Ersoy BAYDAR, Mustafa KÖM, Yesari ERÖKSÜZ, Erdi KIYAKLI

Ratlarda İntraabdominal Adezyonların Önlenmesinde Karboksimetilselüloz, Meloksikam ve Vitamin E Kombinasyonlarının Etkisi

Günümüzde yeni cerrahi tekniklerin gelişmesine rağmen postoperatif intraabdominal adezyonlar; intestinal tıkanıklıklar, infertilite ve ağrıya neden olması bakımından önemli bir sorundur. Bu çalışma; karboksimetilselüloz, meloksikam ve vitamin E kombinasyonlarının adezyon önlemedeki etkinliğinin karşılaştırılması amacıyla yapıldı. Çalışmada 4 aylık 56 adet erkek Sprag-Dawley ırkı rat kullanıldı. Ratlar 8 gruba eşit olarak ayrıldı. Genel anesteziye alındıktan sonra rutin cerrahi kurallara uygun olarak yapılacak operasyonla ilio- sekal bölgede 1 cm2'lik bir alan fırçalanarak travmatize edildi. Birinci grup kontrol grubu olarak kullanıldı ve herhangi bir uygulama yapılmadı. İkinci gruba karboksimetilselülöz, 3. gruba meloksikam, 4. gruba vitamin E, 5. gruba karboksimetilselüloz+meloksikam, 6. gruba karboksimetilselüloz+vitamin E, 7. gruba meloksikam+vitamin E ve 8. gruptakilere ise karboksimetilselüloz+meloksikam+vitamin E kombinasyonları intraperitoneal olarak uygulandı. Sonuçlar makroskopik, biyokimyasal ve histopatolojik olarak değerlendirildi. Karboksimetilselüloz, meloksikam ve vitamin E"nin adezyonları kontrol grubu ile karşılaştırıldığında anlamlı oranda düşürdüğü gözlendi (P

Effect of Combinations of Carboxymethycellulose, Meloxicam and Vitamin E on Preventing Intraabdominal Adhesions in Rats

Despite the development of new surgical techniques in modern times, intraabdominal adhesionsare an important problem for causing intestinal obstruction, infertility and pelvic pain. This studywas performed for comparing the efficacies of carboxymethylcellulose, meloxicam and vitamin E onpreventing adhesions.In this study, 56 male Sprague-Dawley breed rats of 4 months old were used. They were dividedinto 8 groups. Following general anesthesia and preparing the surgical site for aseptic surgery, inall groups 1 cm2area in ileocecal region and equal size in peritoneum was traumatized bybrushing. While group 1 was served as control with no application, the remaining 7 groups wereintraperitonally applied carboxymethylcellulose, meloxicam, vitamin E, carboxymethylcellulose +meloxicam, carboxymethylcellulose + vitamin E, meloxicam + vitamin E, carboxymethylcellulose +meloxicam + vitamin E groups, respectively. The results were evaluated macroscopically,biochemically and histopathologically.Carboxymethylcellulose, meloxicam and vitamin E were observed to have significantly decreasedthe adhesion as compared to the control (P0.005). Itwas determined a significant difference to exist during comparing the combinations of these drugsto their single usages (P0.005).In conclusion, it was determined that various combinations of carboxymethylcellulose, meloxicam, and vitamin E were more effective.

