Polyethylene glycol 4000 attenuates adhesion formation in rats by suppression of peritoneal inflammation and collagen incorporation

Background: Postoperative separation of the peritoneal surfaces is a promising approach for the prevention of adhesion formation. Instillation of polyethylene glycol 4000 (PEG) was recommended as an appropriate method. Methods: In a time-course study in rats, efficacy and mode of action of PEG was investigated. Adhesions were induced by crushing of the cecum. Sixty animals were randomly allocated to three control groups with intraperitoneal instillation of 5 mL 0.9% NaCl and to three therapy groups treated with 5 mL 20% PEG. After 3, 7, and 21 days, adhesion grade, intraperitoneal leukocytes, and collagen incorporation into the adhesion strands were evaluated. Results: Administration of PEG resulted in a decrease of leukocytes by 43% (days 3 and 7), a reduction of the adhesion score by 85% (day 3), 77% (day 7), and 79% (day 21), and an impairment of collagen deposition by 54% (day 7) and 44% (day 21). Conclusions: Coating the peritoneal surfaces with PEG is a highly effective measure to suppress the fatal sequence of posttraumatic inflammation, formation of initial adhesions, and their subsequent organization to strong permanent adhesion strands.