Prevention of Peritoneal Adhesions by Use of Vegetable Ferments. ∗

Abstract

Many operative technics and the use of numerous substances have been advocated in order to prevent the re-formation of adhesions in patients. All, however, have given about the same negative results. Kubota, in 1924, working with vegetable ferments of the papain group, found that it was possible to prevent the formation of adhesions by introducing vegetable ferments into the peritoneal cavity. Quite recently Buchbinder, using intraperitoneal glucose, and Johnson, using amniotic fluid, report brilliant results in the prevention of peritoneal adhesions.

In order to test the efficiency of the vegetable digestants, the following experimental work was carried out: a series of 39 rabbits and 16 dogs was used, and an attempt made to determine the effect of vegetable digestants on the formation and re-formation of peritoneal adhesions. A peritonitis was produced at laparotomy by rubbing the peritoneum covering the loop of the small bowel with a piece of dry gauze until bleeding occurred. Following this a 7% solution of tincture of iodine was applied over the denuded surfaces.

Series 1. 39 rabbits. At the original laparotomy, and at the time of the production of the peritonitis, solutions of papain or substances of the papain group were introduced into the peritoneal cavity. Animals, used as controls, which had no vegetable digestants added to the peritoneal cavity, as well as those to which the ferment was added, were killed on the 4th, 7th, 10th, 15th days postoperatively and also 7 weeks after operation. At autopsy the control animals showed evidence of extensive adhesion formation, whereas those treated with the ferment showed either no evidence of adhesion or the adhesions which were formed were fine and veillike. Control experiments were also carried out using the ferment alone; varying strengths from 1-1000 to 1-400,000 were used, and in none were there any evidences of irritation when papain solution or any of its associated substances were employed.