Implementation of phospholipids as pharmacological modalities for postoperative adhesions prevention

Adhesions formation is considered a significant clinical entity implicating the healing process following major abdominal surgery, with serious clinical consequences and need for substantial health care expenditures. Several agents and substances applied either locally or systematically could potentially function as inhibitors of the formation of peritoneal adhesions endowed by limiting tissue apposition during the critical stages of mesothelial repair. Phospholipids are identified as surfactant-like substances, acting as a temporary membrane-like coverage of serosal defects. The experimental use of phospholipids for adhesions formation totals 24 publications. All retrieved studies, out of two, demonstrated the efficacy of phospholipids use in adhesions prevention. A single intraperitoneal dose of approximately 75 mg/kg of phosphatidylcholine, for a 30-min exposure time, emerges as the standard practice in terms of efficacy in both surgical alone or combined to peritonitis settings. The findings revealing an unimpeded healing of anastomoses and laparotomy wounds support the safety of this agent. The two additional properties of intraperitoneal use of phospholipids involve the inhibition of bacterial adherence/growth following impregnation of intra-abdominal drainages with phospholipids, without influencing bacterial translocation and the elimination of peritoneal carcinosis, through inhibition of intraperitoneal adhesion of tumor cells. The latter effect is achieved by a dose of phospholipids equal to 150 mg/kg. These experimental data, support that the intraperitoneal phospholipids administration can forestall adhesions formation following intra-abdominal surgical trauma, with no considerable overdosing-related adverse effects. Furthermore, these substances could possibly attenuate posttraumatic inflammation, and inhibit intraperitoneal tumor cell adhesion.