An Experimental Study Evaluating the Effect of Mitomycin C on the Prevention of Postoperative Intraabdominal Adhesions

doi:10.1006/jsre.2000.6059

Journal of Surgical Research

Volume 96, Issue 2, April 2001, Pages 163-166

https://doi.org/10.1006/jsre.2000.6059 Get rights and content

Abstract

Background. Fibroblast proliferation is one of the well-known mechanisms for postoperative intraabdominal adhesion formation. Inhibition of fibroblast proliferation is an attractive field of investigation in the prevention of adhesions. Mitomycin C (MMC) is a cytotoxic agent that alkylates and crosslinks DNA and also inhibits fibroblast proliferation up to a few weeks. We aimed to determine the effect of MMC on the prevention of adhesions.

Materials and methods. Generation of adhesions in rats by brushing a 1-cm² area of the cecum and the peritoneum on the right side of the abdominal wall was followed by intraperitoneal administration of saline, 1 mg/kg MMC, and 0.5 mg/kg MMC in saline. After 45 days, formation of adhesions was graded.

Results. The average adhesion scores of the control, and MMC (1 mg/kg), MMC (0.5 mg/kg) groups were 3.2 ± 0.7, 0.8 ± 0.6, and 0.7 ± 0.8, respectively. Adhesion scores of the two MMC-treated groups were significantly lower than that of the control group (P < 0.001). There was no difference between the two MMC groups (P > 0.05). No side effect of MMC was observed.

Conclusion. MMC was found to be very effective in the prevention of postoperative intraabdominal adhesions.

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The appropriate anti-adhesive effect of polymers on cells or tissues in the body is one of the essential requirements of maintaining health and protecting the body from trauma and foreign bodies. Regulating the anti-adhesive properties of biomedical polymers against cells has been considered a pivotal parameter in developing polymeric biomaterials for biomedical applications such as artificial blood vessels and cell encapsulation. Meanwhile, tissue adhesion barriers that can physically isolate wounds and thus effectively prevent the formation of tissue adhesion have been a hot topic in both research and industrial fields. This review describes the comprehensive knowledge and recent research efforts on polymers for anti-adhesion to both cells and tissues. The basic concepts and mechanisms for the design and performance of anti-adhesive polymers are introduced in terms of both cell and tissue. Polymer-based approaches for anti-adhesion to cells or tissues are then extensively discussed.
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Les synéchies endo-utérines sont une des principales causes d’infertilité secondaire. La prévalence des synéchies est probablement sous-estimée du fait de l’hétérogénéité de la symptomatologie. Une recherche bibliographique exhaustive en utilisant les moteurs de recherche MEDLINE, Pubmed, Cochrane Library et Web of Science a été réalisée, afin de faire une mise au point sur la genèse, les conséquences et les méthodes de prévention des adhérences intra-utérines. Les synéchies endo-utérines sont susceptibles de survenir après tout geste endo-utérin via une dysrégulation de la chaîne d’activation de la coagulation liée au processus inflammatoire. Des complications obstétricales précoces et tardives sont également reconnues comme causées par des synéchies. Le diagnostic de certitude est actuellement réalisé par hystéroscopie qui reste un geste invasif même s’il peut être réalisé en ambulatoire. Plusieurs voies de recherche inspirées de la voie intra-abdominale pour la prévention des adhérences pelviennes ont été développées. Cependant? aucune méthode de prévention actuelle a fait la preuve de son efficacité en termes d’amélioration de la fertilité spontanée. L’amélioration des pratiques chirurgicales, la conception de nouveaux dispositifs médicaux intra-utérins et les nouvelles voies de recherche en particulier dans le domaine des cellules souches endométriales permettront peut-être de réduire le taux de synéchies et leurs complications après un geste chirurgical endo-utérin.
Intra-uterine adhesions are a major cause of secondary infertility. The prevalence of adhesions is probably underestimated due to the heterogeneity of the symptoms. An exhaustive literature search using search engines MEDLINE, Pubmed, Cochrane library and Web of Science was performed to make a focus on the origins, consequences and methods of prevention of intra-uterine adhesions. Intra-uterine adhesions are likely to occur after any endo-uterine surgery via dysregulated activation of coagulation chain linked to the inflammatory process. Early and late obstetric complications are also recognized as caused by adhesions. The diagnosis is currently performed by hysteroscopy but it remains an invasive procedure even if it can be done with an ambulatory management. Several research approaches inspired by intra-abdominal surgery for the prevention of pelvic adhesions have been developed. However, no current method of prevention has proven its effectiveness in terms of improving spontaneous fertility. The improvement in surgical practices, the design of new intra-uterine medical devices and new research especially in the field of endometrial stem cells can maybe reduce the rate of adhesions end their complications after intra-uterine surgery.
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It has been combined with a crosslinked hyaluronan hydrogel for the purposes of adhesion reduction in an animal model.70 It has also been used locally in strabismus surgery to limit post-operative adhesion, a property which is attributed to its antifibrinolytic activity,86 and for prevention of recurrent intra-abdominal adhesions in rats.87 Antiproliferative agents such as paclitaxel and sirolimus may also have promising applications in adhesion reduction devices.
Postoperative intra-abdominal adhesions represent a serious clinical problem. In this review, we have focused on recent progress in the cellular and humoral mechanisms underpinning adhesion formation, and have reviewed strategies that interfere with these pathways as a means to prevent their occurrence. Current and previous English-language literature on the pathogenesis of adhesion formation was identified. As the burden of surgical disease in the world population increases, and the frequency of reoperation increases, prevention of adhesion formation has become a pressing goal in surgical research.
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Peritoneal adhesions are serious complications of surgery, and can result in pain, infertility, and potentially lethal bowel obstruction. Pharmacotherapy and barrier devices have reduced adhesion formation to varying degrees in preclinical studies or clinical trials; however, complete prevention of adhesions remains to be accomplished. We and others have hypothesized that the limitations of the two approaches could be overcome by combining their strengths in the context of controlled drug delivery. Here we review the role of polymeric systems in the prevention of peritoneal adhesions, with an emphasis on our recent work in developing and applying polymeric drug delivery systems such as nano- or microparticles, hydrogels, and hybrid systems for peritoneal use.

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Regular ArticleAn Experimental Study Evaluating the Effect of Mitomycin C on the Prevention of Postoperative Intraabdominal Adhesions

Abstract

Fertil. Steril.

Eur. J. Obstet. Gynecol. Reprod. Biol.

J. Surg. Res.

Am. J. Surg.

Am. J. Surg.

Fertil. Steril.

Am. J. Surg.

Intestinal obstruction from adhesions—How big is the problem?

Ann. R. Coll. Surg. Engl.

Postoperative adhesions: Their treatment and relevance in clinical practice

Ann. R. Coll. Surg. Engl.

The operative aetiology and types of adhesions causing small bowel obstruction

Aust. N. Z. J. Surg.

Adhesiolysis

Clin. Obstet. Gynecol.

Regular Article
An Experimental Study Evaluating the Effect of Mitomycin C on the Prevention of Postoperative Intraabdominal Adhesions