Kemal KILIÇ, Nergiz KILIÇ, ENGİN KILIÇ, SADIK YAYLA, CELAL ŞAHİN ERMUTLU, İSA ÖZAYDIN, Kemal PEKER, SERPİL DAĞ

A comparison of the efficacy of dimethyl sulfoxide (DMSO) and synovial fluid in the prevention of peritoneal adhesions: Experimental rabbit model

Bu çalışmada, tavşanlarda deneysel olarak oluşturulan ventral herni modelinde mersilen mesh kullanımına bağlı gelişebilecek peritoneal adezyonların önlenmesinde dimetil sülfoksit ve sinovial sıvı etkinliğinin karşılaştırılması amaçlandı. Çalışmada kullanılan 40 tavşan 4 gruba ayrıldı (n: 10). Operasyon xylazin HCI (5mg/kg im) sedasyonunu izleyerek ketamin HCI (20 mg/kg intratekal) ile elde edilen intratekal anestezi altında gerçekleştirildi. Operasyon masasına sırtüstü pozisyonda yatırılan tavşanlara median deri insizyonu yapıldıktan sonra linea alba düzeyinde 2 cm çaplı daire şeklinde bir defekt oluşturuldu. Defekt önceden disk şeklinde hazırlanan mersilen mesh ile onarıldı. Postoperatif 7. güne kadar; I. gruba 10 ml serum fizyolojik (SF) ve 1.5 g/kg DMSO, II. gruba 7 ml SF, 3 ml synovial sıvı (SS) ve 1.5 g/kg DMSO, III. Gruba 7 ml SF ve 3 ml SS, IV. gruba (kontrol: K) ise yalnızca 10 ml SF intraperitoneal olarak uygulandı. Tavşanlara 10. günün sonunda relaparotomi uygulanarak peritoneal adezyon varlığı ve derecesi Jenkins (1983)in görsel yapışıklık skalasına göre değerlendirildi. Çalışmadan elde edilen tüm veriler Minitab-16 paket programı kullanılarak istatistiksel olarak değerlendirildi. Greft uygulanan bölgeye ait doku örnekleri Hematoksilen-Eozin (HE) ve Crossmanın üçlü boyama yöntemi ile boyanarak ışık mikroskobunda değerlendirildi. Nonparametrik olarak değerlendirilen yapışıklık skala sonuçları Kruskal-Wallis testi ile istatistiki olarak hesaplandı ve gruplar arasında anlamlı bir fark bulunmadı (P>0.05). Histopatalojik inceleme sonuçları ise tüm gruplarda greftin üzerini örten dokunun fibröz doku karakterinde olduğunu gösterdi. Bununla birlikte fibrozisin DMSO grubunda, ES-DMSO, ES ve SF grubuna göre daha zayıf olduğu tespit edildi. Sonuçta gerek relaparotomik makroskobik bulgular gerekse histopatolojik bulgular dikkate alındığında synovial sıvının tavşanlarda postoperatif peritoneal adezyonların önlenmesinde etkili olduğu sonucuna varıldı.

Peritoneal adezyonların önlenmesinde dimetil sülfoksit (DMSO) ve synovial sıvı etkinliğinin karşılaştırılması: Deneysel tavşan modeli

The purpose of this study was to compare the efficacy of dimethyl sulfoxide and synovial fluid (SF) in the prevention of peritoneal adhesions that might develop in connection with the use of mersilen mesh in a ventral hernia model created experimentally in rabbits. The forty rabbits used in the study were divided into four groups of ten. The operation was conducted under intrathecal anesthesia induced with ketamine HCl (20 mg/kg intrathecal) following xylazin HCl (5 mg/kg intramuscular) sedation. A median skin incision was made in rabbits placed on the operating table in the supine position. Then, a defect 2 cm in diameter was created on the linea alba. The defect was repaired with mersilen mesh which had been previously prepared in the shape of a disk. Until the 7th day after the operation, group I was given 10 ml saline (S) and 1.5 g/kg DMSO, group II was given 7 ml saline, 3 ml synovial fluid (SF) and 1.5 g/kg DMSO, group III was given 7 ml saline and 3 ml SF while group IV (control: C) was given only 10 ml saline. All of these were administered intraperitoneally. At the end of the 10th day, the presence and extent of peritoneal adhesion was checked using Jenkins (1983) visual adhesion scale by performing a relaparotomy. All of the data obtained from the study was analyzed statistically using the Minitab-16 package program. Tissue samples from the region where the graft was performed were evaluated under a light microscope by staining them with the Hematoxilen-Eosin (HE) and Crossman triple stain method. The results of the adhesion scale were evaluated nonparametrically and statistical calculations were performed with the Kruskal-Wallis test. No statistical difference was found between the groups (P>0.05). The results of histopathological examination revealed that the tissue which covered the graft in all of the groups was fibrous tissue. However, it was determined that the fibrosis was weaker in the DMSO group than it was in the SF-DMSO, SF and S groups. In the end, it was concluded that synovial fluid is effective in preventing postoperative peritoneal adhesions in rabbits in light of both relaparotomic, macroscopic findings and histopathological findings.

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