Discussion
Postoperative adhesions are a result of the cellular and biochemical
response that occurs after peritoneal trauma while attempting to repair
the peritoneum. Many methods have been used to reduce adhesion
formation, such as reducing the initial inflammatory response,
preventing fibrin formation, increasing fibrinolysis, preventing
collagen deposition, and using a barrier against adhesion formation, and
many studies have been conducted on them
(19, 20)
but today there is still no drug or method that can be used alone that
can prevent adhesion formation satisfactorily. Many studies have shown
that inflammatory cells and reactive oxygen species play a role in the
formation of adhesion (21,
22). Adhesions are cellular and
vascularized structures containing oxidants, angiogenic factors, and
inflammatory cells (23). The
anti-adhesion effects of antioxidants have been tested in various animal
models (24,
25). In this study, we tried to examine
the potential effect of lycopene, a potent antioxidant,
antiproliferative, anticarcinogenic, and anti-inflammatory, on adhesion
formation in rats with traumatized uterine serosa
(9). To our knowledge, the present study
is the first study that used lycopene as an adhesion inhibitor in an
animal model.
MDA is produced by cells involved in the inflammatory response. It is a
by-product formed by oxygen radicals breaking down lipid-containing
structures such as plasma and cell membranes. It is a parameter used in
evaluating both tissue damage and inflammation severity
(26). In our study, a significant
difference was observed between the HLG and CG in terms of MDA levels
[p═0.007]. Although MDA levels were found to be lower in the HLG
than in the LLG, this difference was not statistically significant.
VEGF is an angiogenic cytokine that participates in the process of
adhesion formation through the formation of new vessels
(27). In this study, although there was
no statistical difference between the groups in terms of VEGF release,
numerically, more VEGF positive cells were encountered in the treatment
groups compared to the CG.
Substances that prevent oxidations caused by free radicals and have the
ability to capture and stabilize free radicals are called
’antioxidants’. The total effect of all antioxidants in body fluids is
called total antioxidant capacity [TAC]
(28). In this study, there was no
significant difference between the groups in terms of TAC. Higher TAC
levels were detected in the HLG but it was statistically insignificant.
Various methods have been used for grading intraabdominal adhesions. The
systems that are made according to the percentage of traumatized
adherent area used by Links et al. Or Leach et al.’s systems consisting
of three different parameters are the most commonly used methods.
(29). We used the system of Leach et al.
In this system, adhesions are scored in three separate categories
according to type, prevalence, easy or difficult separation. In our
study, adhesion scores were significantly lower in the lycopene groups
compared to the control group, which indicates the effectiveness of
lycopene alone in reducing adhesion formation, in line with other
studies (1). In in vitro studies, it was
found that vitamin E has antioxidant, anti-inflammatory, anticoagulant
and antifibroblastic effects; It has also been shown to reduce collagen
production and suppress fibrin production
(30). Lycopene has similar properties
with vitamin E in terms of its antioxidant, anti-inflammatory and
antifibroblastic effects. Corrales et al. applied vitamin E
intraperitoneally and showed that its anti-adhesion effects were as much
as bioresorbable membranes containing carboxymethyl cellulose. However,
the same effect could not be shown after intramuscular injection
(31). In another study, Yetkin et al.
demonstrated that intraperitoneal vitamin E injection and human amniotic
membrane separately reduced postoperative adhesion in rats; however, a
synergistic increase in their effects could not be demonstrated with
their co-administration (32). Similarly,
colchicine, which has antifibrotic, anti-inflammatory, antihistamine,
membrane stabilization and lipid peroxidation inhibition effects, is a
plant-based drug. In cases where peritoneum is damaged, adhesions can be
prevented by changing neutrophil migration to the region and the
distribution of adhesion molecules on neutrophil and endothelial cells
by using colchicine (33). The results of
our study are consistent with these studies.
Our study had some limitations. First; It was the route of application
of the anti-adhesion agent. We chose this method in our study because
the intraperitoneal route is generally used in the literature. Another
limitation is that the dose of intraperitoneal lycopene required to
prevent adhesion is unknown. In this study, we used the doses used in
animal models of oxidative stress.
Conflict of Interest: The authors declare that they have no conflict of
interest.