Comparison of the Protective Effects of Calendula officinalis Extract and Hyaluronic Acid Anti-adhesion Barrier against Postoperative Intestinal Adhesion Formation in Rats

Aim: Intra-abdominal adhesions that develop after abdominal surgery are still a cause of serious morbidity and mortality. This study compared the efficacy of a hyaluronic acid adhesion barrier and Calendula officinalis extract (COE) for inhibiting adhesion in rats. Method: We performed laparotomies in 30 rats and induced postoperative intraabdominal adhesions using a scraping model. The animals were divided randomly into 3 groups of 10 rats each. We performed only caecal abrasions and did not apply any substance in the control group (group 1). In group 2, we performed caecal abrasion and then applied the hyaluronic acid adhesion barrier to the abraded area. In group 3, we applied COE after the caecal abrasions. Results: There were no significant differences among the groups in terms of the macroscopic adhesion score. Histopathologically, there was a significant difference in microscopic adhesion scores between groups 1 and 2 (p=0.044). There was also a significant difference between groups 1 and 3 (p=0.010). There was no significant difference between groups 2 and 3 (p=1). Group 1 had the highest score for adhesions between the abdominal wall and intra-abdominal organs. Conclusion: Both the COE and hyaluronic acid adhesion barrier significantly reduced the incidence of postoperative intra-abdominal adhesions in a rat scraping model. Although the mechanism is not clear, the COE applied in the peritoneal cavity reduced the development of adhesions. There was no significant difference between the COE and hyaluronic acid adhesion barrier in terms of preventing adhesions. Although the COE is less expensive than hyaluronic acid adhesion barrier, toxicology studies must be performed before it is used in humans.