JOURNAL OF INVESTIGATIVE SURGERY

Aim: To study the efficacy of pirfenidone for prevention of postoperative adhesion formation in an adhesion rat model. Materials and Methods: Eighteen female Wistar rats were subjected to right-sided parietal peritoneum and right uterine horn adhesion model. Rats were randomized into three groups: group 1 (control) (closure of midline abdominal incision without any agent administration), group 2 (closure of incision after intraperitoneal administration of pirfenidone), and group 3 (closure of incision and only oral administration of pirfenidone for 14 days). Relaparotomy was performed 14 days after the first surgery. Effect of pirfenidone on adhesion formation was assessed on light microscopy by scoring vascular proliferation, inflammation, fibrosis, and collagen formation in the scarred tissue. Effect of pirfenidone on inflammation was assessed by measurement of transforming growth factor-beta and interleukin-17 levels in scarred tissue. Results: The degree of vascular proliferation (1.32 +/- 0.39 versus 2.34 +/- 0.46, p < 0.001), inflammation (1.60 +/- 0.70 versus 2.60 +/- 0.52, p < 0.01), and fibrosis (1.50 +/- 0.53 versus 2.40 +/- 0.52, p < 0.01) were less prominent in group 2 compared to group 1, respectively. Only vascular proliferation was found to be less prominent in group 3 compared to group 1 (1.60 +/- 0.42 versus 2.34 +/- 0.46, p < 0.01). Intraperitoneal and oral administration of pirfenidone reduced tissue levels of inflammatory markers (TGF-beta and IL-17) in parietal and visceral peritoneum compared to control group. Intraperitoneal administration of pirfenidone compared to oral administration was more effective in reducing tissue levels of inflammatory markers. Conclusion: Pirfenidone is an effective agent on the prevention of postoperative vascular proliferation, inflammation and fibrosis in scarred tissue particularly with intraperitoneal administration