Ann Surg Treat Res.  2017 Jul;93(1):50-56. 10.4174/astr.2017.93.1.50.

Evaluation of botulinum toxin type A effectiveness in preventing postoperative intraperitoneal adhesions

• Dokur M
• Uysal E

• KMID: 2392283
• DOI: http://doi.org/10.4174/astr.2017.93.1.50

Abstract

PURPOSE
Postoperative intraperitoneal adhesions (PIAs) are one of the most important problems surgeons have to face after laparotomies. In this study, we aimed to evaluate the effectiveness of local application of botulinum toxin type A (BoNT-A) in various dosages on the prevention of intra-abdominal adhesions in rats with experimental intra-abdominal adhesions.
METHODS
Forty Wistar Albino female rats were randomly separated into 4 groups. The 4 groups were determined as follows: Control (group 1, n = 10); Sham (group 2, n = 10); 10-µg/kg low-dose BoNT-A (group 3, n = 10) and 30-µg/kg high-dose BoNT-A (group 4, n = 10). Subserosal injuries were created on the caecum of all rats. Laparotomy was performed on the fifth day. Adhesion scores, histopathological examination, and E-cadherin expression levels were evaluated.
RESULTS
General adhesion scores for groups 1 and 2 were determined to be significantly high when compared to group 4 (P < 0.001). A significant difference was also determined between groups 3 and 4 in terms of general adhesion scores (P < 0.05). In pair comparisons, a significant decrease in high-dose BoNT-A group (group 4) when compared to groups 1 and 2 in terms of neovascularization, fibroblast density, collagen deposition and inflammatory cell count was determined (P < 0.05).
CONCLUSION
A significant decrease was observed only in postoperative PIAs in the high-dose BoNT-A group between all 4 rat-groups with experimentally created postoperative PIAs. In this study, high-dose BoNT-A is determined to be an effective agent in preventing postoperative PIAs.

Keyword

Type A botulinum toxin; Rats; Tissue adhesions; Cadherins

Figure

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  Fig. 1 Macroscopic appearance of tissues. (A) Control group: intermediate increase adhesion is observed. (B) Sham group: intermediate increase adhesion is observed. (C) Low-dose botulinum toxin type A (BoNT-A) group: small amount adhesion is observed. (D) High-dose BoNT-A group: the lowest amount adhesion is observed.

• 

  Fig. 2 Histopathologic changes in rat groups. (A) Control group: normal fibroblast intensity, neovascularization and collagen fiber formation are observed (H&E, ×100). (B) Sham group: normal fibroblast intensity, neovascularization and collagen fiber formation are observed (H&E, ×100). (C) Low-dose botulinum toxin type A (BoNT-A) group: decrease in fibroblast intensity, neovascularization and collagen fiber formation are observed (H&E, ×100). (D) High-dose BoNT-A group: significant decrease in fibroblast intensity, neovascularization and collagen fiber formation are observed (H&E, ×100). (E) The pattern of grade 1 staining with E-cadherin in control group (immunohistochemistry, ×200). (F) The pattern of grade 0 staining with E-cadherin in sham group (immunohistochemistry, ×200). (G) The pattern of grade 0 staining with E-cadherin in low-dose BoNT-A group (immunohistochemistry, ×200). (H) The pattern of grade 0 staining with E-cadherin in high-dose BoNT-A group (immunohistochemistry, ×200).

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