26 Moreno A, Aguayo JL, Zambudio G. et al . Influence of abdominal incision on the formation of postoperative peritoneal adhesions: an experimental study in rats.  Eur J Surg. 1996;  162 181-185
• 27 Morris KP, Cox PN, Mazer CD. et al . Distribution of pulmonary blood flow in the perfluorocarbon-filled lung.  Intensive Care Med. 2000;  26 756-763
• 28 Myllarniemi H. Adhesion and granuloma formation after abdominal operations.  Int Surg. 1996;  45 325-328
• 29 Myllarniemi H. Foreign material in adhesion formation after abdominal surgery.  A clinical and experimental study. Acta Chir Scand Suppl. 1996;  377 13-48
• 30 Peers E, Gokal R. Icodextrin: overview of clinical experience.  Perit Dial Int. 1997;  17 22-26
• 31 Ray NF, Denton WG, Thamer M. et al . Abdominal adhesiolysis: inpatient care and expenditures in the United States in 1994.  J Am Coll Surg. 1998;  186 1-9
• 32 Schwemmle K. Paralytic and postoperative ileus [author's transl].  MMW Munch Med Wochenschr. 1976;  118 213-216
• 33 Shaffer TH, Wolfson MR, Greenspan JS. et al . Liquid ventilation in premature lambs: uptake, biodistribution and elimination of perfluorodecalin liquid.  Reprod Fertil Dev. 1996;  8 409-416
• 34 Tinker MA, Burdman D, Deysine M. et al . Granulomatous peritonitis due to cellulose fibers from disposable surgical fabrics: laboratory investigation and clinical implications.  Ann Surg. 1974;  180 831-835
• 35 Treutner KH, Schumpelick V. Prevention of adhesions.  Wish and reality. Chirurg. 2000;  71 510-517
• 36 Verco SJ, Peers EM, Brown CB. et al . Development of a novel glucose polymer solution (icodextrin) for adhesion prevention: pre-clinical studies.  Hum Reprod. 2000;  15 1764-1772
• 37 Wiseman DM, Trout JR, Diamond MP. The rates of adhesion development and the effects of crystalloid solutions on adhesion development in pelvic surgery.  Fertil Steril. 1998;  70 702-711
• 38 Zografos GC, Messaris EG. Adhesion formation and intraperitoneal catheters: Histologic findings in a rat model.  Fertil Steril. 2005;  83 516-518
• 39 Zühlke HV. et al . Pathophysiology and classification of adhesions.  Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir. 1990;  1009-1016

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