dc.description.abstract |
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. |
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