Özet: Adezyon, komşu vücut bölümleri arasında fibroproliferatif inflamatuar cevap sonucu oluşan anormal fibröz dokudur. Tüm abdominal cerrahilerin %93100'ünde adezyon geliştiği rapor edilmiştir. Jinekolojik cerrahi girişimlerden sonra %97 oranında postoperatif adezyona rastlanmıştır. Dnfertilite nedeniyle mikrocerrahi işlem uygulanan laparotomilerden sonra adhezyon gelişme sıklığı %85 üzerinde saptamıştır. Laparoskopik adezyolizis sonrası yapılan ikincil laparoskopi sırasında vakaların %97'sinde adezyon reformasyonu gözlenmiştir. Cerrahi sonrası adezyonlar tüm dünyada milyonlarca insanın yaşam kalitesini, ince barsak obstrüksiyonu yaparak, tekrarlayan karın ameliyatlarında güçlüklere neden olarak, kronik karın ve pelvik ağrılara neden olarak, kadın infertilitesine yol açarak etkilemektedir. şu an adezyon formasyonunu önleyen ideal bir yöntem henüz yoktur. Silymarin, Silybum marianum (Milk thistle, Meryemana dikeni) bitkisinden elde edilen bir flavonoidtir. Antiproliferatif, antioksidan, proapopitotik ve antianjiogenetik, antiinflamatuar ve antifibrozis etkileri mevcuttur. Antiinflamatuar etki mekanizması henüz net olarak açıklanamamıştır. Genellikle insanlarda iyi tolere edilir. Deneysel çalışmamızda ratlarda iatrojenik adezyon oluşturarak Silymarin'in postoperatif adezyon oluşumu üzerine etkilerini değerlendirmeyi amaçladık. Toplam 36 ratın kullanıldığı çalışmamızda ratlar sayıları ve ortalama ağırlıkları eşit olacak şekilde 3 gruba ayrıldı. Anestezi sonrası ratlara steril şartlarda 3 cm orta hat laparotomi insizyonu yapıldı. Uterin hornlar ortaya çıkarıldı. Bifürkasyondan 1 cm uzaklıktan başlayarak unipolar elektrokoter aleti ile 250 watt ayarda sağ uterin boynuz antimezenterik tarafına 0,5 x 0,2 cm serozal hasar oluşturuldu. Operasyon günü başlanarak 20 mg/kg Silymarin (Grup II) ve 100 mg/kg Silymarin (Grup III) su ile karıştırılarak beslenme sondası ile oral olarak her iki gruba 14 gün verildi. Grup I kontrol grubu olarak belirlendi. Dlk laparotomiden 14 gün sonra tüm gruplara ikinci laparotomi yapıldı. Oluşan adezyonlar Linsky ve arkadaşlarının yaptığı klinik adezyon skorlama sistemine göre değerlendirildi. Hasarlı yüzeyde oluşan adezyonlardan histopatolojik inceleme için biyopsi alındı. Hazırlanan preparatlar hemotoksilen eozin boyası ile boyandıktan sonra, dokulardaki fibroblastik aktivite, iltihabi hücreler, yabancı cisim dev hücreler ve vasküler proliferasyon açısından değerlendirildi. Çalışmanın sonucunda en yüksek adezyon skoru kontrol grubunda (3.25 +- 0.78), en düşük adezyon skoru 100mg/kg Silymarin (Grup III) verilen grupta (0.33 +- 0.49) saptanmıştır. Ratlara 20mg/kg Silymarin (Grup II) verilen grupta (p< 0.0001) ve 100mg/kg Silymarin (Grup III) verilen grupta (p< 0.0001) kontrol grubuna göre adezyon skoru açısından istatistiksel olarak anlamlı fark tespit edildi. Aynı şekilde 100mg/kg Silymarin (Grup III) verilen grupta 20mg/kg Silymarin (Grup II) verilen gruba göre adezyon skoru açısından istatistiksel olarak anlamlı fark tespit edildi (p< 0.0001).

