A new approach to postoperative peritoneal adhesions: Prevention of peritoneal trauma by aloe vera gel

https://doi.org/10.1016/j.ejogrb.2009.11.019Get rights and content

Abstract

Objective

Covering peritoneal surfaces with aloe vera gel may prevent peritoneal trauma and hence postoperative peritoneal adhesions.

Study design

Forty Wistar albino out-bred female rats (mean weight, 180 ± 25 g; mean age, 6 months) were divided into four groups. In Group 1, 0.1 mL aloe vera gel was injected into the peritoneal cavities. In Group 2, peritoneal adhesions were induced. In Group 3, adhesions were induced and the modeled area was covered by 0.1 mL aloe vera gel. In Group 4, the area was covered with aloe vera gel prior to adhesion induction. The rats were sacrificed on postoperative day 10 and the adhesions were scored both microscopically and macroscopically.

Results

The mean macroscopic adhesion score in the four groups was 0, 5.8 ± 0.42, 5.2 ± 0.79, and 1.1 ± 1.2 respectively, with the difference between Group 4 and Groups 2 (p < 0.001) and 3 (p < 0.05) statistically significant. The mean histopathological fibrosis values were significantly higher in Group 3 than in Group 4 (2.6 ± 0.51 vs 1.2 ± 0.91, p = 0.002).

Conclusion

Aloe vera gel can effectively decrease adhesion formation if applied before, but not after, after peritoneal trauma. This effect is likely due not to its chemical properties but to its viscosity, providing a covering to prevent peritoneal trauma.

Introduction

Postoperative peritoneal adhesions (PPAs) are the most frequent causes of intestinal obstruction, infertility, and abdominal and pelvic pains [1]. Various materials and/or techniques have been investigated but no effective solution has been identified to date.

Aloe vera (synonym: Aloe barbedensis Miller) is a plant with yellow flowers and triangular leaves, similar to cactus. It belongs to the Liliaceal family, which comprises 360 species [2]. Plant leaves contain abundant amounts of mucilaginous fluid of high viscosity, called aloe vera gel. Peripheral bundle sheath cells of leaves contain a less viscous liquid, called aloe vera juice or aloe vera sap [2].

The aloe vera plant contains 75 potentially active substances, including vitamins, enzymes, minerals, sugars, lignin, saponins, salicylic acids, and amino acids [3]. Owing to its rich content, it is used in the treatment of many clinical diseases and has been found to be effective in many pathological conditions [4], [5], [6]. Among these is its positive wound-healing effect. Aloe vera gel accelerates many internal (e.g. peptic ulcer) and external (e.g. dermal/subdermal) wound-healing processes [6], [7]. We have therefore assessed whether aloe vera can prevent PPAs, by applying aloe vera gel to the peritoneal cavity before and after the induction of traumatic adhesions.

Section snippets

Materials and methods

This research was approved by the local ethics committee for experimental animals and was performed at the Experimental Animal Production and Research Laboratory of Cerrahpasa Medical School, Istanbul University, Turkey.

Forty Wistar out-bred female albino rats (mean weight, 180 ± 25 g; mean age, 4.5 months) were divided into four groups of 10 rats each, providing a sample power of 0.9 with a 95% confidence interval. Group 1 rats were injected with 0.1 mL aloe vera gel into the peritoneal cavity

Results

The total adhesion scores of all subjects in all four groups are shown in Table 2, Table 3, and the mean and median scores of the groups are shown in Table 4. Group 1 was used specifically to assess whether aloe vera itself forms adhesions or has an effect on intraperitoneal pathology and no such effect was observed, so this group was excluded from further analyses.

Adhesion size and severity were significantly lower in Group 4 than in Group 2 (p < 0.05 and p < 0.01, respectively) and significantly

Discussion

PPAs are caused by any kind of damage (including mechanical, ischemic, chemical, infective or inflammatory) to the peritoneum, which consists of a single layer of mesothelial cells. During PPA, there is fibrin-rich exudation into the damaged region. The fibrins form bands between surfaces that are in contact with this region. Fibrin bands and a hyaluronic acid-rich matrix, which fills the cavity between these bands, provide a suitable environment for collagen synthesis. Real adhesions occur

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