Effect of intraperitoneal antiadhesive fluids in a rat peritonitis model

Hypothesis: Phospholipids and icodextrin reduce peritoneal adhesions resulting from general peritonitis without promoting abscess formation. Design: Evaluation of adhesion reduction fluids in a randomized animal study using a standardized peritonitis model. Setting: Experimental animal model in a university laboratory. Interventions: In 60 rats, experimental peritonitis was induced using the cecal ligation and puncture model. On day 1, the abdominal cavity was rinsed with 10 mL of isotonic sodium chloride solution and the cecum was resected. Animals were randomly assigned to 3 groups: the RL group, which received Ringer lactate intraperitoneally; the PL group, which received phospholipids intraperitoneally; and the ID group, which received icodextrin intraperitoneally. In each group, 50% of the animals were humanely killed at day 11 and 50% at day 21. Main Outcome Measures: The areas of adhesions were measured and the abscess formation was scored according to location and size. Abscesses, abdominal fluid, and blood were sampled for microbiologic workup. Results: The median area of adhesions was significantly lower in the PL groups (PL11, 43.7 mm(2); PL21, 20.4 mm(2)) than in the RL groups (RL11, 163.8 mm(2); RL21, 120.9 mm(2)) and ID groups (ID11, 418.5 mm(2); ID21, 218.6 mm(2)). Abscess formation was increased by icodextrin but not influenced by phospholipids, whereas microbiologic investigations did not reveal any differences among these 3 groups. Conclusions: In this model of general peritonitis, phospholipids significantly reduced adhesion formation without promoting septic complications. Icodextrin enhanced adhesion and abscess formation in this peritonitis model. Phospholipids may be beneficial for adhesion control in general peritonitis.