ABSTRACT: The formation of adhesions following abdominal surgery is a well known problem. In previous studies we demonstrated the efficacy and safety of intraperitoneally applied phospholipids in order to prevent adhesion formation. This study evaluates the influence of blood on the efficacy of intraperitoneally applied phospholipids for prevention of adhesions.
In 40 Chinchilla rabbits adhesions were induced by median laparotomy, standardized abrasion of the visceral and parietal peritoneum in defined areas of the ventral abdominal wall and the caecum. The animals were randomly divided into four groups. They received either phospholipids 3.0% or normal saline (NaCl 0.9%) (5 ml/kg body weight). In 50% of the rabbits we simulated intraperitoneal bleeding by administration of blood (1.5 ml/kg body weight). The other half served as control group. Ten days following the operation the animals were sacrificed and adhesion formation was assessed by computer aided planimetry and histopathologic examination.
The median adhesion surface area in the NaCl-group (n = 9) amounted to 68.72 mm2, in the NaCl+Blood-group (n = 10) 147.68 mm2. In the Phospholipid (PhL)-group (n = 9) the median adhesion surface area measured 9.35 mm2, in the PhL+Blood-group (n = 9) 11.95 mm2. The phospholipid groups had a significantly smaller adhesion surface area (p < 0.05).
Again these results confirm the efficacy of phospholipids in the prevention of adhesions in comparison to NaCl (p = 0.04). We also demonstrated the adhesion preventing effect of phospholipids in the presence of intraperitoneal blood.
BMC Surgery 02/2007; 7:14. · 1.33 Impact Factor
ABSTRACT: The purpose of this study was to assess the ability of four different either solid or fluid barriers to reduce adhesions in an established model of gynecological surgery.
50 Chinchilla rabbits underwent bilateral deperitonealization and devascularization of the uterine horns (DUH). Afterwards solid membranes of either hyaluronic acid-carboxymethylcellulose (HA-CMC) or lactide-caprolactone-copolymer (LCC) were placed around the injured uterine horns or fluids (icodextrin (ID) or phospholipids (PL)) were intraperitonealy administered. The control group went without protection. After 10 days, adhesions were measured by planimetry.
Phospholipids (median 49.8 mm2) significantly reduced adhesion areas in comparison to all other groups: surgical controls (median 230.6 mm2), HA-CMC (median 194.9 mm2), LCC (median 327.1 mm2), and icodextrin (median 242.1 mm2).
These results prove the efficacy of phospholipids to reduce primary adhesion formation in the Chinchilla double uterine horn model compared to HA-CMC, LCC and icodextrin. Future clinical studies are recommended.
European Journal of Obstetrics & Gynecology and Reproductive Biology 07/2005; 120(2):222-6. · 1.97 Impact Factor
ABSTRACT: Phospholipids and icodextrin reduce peritoneal adhesions resulting from general peritonitis without promoting abscess formation.
Evaluation of adhesion reduction fluids in a randomized animal study using a standardized peritonitis model.
Experimental animal model in a university laboratory.
In 60 rats, experimental peritonitis was induced using the cecal ligation and puncture model. On day 1, the abdominal cavity was rinsed with 10 mL of isotonic sodium chloride solution and the cecum was resected. Animals were randomly assigned to 3 groups: the RL group, which received Ringer lactate intraperitoneally; the PL group, which received phospholipids intraperitoneally; and the ID group, which received icodextrin intraperitoneally. In each group, 50% of the animals were humanely killed at day 11 and 50% at day 21.
The areas of adhesions were measured and the abscess formation was scored according to location and size. Abscesses, abdominal fluid, and blood were sampled for microbiologic workup.
The median area of adhesions was significantly lower in the PL groups (PL(11), 43.7 mm(2); PL(21), 20.4 mm( 2)) than in the RL groups (RL(11), 163.8 mm(2); RL( 21), 120.9 mm(2)) and ID groups (ID(11), 418.5 mm( 2); ID(21), 218.6 mm(2)). Abscess formation was increased by icodextrin but not influenced by phospholipids, whereas microbiologic investigations did not reveal any differences among these 3 groups.
In this model of general peritonitis, phospholipids significantly reduced adhesion formation without promoting septic complications. Icodextrin enhanced adhesion and abscess formation in this peritonitis model. Phospholipids may be beneficial for adhesion control in general peritonitis.
Archives of Surgery 04/2003; 138(3):286-90. · 4.24 Impact Factor
ABSTRACT: To access the ability of intraperitoneal phospholipids to reduce adhesions in a standardized model for gynecologic operations.
A randomized, experimental, blinded study using the double uterine horn model.
Academic animal research laboratory.
Thirty-three Chinchilla rabbits.
Phospholipids or Ringer's lactate were intraperitoneally administered after bilateral uterine horn injury.
After 10 days, adhesions were evaluated concerning area and strength as well as scores describing tenacity and degree.
Phospholipids (median 102.1 mm2) significantly reduce adhesion areas in comparison to surgical controls (median 392.2 mm2) and Ringer group (median 323.8 mm2). Scores reflecting severity and degree of adhesions support this finding.
These results prove the efficacy of phospholipids in the double uterine horn model. Future clinical studies are recommended.
Fertility and Sterility 07/2002; 77(6):1269-73. · 3.56 Impact Factor
ABSTRACT: Postoperative peritoneal adhesions impose a long-term risk of morbidity and mortality. Adjunctive means are needed to prevent these complications. In previous studies we could demonstrate the efficacy and safety of intraperitoneally applied phospholipids with regard to adhesion prevention and wound healing, respectively. The assumption is that phospholipids rapidly adhere to the peritoneal surface and to the mesothelial lesions. This study was designed to evaluate the influence of early drainage of the administered fluid volume on the control of adhesion formation. Forty chinchilla rabbits underwent median laparotomy and standardized abrasion of circumscript areas of the ventral abdominal wall, the cecum, and the ileum. The animals randomly received either 75 mg/kg body weight of phospholipids in a volume of 5.0 mL/kg body weight (n = 20) or the same volume of Ringer's lactate solution (n = 20) prior to closing the laparotomy wounds. In 50% of the rabbits with either medication, 80% of the volume was recovered after 30 min before final closure of the abdominal wall ("drainage"). In the remaining animals the intraabdominal fluid load was not evacuated ("no drainage"). At day 10 after surgery all rabbits were sacrificed for evaluation of adhesion areas by computer-aided planimetry and histopathologic examination. The mean areas of adhesion in both Ringer's lactate groups were significantly larger than in the comparable phospholipid groups (p < .05). In the Ringer's lactate groups, adhesions averaged 341.7 (318.6) mm2 without and 263.3 (275.5) mm2 with drainage. In the phospholipid groups the respective mean areas reached only 24.6 (36.7) mm2 without drainage and 27.0 (49.7) mm2 following evacuation of the fluid 30 min after administration (median, mean in parentheses). These results prove the efficacy of phospholipids after a limited contact period of 30 min. The frequent use of drains in abdominal surgery will not impair the beneficial effect of phospholipids on prevention of adhesions.
Journal of Investigative Surgery 15(1):23-8. · 1.09 Impact Factor