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4 - Postoperative adhesion after deserousing cecum in rats stitch repair versus leaving bare
Sadık Yıldırım, Hakan M.Köksal, M.Fevzi Celayir, Adil Baykan
Aim: Postoperative intraabdominal adhesion is an important and unsolved surgical problem. The prevention of postoperative adhesions has been a complex problem for surgeons from all disciplines for many decades.To investigate the benefit of leaving the bare serousal area open over stitching procedure to prevent adhesion formation and the reformation of serosal layer are the aims of this study.
Material and method: Sixty-five Wistar Albino rats(200-250 g) were allocated to two groups. Each group divided into two subgroups.An area of serosa of cecum denuded in both groups of rat. Bare area left alone in group la and 11a rats and stitch repaired in Group lb and lib rats.Group I and II rats killed on 3rd and 9th postoperative day respectively. Adhesion severity score determined, full thickness cecum wall obtained for hystologic examination to assess fibrin grading, fibrosis, subserosal eosynophyls (ptah, haemotoxylen-eosine and fibrin stains). Reformation of serosal layer particularly emphasized.
Results: No difference noted in adhesion severity score and fibrin grading between group la and group lb.In group lib all rats had adhesion and difference in adhesion severity between I la and lib were significant. Subserosal eosynophyls were significantly increased in group la. No subserosal eosynophyls found in group lib, while in group 11a fibroblasts there were scarce. Fibroblasts found in both groups, but were prominent in group lib rats. Similarity of fibroblasts to mesothelial cells and increased eosynophyls in non-suture repaired rats imply role of eosynophyls on changing fibroplastin to mesothelial cells.
Conclusion: If the bare serosal surface approximated by suture the fibrinous adhesion formed changes into dense fibrous adhesion. Therefore, we suggested that allowing peritoneal defects to heal spontaneously may enhance serosal reformation.
Keywords: Cecum, deserousing, postoperative, adhesion.
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