Prevention of postoperative abdominal adhesions using systemic enoxaparin and local diclofenac. An experimental study

Abstract

Abstract Introduction Postoperative abdominal adhesions (PAA) are a cause of morbidities, generating higher health care costs for patients and institutions responsible for health procurement. PAAs occur due to an imbalance between the enzymatic linkage in favour of fibrinogenesis in the cascade of coagulation, which encompasses a pathological process initiated by injury to the peritoneum amid the additional activation of inflammatory processes under tissue hypoxia. The objective of this study was to test the potential benefits of the use of subcutaneous enoxaparin plus intraperitoneal diclofenac in a porcine model. Material and Methods Using 32 hybrid female pigs, surgical adhesions were induced by open conventional splenectomy. The animals were divided into four groups: (I) control, irrigation with saline solution; (II) subcutaneous enoxaparine was applied; (III) intraperitoneal diclofenac; and (IV) combination of both. Results By far, the greater degree of formation of abdominal adhesions occurs in the non‐treated control group I ( P < .01). In contrast, in the macroscopic and histopathological report in terms of the degree of abdominal adhesion formation encountered in our assessments, the comparison among the treated groups showed no statistically significant differences among them, but asserted the preventive formation of PAA after the systemic application of enoxaparin and local diclofenac. Conclusions Subcutaneous enoxaparine and intraperitoneal diclofenac reduced the formation of PAA significantly, but we found no synergic action in their combination.