The systemic effect and the absorption rate of aerosolized intra-peritoneal heparin with or without hyaluronic acid in the prevention of postoperative abdominal adhesions.

BACKGROUND

Adhesions are a known cause of morbidity and mortality following abdominal surgery. Multiple approaches have been evaluated to prevent or minimize the occurrence of adhesions. Administration of aerosolized heparin and hyaluronic acid is an effective method to prevent postoperative adhesions whether they are used independently or in synergism. However, absorption rate and the systemic effect of heparin given intra-peritoneal have never been investigated. The purpose of this study was to evaluate the systemic effect and the absorption rate of heparin with or without hyaluronic acid in the prevention of postoperative abdominal adhesion.

MATERIALS AND METHODS

This is a cross-sectional study comparing thirty rats (n = 30) divided into 3 groups, each consisting of 10 rats. First group (n = 10) received aerosolized intra-peritoneal heparin (IPH). Second group (n = 10) received intra-peritoneal heparin with hyaluronic acid (IPHHA). Intravenous heparin (IVH) was given to the third group (n = 10). Serum heparin levels were measured and compared between the groups over 120 min's period.

RESULTS

None of the rats had intra-operative bleeding. The level of serum heparin was significantly lower in the IPHHA group compared to IPH and the IVH at all points of measurements (30, 60, 90, and 120 min) (p < 0.0001). The serum level of heparin of all groups peaked at 90 min. Area-under-the-curve 0-120 was significantly lower in the IPHHA group as compared to both IPH and IVH (p < 0.0001).

CONCLUSION

The aerosolized intra-peritoneal administration of heparin or heparin with hyaluronic acid resulted in minimal systemic absorption rendering it safe for the use as method to prevent intra-peritoneal adhesions. Human studies are planed next.