The effect of intraperitoneal colchicine on the formation of peritoneal adhesions in the rat

Comparison of the preventive effect of colchicine versus diphenhydramine, prednisolone, and a combination therapy on intraperitoneal adhesion bands: an experimental study in rats

BACKGROUND

Peritoneal adhesion formation is an inevitable consequence of abnormal repair of the peritoneum following different peritoneal injuries of intra-abdominal operations with the subsequent morbidity that they represent. Vast efforts have been made to elucidate the cause and prevent the development of abdominal adhesions. The aim of our study is to compare the capability of colchicine versus diphenhydramine (DPH) and methylprednisolone (MP), and also prednisolone in adhesion prevention.

METHODS

Sixty-one male Wistar stock rats were divided into four groups. The first group attended as the control group. Groups 2, 3, and 4 received oral combination of MP + DPH solution (20 mg/kg), colchicine (0.02 mg/kg), and prednisolone (1 mg/ kg), respectively. Adhesion bands were induced by standardized abrasion of the peritoneum through a midline laparotomy. All rats were sacrificed on the 15^th-day post medication administration and the subjects underwent an exploratory laparotomy. The presence of adhesions was evaluated with the modified using Nair's classification.

RESULTS

The proportion of the control group with substantial adhesion bands (73.3%) was significantly higher than that of the MP + DPH (13.3%), colchicine (33.3%), and prednisolone (31.3%) groups. There were significant differences between the scores of the control and the MP + DPH, colchicine, and prednisolone groups (P = 0.001, 0.028, and 0.019, respectively). There was no statistically significant difference to favor colchicine against MP + DPH (P = 0.390) or MP + DPH against prednisolone (P = 0.394).

CONCLUSIONS

Both colchicine and combination of DPH + MP prevented postoperative abdominal adhesions separately in our study. However, the lowest adhesion formation rate was observed in the DPH + MP group, even lower than the prednisolone group.

Prevention of postoperative peritoneal adhesions

Adhesions are bands of tissue that connect organs together. It is frequently reported after surgery and remains a major problem for health and society. Efforts to prevent or reduce peritoneal adhesions mostly have been unsuccessful, hindered by their empirical basis, lack of good predictive animal models and complexity of adhesion pathogenesis. Although a good surgical technique is a crucial part of adhesion prevention, the technique alone cannot effectively eliminate the adhesions. Thus, there remains a room for further research. A comprehensive literature review of published experimental and clinical studies of adhesion prevention was carried out at the University of Bristol electronic library (MetaLib) with cross-search of seven different medical databases (AMED-Allied and Complementary Medicine Database, BIOSIS Previews on Web of Knowledge, Cochrane Library, Embase and Medline on Web of Knowledge, OvidSP and PubMed) by using key words (peritoneal adhesions, postoperative adhesions, prevention) to explore the progress in different surgical strategies and adjuvant materials used to prevent adhesions formation and reformation. By the end of the study, recommendations formulated for surgeons to be followed during the operations to prevent, as much as possible, the postoperative adhesions.

Reduction of peritoneal adhesion formation by colchicine: a comparative study in the rat

Colchicine inhibits processes known to be involved in the pathogenesis of peritoneal adhesions. Daily administration of 50 micrograms of colchicine to 22 rats significantly diminished adhesion formation, as compared with dexamethasone-treated and untreated rats. Rats that developed at least three adhesions of grade 3 (scale 0 to 4) were strikingly less prevalent among the colchicine-treated animals than the untreated group (9.1% versus 40.9%, P less than 0.001). The double product of the number and grading of adhesions was significantly lower (P less than 0.05) in the colchicine group. Colchicine is more effective than dexamethasone in inhibiting adhesion formation in the rat.

Effects of dexamethasone on proliferation of autologous fibroblasts and on the immune profile in women undergoing pelvic surgery for infertility

Dexamethasone (DEX) was administered postoperatively to six patients undergoing lysis of pelvic adhesions. During therapy the proportion of T cells among the peripheral blood lymphocytes sharply declined from 60% to 20%. Response to T- and B-cell mitogens decreased to 20% to 40% of the original response prior to surgery. DEX-containing serum had an enhancing effect on the growth of autologous fibroblasts derived from pelvic adhesions (50% more than the effect of pretreatment serum). Pure cortisol and DEX induced a similar enhanced growth. The enhancing ability of the patients' sera disappeared 48 hours after discontinuation of DEX, corresponding to the recovery of the lymphoid system. If there is any benefit in steroid treatment to prevent pelvic adhesion formation, it is apparently not via an inhibitory effect on fibroblast proliferation. Such treatment, however, clearly suppresses the immune response of the patients during the early postoperative course.