Prevention of peritoneal adhesions by administration of sodium carboxymethyl cellulose and oral vitamin E

Abstract

Background: Previous studies have shown that dietary supplements of vitamin E or the intraperitoneal administration of sodium carboxymethyl cellulose (SCMC) solution reduces postoperative adhesions by approximately 50%. The aim of this study was to determine whether there is a synergistic beneficial effect of vitamin E and SCMC in reducing postoperative adhesions.

Methods: Sixty Sprague-Dawley rats were fed an identical diet containing 32 IU vitamin E/kg and were divided into four main groups: group A (control) and groups B, C, and D (experimental). Group D was further subdivided into three subgroups (D1, D2, and D3). Oral supplements of vitamin E in doses of 10 IU, 30 IU, and 30 IU/kg body weight were given to subgroups D1, D2, and D3 and group B, respectively, 5 days before operation and were continued until the fourteenth postoperative day when all animals were killed. Adhesions were created by scraping the cecum with mesh gauze followed by application of absolute alcohol and placement of silk suture in the parietal peritoneum. SCMC solution was administered intraperitoneally in groups C and D before closure. Adhesions were graded by two different investigators.

Results: All control animals developed significant adhesions, compared with no adhesions in 30% of group B (vitamin E) (p < 0.04), 40% in group C (SCMC) (p = 0.0001), and an average of 90% in the D groups (SCMC+vitamin E) (p = 0.0001).

Conclusions: It appears that there is a synergistic beneficial effect of oral supplements of vitamin E and the intraperitoneal administration of SCMC solution in reducing the incidence and degree of intraperitoneal adhesions.