World Journal of Surgery

, Volume 34, Issue 4, pp 721–727 | Cite as

Peritoneal Infusion with Cold Saline Decreased Postoperative Intra-Abdominal Adhesion Formation

  • Cheng-Chung Fang
  • Tzung-Hsin Chou
  • Geng-Shiau Lin
  • Zui-Shen Yen
  • Chien-Chang Lee
  • Shyr-Chyr ChenEmail author



Postoperative intra-abdominal adhesion is a common morbidity after laparotomy. We try to determine whether peritoneal infusion with cold saline may decrease postoperative intra-abdominal adhesion formation.


Ninety-six male BALB/c mice weighing 25-30 g were randomized into four groups: (I) adhesion model with infusion of 4°C cold saline, (II) adhesion model with infusion of room temperature saline, (III) adhesion model without infusion of saline, and (IV) sham operation without infusion of saline. Adhesion scores, incidence of adhesion, and serum cytokines were measured at postoperative days 1, 3, 7, and 14.


Group I had lower adhesion scores than groups II and III (P < 0.0001). IL-6, IL-10, and TNF-α were significantly increased in the groups I, II, and III compared to group IV (P < 0.0001). IL-6 in group I was significantly decreased compared to that in group III (P < 0.0004). IL-10 in group I was significantly increased compared to that in groups II (P < 0.0001) and III (P < 0.05). TNF-α in group I was significantly decreased compared to that in groups II (P < 0.0004), and III (P < 0.05).


Peritoneal infusion with cold saline may decrease the degree of postoperative intra-abdominal adhesion formation.


Nimesulide Adhesion Formation Cold Saline Adhesion Score Adhesion Model 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This study was partly supported by the National Science Council Grant NSC 93-2314-B-002-260.


