The Effectiveness of Systemic Antibiotics in Preventing Postoperative, Intraabdominal Adhesions in an Animal Model Mustafa Oncel, M.D.,* , † ,1 Necmi Kurt, M.D.,* Feza H. Remzi, M.D.,† Sibel S. Sensu, M.D.,‡ Selahattin Vural, M.D.,* Cem F. Gezen, M.D.,* Tarik G. Cincin, M.D.,* and Ergin Olcay, M.D.* *General Surgery Department, Kartal Education and Research Hospital, Istanbul, Turkey; †Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio; and ‡Pathology Department, Kartal Education and Research Hospital, Istanbul, Turkey Submitted for publication January 23, 2001; published online September 13, 2001 Objective. Postoperative intraabdominal adhesions can be prevented by antibiotic lavage. We assessed whether systemic antibiotics could prevent adhesion formation in a rat model. Methods. Cecal abrasion was performed in the peri- toneal cavities of 40 Wistar albino rats. Twenty rats were treated with a 5-day course of cefepim and met- ronidazole; the remaining animals were given saline injections. The animals were sacrificed 14 days after surgery. Adhesion severity scores and histopathologic findings were compared. Results. The median adhesion severity score was 2 (0 –3) in the antibiotic group and 2.5 (1– 4) in the con- trols (P  0.03). In tissue specimens from controls, the adhesions were marked by mature collagen bundles. In treated rats, the adhesions were immature, charac- terized by early inflammatory cells, less collagen for- mation, and no collagen bundles. Conclusion. Postoperative systemic antibiotics slow adhesion formation and reduce the severity of the ad- hesions. © 2001 Academic Press Key Words: antibiotics; intraabdominal postopera- tive adhesions. INTRODUCTION In abdominal and gynecologic surgery, postoperative adhesions can cause serious bowel obstructions, and adhesions from previous surgeries pose the risk of in- traoperative dissection. Adhesions are responsible for more than 60% of all intestinal obstructions and ap- proximately 10% of all repeat laparotomies [1–5]. Ad- hesions may cause visceral dysfunction by distorting or displacing an organ [6]. Chronic pelvic pain and female infertility are associated with adhesive disease [7, 8]. Intraabdominal adhesions may be postoperative, in- flammatory, or, rarely, congenital. Mechanical injury, foreign bodies, ischemia, and infection in abdominal operations can increase the severity of adhesions [9 –11]. Postinflammatory (infectious) adhesions account for 10 to 20% of all intestinal obstructions [1]. The effects of surgery and infection may be synergistic [12]. These observations have led to research on the effect of anti- biotics on adhesion formation. Surgeons first observed evidence for an antiadhesive effect of antibiotics during the 1980s, when antibiotics were used in intraperito- neal irrigation fluid [2, 3]. Brolin et al. showed that the subcutaneous use of the combination of trimethoprim with sulfamethoxazole and tinidazole significantly re- duces the frequency and severity of postoperative ad- hesions [21]. The effect on adhesions may be secondary to the reduction in the frequency and duration of in- fections, because adhesion formation becomes more likely with prolonged infection [9]. Overall, the effect of systemic antibiotics is still not clear and deserves fur- ther study. Intraabdominal infection and abscess are frequently caused by gastrointestinal organisms such as Esche- richia coli and Bacteroides fragilis, and secondary peri- tonitis is usually caused by a mix of bacteria of gastro- intestinal origin [18]. Therefore, to study this question, we selected a drug combination with known effectiveness against gastro- intestinal infections. Cefepime provides excellent cov- erage for both grain-positive and gram-negative facul- tative bacteria and Pseudomonas. The antianaerobe metronidazole is often added to cephalosporin regi- mens and in vivo activity of this antibiotic combination 1 To whom correspondence and reprint requests should be ad- dressed at Nalcaci cad. Aysu sit. No:18, Konya, 42060, Turkey. E-mail: mustafaoncel@hotmail.com. Fax: 332/320-9361 (Turkey). Journal of Surgical Research 101, 52–55 (2001) doi:10.1006/jsre.2001.6245, available online at http://www.idealibrary.com on 52 0022-4804/01 $35.00 Copyright © 2001 by Academic Press All rights of reproduction in any form reserved.