Page 33 - Postoperative Intra-Abdominal Adhesions- New insights in prevention and consequences

Current status postoperative abdominal adhesions
side effects, such as leakage from the incision, labial oedema, feeling
of fluid moving around, abdominal discomfort, abdominal distension
and complications such as pulmonary and peripheral oedema. Large
volumes of intraperitoneal fluids may decrease the peritoneum ability to 2 confront bacterial infections [44, 81, 89]
Lactated Ringer’s solution
Lactated Ringer’s solution (LRS) is a crystalloid solution, which is isotonic with blood and contains sodium, lactate, chloride, potassium and calcium. The mechanism of action is unclear, but it has been suggested that the solution works by separating damaged peritoneal surfaces by the process of hydroflotation [19]. It is also believed that LRS dilutes the local fibrin concentration, resulting in fewer adhesions. Nevertheless, most experimental trails could not show a significant effect in reducing adhesions [19]. The possible reason for this is that LRS is absorbed within 24 hours after instillation, whereas adhesion formation takes place up to 8 days [90]. On the contrary, in a recent meta-analysis it was concluded that intrapertioneal installation of Ringers solution possibly increases the formation of adhesions [91].
Saline solution (NaCl 0,9%)
For many years, saline has been used to rinse the peritoneal cavity after contamination by blood, bile and other adjuvants of bacterial infection following laparotomy or laparoscopy. It is, just like LRS, being absorbed within 24h hours after administration to the peritoneal cavity [92]. In 1995, Burns et al performed an animal study in which they investigated adhesion formation after rinsing the peritoneal cavity with a saline solution compared with no rinsing at all [93]. They found no significant difference in the results. Moreover, van Westreenen et al reported that rinsing with saline solution increased adhesion formation by 150%, compared to a control group with no peritoneal lavage [94]. So, when used solitary (phosphate buffered) saline seems to be ineffective or even contraproductive in preventing adhesion formation [60].
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