This project will be the first to examine the effects of abdominal massage (therapeutic mobilization of the abdominal contents and wall) on the prevention and treatment of postoperative peritoneal adhesions and ileus. Intra-abdominal adhesions (pathological bands of fibrous connective tissue that develop after peritoneal injury) are a leading cause of bowel obstruction, infertility, chronic pain, and repeated surgeries. Although they can occur spontaneously, adhesions have been reported as an adverse side effect of surgery for over a century, occurring at a rate of 95% or higher. The most recent estimate of the economic burden of the associated morbidity of postoperative adhesions is $5 billion in the United States alone. Abdominal surgery also invariably causes a temporary alteration of intestinal function, called ileus. Ileus is an important cause of postoperative discomfort and prolonged hospital stay, and also places a huge financial burden on the health care delivery system. Despite substantial efforts, effective prevention and treatment methodologies remain unsatisfactory for both of these conditions. Methods of abdominal massage have been used for centuries to treat various abdominal complaints, and are anecdotally reported to treat symptoms of adhesions and ileus. Our preliminary experimentation using rat models has led to the hypotheses that abdominal massage prevents postoperative adhesion formation, and attenuates postoperative ileus. Testing will address the effect of abdominal massage on: 1) postoperative ileus. Abdominal massage will be performed on rats following cecal abrasion throughout the inflammatory and adhesiogenic periods. Assays of gastrointestinal function, inflammation, and the fibrinolytic system will be performed at numerous endpoints. 2) postoperative adhesion formation. Abdominal massage will be performed on rats following cecal abrasion throughout the inflammatory and adhesiogenic periods, and the rat allowed to survive for 7 days. The abdomens will be dissected and quantitatively evaluated for adhesions. 3) vagal afferent discharge, and whether an intact vagal sensory system is necessary for the effects of massage. Inflammation is key to both ileus and adhesion formation, and is modulated by the vagus nerve. In one set of experiments, unitary vagal afferent discharge properties will be recorded during abdominal massage, comparing operated to unoperated rats. In a separate experiment, the effect of abdominal massage on ileus will be measured in vagal-deafferented rats, and compared to deafferented but untreated rats. 4) the healing of a rat colonic strictureplasty. Strictureplasty will be performed on two groups of rats, one of which will receive massage. After 7 days, the operated section of colon will be tested for the ability to withstand intraluminal pressure. The presence of postoperative adhesions will also be evaluated.
Although life-saving, abdominal surgery leads to ileus and intra-peritoneal adhesions. Both are major causes of morbidity and mortality, and create substantial financial burdens on our health care system. Peritoneal adhesions are a leading cause of bowel obstruction, infertility, chronic pain, and repeated surgeries. Postoperative ileus extends hospital stay, and greatly increases the cost of hospitalization. Despite extensive research, effective preventive measures and treatment methods are lacking for both these conditions. We have shown that in rat models, both of these conditions appear to be attenuated by abdominal massage, but there is little other supportive scientific evidence. The experiments described in this application will comprise the first known formal inquiry into the possible effect of abdominal massage on postoperative peritoneal adhesions and ileus.