Practical considerations in the use of a porcine model (Sus scrofa domesticus) to assess prevention of postoperative peritubal adhesions

PLoS One. 2020 Jan 9;15(1):e0219105. doi: 10.1371/journal.pone.0219105. eCollection 2020.

Abstract

Infertility has been a common postoperative problem caused by peritoneal adhesions. Since several prophylactic agents have recently shown promising preliminary results, more complete studies comparing their real efficacy and safety are needed urgently. The aim of this study was to investigate and describe practical considerations of a porcine model that can be used to assess such prophylactic agents. First, 10 healthy 5½ months old female pigs (24.3-31.3 Kg) underwent a standardized laparoscopy to provoke peritubal adhesion formation without prophylactic agents. After 30 days, a second-look laparoscopy was performed to evaluate adhesions and perform adnexectomy for histopathological evaluation. Adhesions at different sites were classified by grade, for which the scores range from 0 (no adhesion) to 3 (very strong vascularized adhesions), and also by area, with scores ranging from 0 (no adhesion) to 4 (>75% of the injured area). The histopathological evaluation of the distal uterine horns, oviducts and ovaries were compared withthose from a control group of six healthy pigs with no previous surgery. Biological samples were collected to assess vitality, inflammation and renal, hepatic and hematopoietic systems. There were small (but significant) changes in serum albumin (P = 0.07), globulin (P = 0.07), C-reactive protein (P = 0.011), fibrinogen (P = 0.023) and bilirubin (P<0.01) after 30 days, but all values were within the normal range. No inflammation or abscess formation was observed, but different degrees of adhesion were identified. The estimated occurrence of adhesion (scores >0) and of strong / very strong adhesion (scores >1) was 75% (95% CI: 55-94.9) and 65% (95% CI: 45-85), respectively. The porcine model represents a useful animal platform that can be used to test the efficacy and safety of candidate prophylactic agents intended to prevent postoperative peritubal adhesions formation. We present several practical considerations and measures that can help to minimize animal suffering and avoid problems during such experiments.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Bilirubin / blood
  • Biomarkers / blood
  • C-Reactive Protein / metabolism
  • Disease Models, Animal
  • Fallopian Tubes* / metabolism
  • Fallopian Tubes* / pathology
  • Female
  • Fibrinogen / metabolism
  • Laparoscopy* / adverse effects
  • Ovary* / metabolism
  • Ovary* / pathology
  • Postoperative Complications* / blood
  • Postoperative Complications* / pathology
  • Serum Albumin / metabolism
  • Severity of Illness Index
  • Swine
  • Tissue Adhesions* / blood
  • Tissue Adhesions* / etiology
  • Tissue Adhesions* / pathology

Substances

  • Bilirubin
  • Biomarkers
  • C-Reactive Protein
  • Fibrinogen
  • Serum Albumin

Grants and funding

This study was supported by DMC Importação e Exportação de Equipamentos Ltda which provided advanced medical devices and equipment for surgical procedures through its product development centers and manufacturing facilities in São Carlos - SP, Brazil, and by Instituto Crispi de Cirurgias Minimamente Invasivas (Rio de Janeiro - RJ, Brazil). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.