  1. 1.
    Ellis H, Moran BJ, Thompson JN et al (1999) Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet 353:1476–1480CrossRefPubMedGoogle Scholar
  2. 2.
    Chen SC, Lin FY, Lee PH et al (1998) Water soluble contrast study predicts the need for early surgery in adhesive small bowel obstruction. Br J Surg 85:1692–1694CrossRefPubMedGoogle Scholar
  3. 3.
    Wilson MS, Hawkswell J, McCloy RF (1998) Natural history of adhesional small bowel obstruction: counting the cost. Br J Surg 85:1294–1298CrossRefPubMedGoogle Scholar
  4. 4.
    Choi HK, Chu KW, Law WL (2002) Therapeutic value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: a prospective randomized trial. Ann Surg 236:1–6CrossRefPubMedGoogle Scholar
  5. 5.
    Chen SC, Yen ZS, Lee CC et al (2005) Nonsurgical management of partial adhesive small-bowel obstruction with oral therapy: a randomized controlled trial. CMAJ 173:1165–1169PubMedGoogle Scholar
  6. 6.
    Ellis H (2007) Postoperative intra-abdominal adhesions: a personal view. Colorectal Dis 9(Suppl 2):3–8CrossRefPubMedGoogle Scholar
  7. 7.
    Parker MC, Ellis H, Moran BJ et al (2001) Postoperative adhesions: ten-year follow-up of 12, 584 patients undergoing lower abdominal surgery. Dis Colon Rectum 44:822–830CrossRefPubMedGoogle Scholar
  8. 8.
    Kossi J, Salminen P, Rantala A et al (2003) Population-based study of the surgical workload and economic impact of bowel obstruction caused by postoperative adhesions. Br J Surg 90:1441–1444CrossRefPubMedGoogle Scholar
  9. 9.
    Ellis H (1997) The clinical significance of adhesions: focused on intestinal obstruction. Eur J Surg 577:5–9Google Scholar
  10. 10.
    Ray NF, Larsen JW Jr, Stillman RJ et al (1993) Economic impact of hospitalizations for lower abdominal adhesionolysis in the United States in 1988. Surg Gynecol Obstet 176:271–276PubMedGoogle Scholar
  11. 11.
    Greene AK, Alwayn IPJ, Nose V et al (2005) Prevention of intra-abdominal adhesions using the antiangiogenic COX-2 inhibitor Celecoxib. Ann Surg 242:140–146CrossRefPubMedGoogle Scholar
  12. 12.
    DiZerega GS, Campeau JD (2001) Peritoneal repair and post-surgical adhesion formation. Hum Reprod Update 7:547–555CrossRefPubMedGoogle Scholar
  13. 13.
    Beck DE, Cohen Z, Fleshman JW et al (2003) Adhesion Study Group Steering Committee. A prospective, randomized, multicenter, controlled study of the safety of Seprafilm adhesion barrier in abdominopelvic surgery of the intestine. Dis Colon Rectum 46:1310–1319CrossRefPubMedGoogle Scholar
  14. 14.
    DeVirgilio C (1999) Fibrin glue reduces the severity of intra-abdominal adhesions in a rat model. Am J Surg 178:577–580CrossRefGoogle Scholar
  15. 15.
    Vrijland WW, Tseng LN, Eijkman HJ et al (2002) Fewer intraperitoneal adhesions with use of hyaluronic acid-carboxymethylcellulose membrane: a randomized clinical trial. Ann Surg 235:193–199CrossRefPubMedGoogle Scholar
  16. 16.
    Oncel M, Kurt N, Remzi FH et al (2001) The effectiveness of systemic antibiotics in preventing postoperative, intraabdominal adhesions in an animal model. J Surg Res 101:52–55CrossRefPubMedGoogle Scholar
  17. 17.
    Tamion F, Richard V, Lyoumi S et al (1997) Gut ischemia and mesenteric synthesis of inflammatory cytokines after hemorrhagic or endotoxic shock. Am J Physiol 36:G314–G321Google Scholar
  18. 18.
    Lee CC, Chang IJ, Yen ZS et al (2005) Effect of different resuscitation fluids on cytokine response in a rat model of hemorrhagic shock. Shock 24:177–181CrossRefPubMedGoogle Scholar
  19. 19.
    Holmdahl L, Kotseos K, Bergstrom M et al (2001) Overproduction of transforming growth factor-beta1 (TGF-beta1) is associated with adhesion formation and peritoneal fibrinolytic impairment. Surgery 129:626–632CrossRefPubMedGoogle Scholar
  20. 20.
    Decker D, Tolba R, Springer W et al (2005) Abdominal surgical interventions: local and systemic consequences for the immune system–a prospective study on elective gastrointestinal surgery. J Surg Res 126:12–18CrossRefPubMedGoogle Scholar
  21. 21.
    Badia JM, Whawell SA, Scott-Coombes DM et al (1996) Peritoneal and systemic cytokine response to laparotomy. Br J Surg 83:347–348CrossRefPubMedGoogle Scholar
