Surgical adhesions: evidence for adsorption of surfactant to peritoneal mesothelium

Chen, Y. and Hills, B. A. (2000) Surgical adhesions: evidence for adsorption of surfactant to peritoneal mesothelium. Australian and New Zealand Journal of Surgery, 70 6: 443-447. doi:10.1046/j.1440-1622.2000.01841.x

Author Chen, Y.
Hills, B. A.
Title Surgical adhesions: evidence for adsorption of surfactant to peritoneal mesothelium
Journal name Australian and New Zealand Journal of Surgery   Check publisher's open access policy
ISSN 0004-8682
Publication date 2000-06
Sub-type Article (original research)
DOI 10.1046/j.1440-1622.2000.01841.x
Volume 70
Issue 6
Start page 443
End page 447
Total pages 5
Place of publication Carlton, VIC, Australia
Publisher Blackwell Science
Collection year 2000
Language eng
Subject C1
321029 Surgery
730109 Surgical methods and procedures
Formatted abstract
Background: It has been speculated that the formation of surgical adhesions must be preceded by physical adhesion of the two surfaces, a process normally prevented by a lining of adsorbed surface-active phospholipid (surfactant) acting as both a superb boundary (solid-to-solid) lubricant and a release (antistick) agent. Animal trials administering exogenous surfactant as a dry powder (ALEC™) have previously demonstrated a reduction of 80% in abdominal adhesions.

Methods: Incubation of rat peritoneum (both live and excised) with radiolabelled dipalmitoyl phosphatidylcholine (DPPC) has been used to demonstrate adsorption; while the normal lining of surfactant in the human abdominal cavity has been confirmed by epifluorescence microscopy using Phosphin E as the hydrophobic probe.

Aims: The overall aim is to confirm that peritoneal mesothelium has a lining of surfactant known for its lubricating and release properties, and that this lining can be enhanced by the adsorption of exogenous material.

Results: Adsorption of DPPC to peritoneal mesothelium was 470 ng/cm2 (n = 8) ex vivo and 598 ng/cm2 (n = 18) in vivo, these rates being enhanced by EggPG by 62% ex vivo and 47% in vivo to reach the equivalent of almost three close-packed monolayers.

Conclusions: These results can explain the reduction in surgical adhesions previously reported in animals by administering ALEC™ (7:3 DPPC:EggPG) as a highly surface-active dry powder, although it is now used in saline suspension to treat respiratory distress syndrome in newborns, in whom it has no side-effects. These findings would appear to justify clinical trials for dry ALEC™ in suppressing surgical adhesions with minimal risk of an adverse reaction. The results of these trials are also discussed and found to be compatible with the known ability of surfactant to resist physical adhesion by fibronectin, the tacky ‘glue’ by which fibroblasts attach to surfaces as the first step in formation of fibrinous adhesions.
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 23 times in Thomson Reuters Web of Science Article | Citations
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Created: Tue, 10 Jun 2008, 13:16:00 EST