The comparative in vitro – effectiveness of postoperative adhesions (PAs) preventing agents in human peritoneal fibroblast culture

Intra-abdominal adhesion formation is a major complication of serosal repair following surgery (postoperative adhesions-PAs), ischaemia or infection, leading to conditions such as intestinal obstruction and infertility. Adhesion formation in the peritoneal cavity is the most common cause of intestinal obstruction as well as secondary female infertility and adhesion-related readmissions are frequent sequelae to gynaecological surgery.
A great effort has been dedicated to reduce adhesion formation because of the associated infertility, morbidity and its complications.
PAs are usually clinically asymptomatic but in some cases presentig with chronic abdominal and pelvic pain, infertility, and intestinal obstruction may require intensive, costly therapeutic modalities.
The element of more complex activities against adhesion creation is to limit an inflamatory reaction in the area of operation by intraperitoneal and systemic pharmacotherapy. It includes in the field of pharmacological prophylaxis a systemic use of pharmaceutics such as steroids and intraperitoneal dosing of dextran 70 000, just before closing the peritoneal cavity. Verification of the results of these activities during laparoscopy or laparotomy shows in some papers its high effectiveness. Using dextran as one of the agents points its role in adhesions prevention by separating healing peritoneal surfaces. But its effectiveness seems to limits the rapid absorption of the solutions as well as Ringer’s lactated saline (RLS). The influence of the dextran on mesothelial fibroblasts and its migration in healing of peritoneum is still unknown.
Attempts to prevent adhesions by separating healing peritoneal surfaces include site-specific barriers and hydroflotation by instilled solutions.
The aim of the presented study was to compare the effectiveness of 4% solution of icodextrin and dextran 70 000 in in vitro culture of Human Peritoneal Fibroblasts, evaluating migration of the cells. We used, in HPF culture, tissue from patient with intraperitoneal adhesions, collected during laparoscopy.
These studies suggest that icodextrin solution reduce in wound assay test migration of fibroblasts more effectively than dextran.
The reduction of fibroblasts migration depends on concentration of icodextrin and no association with dextran concentration was observed.
The studies with in vitro model of fibroblasts migration can be useful to evaluate effectivenes of intraperitoneal agents preventing adhesions.