Efficacy of adhesion prevention and impact on wound healing of intraperitoneal phospholipids

Postoperative peritoneal adhesions are a major complication of abdominal surgery. Adjuvant therapy is needed to prevent adhesion formation and subsequent sequelae. Previously published data proved the efficacy of phospholipids (PL) for this indication; however, additional information on drug safety was still outstanding. The underlying study was designed to investigate the influence of phospholipids on three different types of healing tissue.

A total of 48 Chinchilla rabbits underwent median laparotomy, standardized abrasion of the visceral and parietal peritoneum, jejunal anastomosis, and an electrocautery incision of the liver. The operation was completed by intraperitoneal administration of 10 ml/kg of either normal saline (NaCl) or phospholipids (12%).

After 5 (NaCl 691 mm(2) vs PL 192 mm(2)) and 10 days (NaCl 625 mm(2) vs PL 88 mm(2)) the control group presented with significantly larger adhesion areas (P < 0.05). The bursting pressure of the anastomosis on the 5th (NaCl 16.1 kPa vs PL 18.2 kPa) and 10th (NaCl 19.7 kPa vs PL 18.6 kPa) postoperative days showed no statistically significant difference. The tensile strength of the laparotomy wound measured after intervals of 5 (NaCl 8.5 N cm(-1) vs PL 6.8 N cm(-1)) and 10 days (NaCl 23.0 N cm(-1) vs PL 20.2 N cm(-1)) was not statistically different either. The collagen protein ratio of anastomoses, laparotomy wounds, and liver incisions as well as the inflammatory-reparative response of the different tissues was not affected by PL.

These results confirm the efficacy of phospholipids in adhesion prevention. The findings of uncompromised healing of anastomoses, laparotomy wounds, and liver incisions demonstrate the safety of this agent. Further data may qualify phospholipids for a clinical trial.