Influence of intraperitoneal phospholipid dosage on adhesion formation andwound healing at different intervals after surgery

Background: Adjuvant therapy is needed to prevent adhesion formation as a m ajor cause of postoperative morbidity and mortality. The efficacy of phosph olipids (PLs) has been proven; however, information on dosage and drug safe ty are still outstanding. Materials arid methods: Forty-eight Chinchilla ra bbits underwent median laparotomy, abrasion of the peritoneum, jejunal anas tomosis, and an electrocautery incision of the liver. The operation was com pleted by intraperitoneal administration of PLs in two different concentrat ions (30 mg/kg and 70 mg/kg body weight). In the control group, the abdomen was closed without additional treatment. Adhesion area, anastomotic bursti ng pressure, tensile strength of the midline incision, and healing of the l iver wound were assessed on days 3, 5, 7, and 10, respectively. Results: Th e mean areas of adhesions in the control group were slightly larger than in the PL groups after 3 days and 5 days. On day 7 and day 10, both PL groups presented with significantly smaller adhesion areas (P<0.05). In all group s, we measured equal anastomotic bursting pressures on the 3rd, 5th, and 10 th postoperative days. After 7 days, the mean value of the PL 70-mg group ( 17.2 kPa) was significantly lower than in the other groups (control 22.1-kP a, PL 30 mg 20.-7 kPa; P<0.05). The tensile strengths of the laparotomy wou nd measured after intervals of 5 days and: 7 days were not statistically di fferent. On day 3, it was reduced after 30 mg PL but enhanced after 70 mg P L, whereas 10 days after surgery the strength increased with the PL dosage. The inflammatory reparative response to hepatic injury, jejunal anastomosi s, and midline incision was not affected by PLs as assessed by histological analysis. Conclusion: These results prove the efficacy of PLs in adhesion prevention in two concentrations. The findings reveal an unimpeded healing of anastomoses, laparotomy wounds, and liver incisions at different periods after surgery.