Influence of intraperitoneal phospholipid dosage on adhesion formation and wound healing at different intervals after surgery

Abstract.

Background: Adjuvant therapy is needed to prevent adhesion formation as a major cause of postoperative morbidity and mortality. The efficacy of phospholipids (PLs) has been proven; however, information on dosage and drug safety are still outstanding. Materials and methods: Forty-eight Chinchilla rabbits underwent median laparotomy, abrasion of the peritoneum, jejunal anastomosis, and an electrocautery incision of the liver. The operation was completed by intraperitoneal administration of PLs in two different concentrations (30 mg/kg and 70 mg/kg body weight). In the control group, the abdomen was closed without additional treatment. Adhesion area, anastomotic bursting pressure, tensile strength of the midline incision, and healing of the liver wound were assessed on days 3, 5, 7, and 10, respectively. Results: The mean areas of adhesions in the control group were slightly larger than in the PL groups after 3 days and 5 days. On day 7 and day 10, both PL groups presented with significantly smaller adhesion areas (P<0.05). In all groups, we measured equal anastomotic bursting pressures on the 3rd, 5th, and 10th postoperative days. After 7 days, the mean value of the PL 70-mg group (17.2 kPa) was significantly lower than in the other groups (control 22.1 kPa, PL 30 mg 20.7 kPa; P<0.05). The tensile strengths of the laparotomy wound measured after intervals of 5 days and 7 days were not statistically different. On day 3, it was reduced after 30 mg PL but enhanced after 70 mg PL, whereas 10 days after surgery the strength increased with the PL dosage. The inflammatory reparative response to hepatic injury, jejunal anastomosis, and midline incision was not affected by PLs as assessed by histological analysis. Conclusion: These results prove the efficacy of PLs in adhesion prevention in two concentrations. The findings reveal an unimpeded healing of anastomoses, laparotomy wounds, and liver incisions at different periods after surgery.