Background
In a high proportion of patients, operatively lysed adhesions reform. Using a rabbit
adhesiogenesis model, this study assessed the efficacy of adhesiolysis and examined
how this relates to the tissue composition of adhesions at the time of lysis.
Methods
Polypropylene meshes (5 × 3.5 cm) were implanted on the parietal peritoneum of New
Zealand white rabbits. Some animals were killed 3, 7, 14, and 90 days postimplantation
to obtain adhesion tissue. Adhesion formation/reformation was monitored by sequential
laparoscopy in other animals kept for 90 days and in a separate experimental group
subjected to adhesiolysis at 3 days postimplantation. Immune and inflammatory response
markers were determined by immunohistochemical, Western blotting, and real-time reverse
transcriptase polymerase chain reaction procedures in adhesion tissue; areas occupied
by adhesions were quantified in meshes.
Results
In animals undergoing adhesiolysis, mesh areas covered by adhesions were significantly
decreased at each follow-up time and affected areas became mesothelialized. Increased
transforming growth factor (TGF)-β1 expression was detected in adhesions at 3 days.
Greatest TGF-β1 and vascular endothelial growth factor (VEGF) protein expressions
were observed at 7 days, whereas genetic overexpression was noted at 14 days. Active
inflammatory cells peaked at the 7-day time point.
Conclusion
Adhesions formed at 3 days; at this critical time, an adhesiolysis was effective in
preventing reformation of future adhesions. TGF-β1 gene and protein expression were
increased in 3-day adhesions with respect to the omentum. Levels of active TGF-β1
and VEGF were increased at 7 days, along with the inflammatory response at this time
point related to tissue remodeling, which led to stabilization of adhesions.
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Article info
Publication history
Published online: December 11, 2009
Accepted:
October 5,
2009
Identification
Copyright
© 2010 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
