The effect of propolis treatment to prevent postoperative i̇ntraperitoneal adhesions

The Effect of Propolis Treatment to Prevent Postoperative İntraperitoneal Adhesions Intra-abdominal adhesions; caused against peritoneal injury and they known as fibrous bands that are dynamic, fibroproliferative and inflammatory defense mechanisms of the tissues or organs (11). The consists of patients undergoing intra-abdominal surgery and caused with adhesion rates varied between 64% and 97%, this ratio is higher in open surgical procedures to laparoscopic sugery (1,2). Post-operative adhesions are serious problems because surgeons In cases of reoperation can have many difficulties like increasing the time to reach into the abdominal cavity, to complicate the exploration of intra-abdominal area and increase the risk of injury of the abdominal organs (4-6). Adhesions when they become clinically symptomatic treatment is attempted. Surgery is required in cases not get better with conservative treatment (12). So far, none of the agents used in the prevention of intra-abdominal adhesions has not been proven to be effective (10). Bee propolis is a product that they produce to protect themselves from insects and microorganisms (71). Propolis have various therapeutic effects such as antibacterial, anti-inflammatory, healing, anesthetic, anti-caries, antifungal, antiprotozoal and antiviral activities (72,80). Most of propolis product or isolated indicates inhibit inflammation with different mechanisms. However, the anti-inflammatory effect of propolis mainly depends on the route of administration and dosing (89). In this experimental study, we aimed to evaluate the effect of propolis which has anti-inflammatory and anti-oxidant effects in the prevention of postoperative intra-abdominal adhesions that can result in serious problems. İn this study, totaly 30 young male Sprague-Dawley rats close in age range randomly were divided into three groups with 10 animals. After three cm median laparotomy all rat's 1 cm ² area in the wall of the cecum has been created abrasion by friction of sponge per 60 times and was excised across the peritoneal part of the cecal abrasion. Propolis material that will be used in this study was obtained as propolis of Rize and Artvin region from Hacettepe University. For group 2, 0.4 mL ethanol (96%), for group 3, 0.4 mL of propolis (900 mg / kg) and ethanol (96%) was intraperitoneally applied. Group 1 was identified as Sham group was and no solution applied after abrasion and then abdomen was closed. Rats were sacrificed on day 21. Inverted U-shaped abdomen was opened. Adhesions were counted macroscopically and was evaluated by Nair scoring. From abrasion created space samples were obtained for biochemical analysis (malondialdehyde (MDA), the level of glutathione (GSH) and histopathological evaluation. To assess the fibrinolytic system approximately 5-6 ml blood samples were taken and tissue plasminogen activator (TPA), plasminogen activator inhibitor-1 (PAI-1), α2-macroglobulin the α1-antitrypsin and prostaglandin E2 (PGE2) and leukotriene B4 (LB4) values were measured. Propolis group was found to have significant differences according to the macroscopic Nair (ethanol-propolis, P> 0.002 and sham-propolis, P> 0.023) and microscopic Zühlke (ethanol-propolis, P> 0.033 and sham-propolis, P> 0.024) scale. İn terms of fibrosis a significant difference was found in patient groups (P> 0.01). İn terms of vascular proliferation A significant difference was found in patient groups (P> 0.01). İn terms of foreign body reaction a significant difference was found in patient groups (P <0.007). According to Biochemistry a statistically significant difference was found in TPA group (P> 0.029), α1-antitrypsin group (P> 0.023), GSH group (P> 0.040), alpha2-macroglobulin group (P> 0.01). İn the group of propolis we found statistically significant more adhesions. This situation is thought to be related to propolis route of administration, the amount applied and concentration of the solvent. To evaluate the effectiveness of propolis should be considered in other studies dose adjustment should be done in practice, setting the lower concentrations of solvent, did the anti-inflammatory agent not be left in prolonged in abdominal area, after application in the early period with the solvent by washing the peritoneal lavage are suggested to be done for avoiding propolis due to the increase intraperitoneal adhesions. Keywords: Anti-inflammatory, Anti-oxidant, Peritoneal adhesions, Propolis.