Effects of intraperitoneal N-acetylcysteine on intrabdominal adhesion formation in rats

Purpose: Adhesions are abnormal fusions of two or more serosal surfaces after injury and seen approximately 90 % after abdominal surgery. 20 to 30 % of these may cause clinical significance. Although adhesions generally can be treated conservatively; worsening clinical course with recurrent surgeries, bowel resections, complicated enterocutaneus fistulas and peritonitis may lead to mortality of the patient.This study aims to search effects of N-Acetylcysteine which has previously proven to be antioxydant, anti-inflamatory and fibrinolitic on intrabdominal adhesions in experimental rat model.Material and Method: Twenty male Wistar-Albino rats weighing 250-350 gr were seperated into two groups. Surgery was performed under intramuscular 50 mg/kg Ketamine (Ketalar®, Pfizer) and 10 mg/kg Xylazine hidrochloride (Rompun® Bayer) general anesthesia. Under sterile conditions a 3-cm-median incision was used to reach abdominal cavity. Antimesenteric surface of ceacum and peritoneal surface nearby had been abraded by dry tamps until superficial pethecia developed. Intraperitoneal 1 ml 0.09% NaCl solution and intraperitoneal 300 mg/kg NAC (ASIST %10 3 ML 300 MG Hüsnü Arsan İlaçları A.Ş.) were administered to Group 1 and Group 2 respectively and incisions were closed with continious 3/0 silk sutures. All the rats were sacrified on postoperative day 7 with high doses of ether anesthesia. After sacrification abdomens were incised as before and macroscopic adhesion scoring (0-3) was assesed. If present, adhesions and related organs were excised. In case of absence of adhesions ceacum anterior wall and parietal periton (excluding skin) was excised for pathologic examination. Specimens were fixated in 10 % formaldehyde and waxed in parafine blocks. Three-mm sections were stained with hematoxylen-eosine and scored with histologic scoring system under light microscope.Mann-Whitney-U test was used for statistical analysis and p<0.05 value is accepted as significant.Findings: Histopathological evaluation revealed that both groups were homogeneous in terms of severity of peritoneal damage for visceral and parietal surfaces (7,5[1:11] ve 8[7:11]; p=0.353). Macroscopic adhesions scores were significantly lower in NAC group compared with control group (0[0:1] ve 2,5[1:3]; p=0.000). In NAC group three rats had grade 1 adhesion while remaining seven rats had no adhesion at all in peritoneal abrasion field (grade 0). On the other hand, all rats in control group had macroscopic peritoneal adhesions. One of them was grade 1 and remaining nine were grade 2 or 3 adhesions.Conclusion: Considering the results of this study intraperitoneal NAC may be useful in preventing postoperative abdominal adhesions.