Abdominal adhesions - clinical impact and experimental prevention

Abstract: Intraabdominal adhesions are formed after most operations and a limited number of studies have to examine the long-term spectrum of adhesion-related disorders and the cost associated with this. Only a few numbers of antiadhesive agents are available which, however, do not decrease the actual morbidity that follows intraabdominal adhesions, such as small bowel obstruction, infertility and pain. Futhermore, these agents can?t be used in abdominal infection, bleeding or when performing an intestinal anastomosis due to side effects. The use of two differently charged polypeptides covering peritoneal wounds and acting as a barrier against adhesion formation have in previous experimental studies demonstrated a positive effect. The aim of this study was to retrospectively study the long-term outcome of postoperative intraabdominal adhesions following appendectomy (I) and in patients with proven abdominal adhesive disease (II) and also to determine the national health care cost for the latter cohort (II). Experimentally, bioactive polypeptides were examined in mouse and rat models concerning adhesion prevention in different clinically relevant situations, such as following anastomotic surgery (III), insufficient anastomosis and accidentally injured bowels (IV) and in a bleeding model (V). The amounts of adhesions were measured (III-V), as well as the bursting pressure of the intestinal anastomosis (III-IV), and the amount of bleeding (V). Abdominal complaints, i.e. small bowel obstruction and pain, during long-term follow-up after appendectomy and in patients with proven adhesive disease, showed higher rates of recurring episodes than previously have been reported. The adhesion related costs in this study amounts to a national cost, in Sweden, of ? 40 to 60 millions, with an in-patient cost per episode almost equal to that of gastric cancer (?6702 vs. ?7345). A significant decrease in abdominal adhesions by the polypeptide administration was noted in all experiments performed. Bursting pressure was significantly raised in the early postoperative period after anastomosis and accidentally injured intestines. No negative effects were noted when using the polypeptides in an infectious environment. Bleeding from liver and spleen injuries significantly decreased and no signs of defect healing in neither anastomosis nor parencymal wounds were noted. In conclusion, abdominal complaints due to adhesions seem to be more common than previously reported and carry a substantial cost for health care economy. Bioactive, differently charged polypeptides have an antiadhesive effect in clinically relevant situations.