[Complications and side effects of artificial ascites for adhesion prevention]

The side-effects of "artificial ascites" induced with Dextran 60 (Makrodex 6%) as a mean of preventing adhesions were investigated in 47 patients (treatment group: 32 patients; control group: 15 patients) in whom microsurgery had been performed for infertility with adhesiolysis. On the day of surgery and the following four days 300 to 500 ml of Makrodex was instilled via an intraperitoneal catheter (7.5 ml/kg body weight on day of surgery; 5 ml/kg body weight on days 2 to 5). In addition, the patients received, on the day of surgery, single doses of 450 IU of hyaluronidase (Kinetin), 500,000 KIU of aprotinine (Trasylol) and 1 g of hydrocortisone acetate instilled intraperitoneally. In the group treated with Dextran, there was a significantly higher number of patients who felt unwell and had abdominal complaints and dyspnea. In six cases in the Dextran group a vulval edema was seen, and in 2 cases a thigh edema. A significant weight increase and elevation of central venous pressure occurred for the duration of the "artificial ascites" in this group. There were a few cases of bradycardia with frequencies of under 50 beats per minute. On the fifth p.o. day 75% of the patients in the Dextran group had a pleural effusion. Such changes were not observed in the control group. In view of these side-effects and the fact that it is still not proven that Dextran effectively prevents adhesions we no longer carry out this form of adhesion prophylaxis.