  22. 22.
    van Berge Henegouwen MI, van der Poll T, Deventer SJH et al (1998) Peritoneal cytokine release after elective gastrointestinal surgery and postoperative complications. Am J Surg 175:311–316CrossRefPubMedGoogle Scholar
  23. 23.
    Biffl WL, Moorev EE, Moore FA et al (1996) Interleukin-6 in the injured patient. Marker of injury or mediator of inflammation? Ann Surg 224:647–664CrossRefPubMedGoogle Scholar
  24. 24.
    Bone RC (1996) Toward a theory regarding the pathogenesis of the systemic inflammatory response syndrome: What we do and do not know about cytokine regulation. Crit Care Med 24:163–172CrossRefPubMedGoogle Scholar
  25. 25.
    van Westreenen M, van den Tol PM, Pronk A et al (1993) Peritoneal lavage promotes intraperitoneal adhesion in the rat. Eur Surg Res 31:196–201CrossRefGoogle Scholar
  26. 26.
    Sortini D, Feo CV, Maravegias K et al (2006) Role of peritoneal lavage in adhesion formation and survival rate in rats: an experimental study. J Invest Surg 19:291–297CrossRefPubMedGoogle Scholar
  27. 27.
    Hague BA, Honnas CM, Berridge BR et al (1998) Evaluation of postoperative peritoneal lavage in standing horses for prevention of experimentally induced abdominal adhesions. Vet Surg 27:122–126CrossRefPubMedGoogle Scholar
  28. 28.
    Montz EJ, Monk BJ, Lacy SM et al (1993) Ketorolac tromethamine, a nonsteroidal anti-inflammatory drug: ability to inhibit postradical pelvic surgery adhesions in a porcine model. Gynecol Oncol 48:76–79CrossRefPubMedGoogle Scholar
  29. 29.
    Siegler AM, Kontopoulos V, Wang CF (1980) Prevention of postoperative adhesions in rabbits with ibuprofen, a nonsteroidal anti-inflammatory agent. Fertil Steril 34:46–49PubMedGoogle Scholar
  30. 30.
    Holtz G (1982) Failure of a nonsteroidal anti-inflammatory agent (ibuprofen) to inhibit peritoneal adhesion formation reformation after lysis. Fertil Steril 37:582–583PubMedGoogle Scholar
  31. 31.
    Guvenal T, Cetin A, Ozdemir H et al (2001) Prevention of postoperative adhesion formation in rat uterine horn model by nimesulide: a selective COX-2 inhibitor. Hum Reprod 16:1732–1735CrossRefPubMedGoogle Scholar
  32. 32.
    Replogle RL, Johnson R, Gross RE (1966) Prevention of postoperative intestinal adhesions with combined promethazine and dexamethasone therapy: experimental and clinical studies. Ann Surg 163:580–588CrossRefPubMedGoogle Scholar
  33. 33.
    Risberg B (1997) Adhesions: preventive strategies. Eur J Surg Suppl 577:32–39PubMedGoogle Scholar
  34. 34.
    Grosfeld JL, Berman IR, Schiller M et al (1973) Excessive morbidity resulting from the prevention of intestinal adhesions with steroids and antihistamines. J Pediatr Surg 8:221–226CrossRefPubMedGoogle Scholar
  35. 35.
    Reijnen MM, Falk P, Van Goor H et al (2000) The antiadhesive agent sodium hyaluronate increases the proliferation rate of human peritoneal mesothelial cells. Fertil Steril 74:146–151CrossRefPubMedGoogle Scholar
  36. 36.
    Zeng Q, Yu Z, You J et al (2007) Efficacy and safety of Seprafilm for preventing postoperative abdominal adhesion: systematic review and meta-analysis. World J Surg 31:2125–2132CrossRefPubMedGoogle Scholar
  37. 37.
    Becker JM, Dayton MT, Fazio VW et al (1996) Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study. J Am Coll Surg 183:297–306PubMedGoogle Scholar
  38. 38.
    Bahadir I, Oncel M, Kement M et al (2007) Intra-abdominal use of taurolidine or heparin as alternative products to an antiadhesive barrier (Seprafilm) in adhesion prevention: an experimental study on mice. Dis Colon Rectum 50:2209–2214CrossRefPubMedGoogle Scholar
  39. 39.
    Fazio VW, Cohen Z, Fleshman JW et al (2006) Reduction in adhesive small-bowel obstruction by Seprafilm adhesion barrier after intestinal resection. Dis Colon Rectum 49:1–11CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Cheng-Chung Fang
    • 1
  • Tzung-Hsin Chou
    • 1
  • Geng-Shiau Lin
    • 1
  • Zui-Shen Yen
    • 1
  • Chien-Chang Lee
    • 1
  • Shyr-Chyr Chen
    • 1
    Email author
  1. 1.Department of Emergency MedicineNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan

Personalised recommendations