PDF

___

1. Kamel RM. Prevention of postoperative peritoneal adhesions. Eur J Obstet Gyn R B 2010; 150: 111-118.
2. Boland GM, Weigel RJ. Formation and prevention of postoperative abdominal adhesions. J Surg Res 2006; 132: 3-12.
3. Ward BC, Panintch A. Abdominal adhesions: Current and novel therapies. J Surg Res 2011; 165: 91-111.
4. Koç Y, Alkan F, Uyaroğlu A. Tavşanlarda intraabdominal adezyonların önlenmesinde sodyum karboksimetilselülozun kullanımı. Turk J Vet Anim Sci 2003; 27: 965-970.
5. Arung W, Meyrisse M, Detry O. Pathophysiology and prevention of postoperative peritoneal adhesions. World J Gastroenterol 2011; 17: 4545-4553.
6. Schnüriger B, Barmparas G, Branco B, et al. Prevention of postoperative peritoneal adhesions: A rewiew of the literature. Am J Surg 2011; 201: 111-121.
7. Günay C, Sağlıyan A, Yaman İ. Ratlarda deneysel olarak oluşturulan intraabdominal adezyonların önlenmesinde aprotinin ile metilen mavisinin etkinliğinin karşılaştırılması. F.Ü. Sağlık Bil Derg 2005; 19: 51-55.
8. Durmuş AS, Han MC. Comparison of the effects of different concentrations of sodium carboxymethylcellulose on prevention of intraabdominal adhesions in rats. Revue Med Vet 2006; 157: 535-538.
9. Alkan F, Koç Y, Çelik İ, ve ark. Tavşanlarda peritoneal adezyonların önlenmesinde metilprednisolon (MP) ve dimetil sülfoksit (DMSO)"in etkilerinin araştırılması. Vet Bil Derg 2007; 21(2): 73-79.
10. Maghsoudi H, Askary B. The effect of piroxicam on the formation of postoperative, intraabdominal adhesion in rats. Saudi J Gastroenterol 2008; 14: 198-201.
11. Güvenal T, Cetin A, Ozdemir H, et al. Prevention of postoperative adhesion formation in rat uterine horn model by nimesulide: a selective COX-2 inhibitor. Hum Reprod 2001; 16: 1732-1735.
12. Wang XC, Gui CQ, Zheng QS. Combined therapy of allantoin, metronidazole, dexamethasone on the prevention of intra-abdominal adhesion in dogs and its quantitive analysis. World J Gastroenterol 2003; 9: 568- 571.
13. Yıldız H, Durmuş AS, Şimşek H, et al. The comparison of methylene blue and vitamin E in prevention of abdominal postoperative adhesion formation in rat uterine horn models. Biochemical and histopathologic evaluation. Acta Cir Bras 2011; 26: 51-57.
14. Durmus AS, Yıldız H, Yaman I, Simsek H. Efficacy of vitamin E and selenium for the prevention of intraabdominal adhesions in rats: uterine horn models. Clinics 2011; 66: 1247-1251.
15. Corrales F, Corrales M, Schirmer CC. Preventing intraperitoneal adhesions with vitamin E and sodium hyaluronate/carboxymethycellulose. A comparative study in rats. Acta Cir Bras 2008; 23: 36-41.
16. Yetkin G, Uludağ M, Citgez B, et al. Prevention of peritoneal adhesions by intraperitoneal administration of vitamin E and human amniotic membrane. Int J Surg 2009; 7: 561-565.
17. Nair SK, Bhat IK, Aurora AL. Role of proteolytic enzyme in the prevention of postoperative intraperitoneal adhesions. Arch Surg 1974; 108: 849-853.
18. Hooker GD, Taylor BM, Driman DK. Prevention of adhesion formation with use of sodium hyaluronate- based bioresorbable membrane in a rat model of ventral hernia repair with polypropylene mesh. A randomized, controlled study. Surgery 1999; 125: 211-216.
19. Knol JS. Diagnostic procedures for the private practice laboratory. In: Aiello SE. (Editor). Merck Veterinary Manual. 8th Edition, Philadelphia: Whitehouse Station, NJ: Merck & Co, 1998: 1187-1214.
20. Hellebrekers BW, Trimbos-Kemper TC, et all. Use of fibrinolytic agents in the prevention of postoperative adhesion formation. Fertil Steril 2000; 74: 203-212.
21. Makarska J, Sosada K, Stepien T, et al. Influence of vitamin E given intraperitoneally to prevent peritoneal adhesions in rats. Polski Przeglad Chirurgiczhy 2010; 82: 547-552.
22. Lalountas MA, Ballas KD, Skouras C, et al. Preventing intraperitoneal adhesions with atorvastatin and sodium hyaluronate/carboxymethylcellulose: A comparative study in rats. Am J Surg 2010; 200: 118-123.
23. Portilla F, Ynfante I, Bejarano D, et al. Prevention of peritoneal adhesions by intraperitoneal administration of vitamin E: An experimental study in rats. Dis Colon Rectum 2005; 47: 2157-2161.
24. Arıkan S, Adas G, Barut G, et al. An evaluation of low molecular weight heparin anf hyperbaric oxygen treatment in the prevention of intra-abdominal adhesions and wound healing. Am J Surg 2005; 189: 155-160.
25. Attar R, Yıldırım G, Kumbak B, et al. Efficacy of melatonin and hyaluronate/carboxymethycellulose membrane in preventing adhesion reformation following adhesiolysis in a rat uterine model. J Obsest Gynaecol Res 2011; 37: 125-131.
26. Avşar AF, Avşar FM, Şahin M, et al. Diphenhydramine and hyaluronic acid derivaties reduce adnexal adhesions and prevent tubal obstructions in rats. Eur J Obstet Gyn R B 2003; 106: 50-54.
27. Bae J, Jin H, Jang K. The effect of polysaccharides and carboxymethylcellulose combination to prevent intraperitoneal adhesion and abcess formation in rat peritonitis model. J Vet Med Sci 2004; 66: 1205-1211.
28. Başbuğ M, Aygen E, Tayyar M, et al. Hyaluronic acid plus heparin for improved efficacy in prevention of adhesion formation in rat uterine horn model. Eur J Obstet Gyn R B 1998; 78: 109-112.
29. Demirbağ S, Çetinkurşun S, Taşdemir U, et al. Comparison of hyaluronate/carboxymethylcellulose membrane and melatonin for prevention of adhesion formation in a rat model. Hum Reprod 2005; 20: 2021- 2024.
30. Küçüközkan T, Ersoy B, Uygur D, et al. Prevention of adhesions by sodium chromoglycate, dexamethasone, saline and aprotinin after pelvic surgery. ANZ J Surg 2004; 74: 1111-1115.
31. Şahin Y, Sağlam A,Turan R. Rat uterin horn modelinde sodyum karboksimetilseluloz ve düşük molekül ağırlıklı heparinin adezyon önleyici etkisi. Türkiye Klinikleri J Gynecol Obst 1992; 2: 201-204.
32. Schneider A, Bennek J, Olsen K, et al. Experimental study evaluating the effect of a barrier method on postoperative intraabdominal adhesions. Dig Dis Sci 2006; 51: 566-570.
33. Sosua AA, Petroinau A, Trapiello V, et al. Effect of sodium carboxymethycellulose and methlyprednisolone on the healing of jejunal anastomoses in rats. Bras J Med Bio Res 2001; 34: 519-523.
34. Tokmak H,Tibet HB, Balkanlı M, ve ark. Postoperatif yapışıklıkların önlenmesinde vitamin E"nin sinerjik etkileri. Ulusal Cerrahi Derg 1995; 11: 162-167.
35. Baydar E. Sığırlarda akut faz inflamasyonun belirlenmesinde demir düzeyinin diyagnostik öneminin araştırılması. Doktora Tezi, Elazığ: Fırat Üniversitesi, Sağlık Bilimleri Enstitüsü, 2010.