Effects of peroperative intra-abdominal cleaning methods on peritoneal adhesion during gastric perforations

Abstract

Purpose: This experimental study was planned to investigate whether intraabdominal cleaning with moist compresses or intraabdominal washing with saline, which is a frequently used method, has more decreasing effect on formation of postoperative peritoneal adhesion after the source control in gastric perforations.

Material and method: In this study 40 male Wistar albino rats were divided into four equal groups. 1st group was assigned as control group and laparotomy was done without gastric perforation and abdomen was closed. Gastric perforation was applied to other groups and one hour later gastric primary repair was done and the abdomen was closed without cleaning, after washing with saline and after cleaning with moist compresses, respectively. All rats were sacrificed on the 7th post-operative day and adhesions were staged according to the Evans method. Peritoneal samples were taken from all rats and rat specific tissue plasminogen activator (t-PA) and plasminogen activator inhibitor1 (PAI-1) were studied.

Results: Adhesion scores were found lower in compress groups than other groups. The t-PA levels studied from the peritoneal samples on the 7th post-operative day were observed to increase in the compress group. The PAI-1 levels were highest in the saline group.

Conclusion: Our study showed that intra-abdominal cleaning with moist compresses after gastric perforations causes less adhesion than saline irrigation. Studies on peritoneal samples showed that the t-PA level, which prevents adhesion formation, increased in the compress group while the PAI-1 level, which is related to the increased adhesions, increased in saline group.