PHOSPHOLIPASE-RESISTANT PHOSPHATIDYLCHOLINE REDUCES INTRAABDOMINAL ADHESIONS INDUCED BY BACTERIAL PERITONITIS

The majority of intra-abdominal adhesions develop postoperatively or f ollowing peritonitis. We have previously shown that L-phosphatidylchol ine reduces postoperative peritoneal adhesions in rats. In the present study, we examined whether adhesion formation after bacterial periton itis is also reduced by L-phosphatidylcholine or by DL-alpha-phosphati dylcholine, which is degraded only 50% by phospholipase A2. Peritoniti s was induced in the rat by caecal ligation and double puncture; cecot omy was performed 12, 15, or 18 h later. Adhesions were assessed blind ly by a scoring system 7 days after cecotomy. When cecotomy was schedu led for 18 h after caecal ligation and puncture, the 7-day mortality w as 90% (n = 20). When cecotomy was performed at 12 h, no mortality was seen; however, the adhesion score was low (2.3 +/- 0.7). When cecotom y was performed 15 h after caecal ligation and puncture, the mortality was 25% and the adhesion score was 4.3 +/- 0.9. This figure was reduc ed significantly by intraperitoneal instillation Of L-phosphatidylchol ine or DL-alpha-phosphatidylcholine for 3 subsequent days. However, th e mortality increased by L-phosphatidylcholine (P < 0.01), whereas mor tality after DL-alpha-phosphatidylcholine remained at 30%. We conclude that administration of both L-phosphatidylcholine and DL-alpha-phosph atidylcholine decrease adhesion formation after bacterial peritonitis.