Preventing intraperitoneal adhesions with ethyl pyruvate and hyaluronic acid/carboxymethylcellulose: a comparative study in an experimental model

Abstract

Objective: To compare the effectiveness of ethyl pyruvate (EP) with that of hyaluronic acid + carboxymethyl cellulose (Seprafilm) for the prevention of intraperitoneal adhesions. Seprafilm has been shown to be effective in many experimental and clinical studies. Study design: Thirty rats were divided into three groups at random, and uterine horn abrasion was performed by laparotomy. One group received no treatment (control group), one group received a single intraperitoneal dose of EP 50 mg/kg (EP group), and a 2 x 1-cm patch of Seprafilm was applied in the third group (Seprafilm group). All rats were killed 14 days after surgery. Macroscopic and histopathological evaluation were performed by a surgeon and a pathologist who were blinded to group allocation. Histopathologically, inflammation, fibroblastic activity, foreign body reaction, collagen proliferation, vascular proliferation, Masson-Trichrome score, matrix metalloproteinase-2 score and vascular endothelial growth factor score were studied. Results: Median macroscopic intraperitoneal adhesion scores for the control, EP and Seprafilm groups were 2.8, 1.2 and 1.1, respectively. Multiple comparisons between groups showed a significant difference (p < 0.05). In binary comparisons, significant differences were found between the control group and the EP group, and between the control group and the Seprafilm group (p < 0.05). No significant difference was found between the adhesion scores for the EP group and the Seprafilm group (p > 0.05). After histopathological evaluation, significant differences in all parameters were found between the groups (p < 0.05). In the paired comparison, significant differences were found between the control group and the EP group, and between the control group and the Seprafilm group (p < 0.0167), but no significant difference was found between the EP group and the Seprafilm group (p > 0.0167). Conclusions: In comparison with the untreated control group, EP and Seprafilm were found to reduce the formation of intraperitoneal adhesions. No significant difference was found between EP and Seprafilm. (C) 2014 Elsevier Ireland Ltd. All rights reserved.