Abstract: Adhesion is defined as abnormal fibrous tissue between body parts, developed as a result of fibroproliferative inflammatory reaction. Adhesion formation rate after abdominal surgery has been reported to be 93100%. Postoperative adhesion formation rate is 97% after gynecological operations, 85% after microsurgical operations performed for infertility, 97% for second laparoscopy performed after laparoscopical adhesiolysis. Adhesion development after surgery causes bowel obstruction, surgical technical difficulties, chronic abdominopelvic pain, infertility and affects quality of life for millions of people worldwide. A procedure to prevent adhesion formation had not yet been defined. Silymarin is a flavonoid extracted from Silybum marianum which has antiproliferative, antioxydant, proapopitotic, antiangiogeneic, antiinflammatory and antifibrotic effects. The mechanism for its antiinflammatory effect is unclear. It is usually well tolerated in humans. Our experimental study aimed to evaluate Silymarin's effect on postoperative adhesion formation with iatrogenic rat adhesion model. Our study included 36 rats and 3 groups were formed with equal numbers and mean weights. After induction of anesthesia, a median incision 3 centimeters long was performed on each rat in sterile conditions. Uterine horns were exposed and a serosal injury was created on the antimesenteric side of right uterine horn having dimensions of 0,5x0,2 cm aquired with 250 watt powered unipolar electrocautery, 1 cm away from the uterine horn bifurcation. Silymarin was diluted in water and was applied to Group II (20 mg/kg Silymarin) and Group III (100 mg/kg Silymarin) with an oral feeding catheter for 14 days starting from the first operation day. Group I was defined as the control group. After 14 days from operation, a second laparotomy was performed to all groups. The adhesions were scored based on the Linsky's cinical adhesion score system. Biopsies were taken from injured tissues for histopathological study of adhesion formation, were dyed with hemotoxilene eosine and were evaluated for tissue fibroblastic activity, inflammatory cells, giant cells and vascular proliferation. The highest adhesion score was detected in the control group (3.25 +- 0.78) and the lowest was the group III (100 mg/kg Silymarin) (0.33 +- 0.49). Adhesion scores of Group II (20 mg/kg Silymarin) (p< 0.0001) and group III (100 mg/kg Silymarin) (p< 0.0001) had statistically significant difference between the control group (Group I). Similarly, statistically significant difference was detected between the adhesion scores of Group III and Group II (p< 0.0001). The highest pathological score was viewed in the control group (9.91 +- 4.07) and the lowest in Group III (2.08+-2.15). Group II (20 mg/kg Silymarin) and Group III (100 mg/kg Silymarin) had statistically significant difference of histopathological score when compared to the control group. Similarly, statistically significant difference was detected between the histopathological scores of Group III (100mg/kg Silymarin) and Group II (20 mg/kg Silymarin) (p.0.003). We evaluated the histopathological score system between the groups. The inflammatuary cell score of Group III had significant decrease compared to control group (p<0.0001) and Group II (p<0.0001). But difference hadn't detected between control group (Group I) and Group II (p.0,335). This result suggested that Silymarin leads a dose dependent decrease on inflammatuary cell score. High dose group (Grup III) (p<0.0001) and low dose group (Grup II) (p<0.0001) had significant decrease of fibroblastic activity compared with control group (Grup I). Similarly compared to high dose group and low dose group decrease had detected (p.0.004). This result suggested that Silymarin leads a high sensitive decrease on fibroblastic activity. High dose group (Grup III) (p<0.0001) and low dose group (Grup II) (p.0.005) had significant decrease of vasculary proliferation activity compared with control group. But the decrease was more significant for high dose group and difference hadn't detected between high dose and low dose group (p.0,947). High dose group (Grup III) had significant decrease of collagen formation activity compared with control group (p.0.001). But difference hadn't detected between low dose group (Grup II) and control group (p.0.906) and high dose group and low dose group (p.0.010). High dose group (Grup III) (p.0,032) and low dose group (Grup II) (p.1,000) hadn't lead significant decrease of giant cell score compared with control group. Similarly difference hadn't detected between high dose and low dose group (p.0.242). It's suggested that Silymarin has a potential to prevent postoperative adhesion formation as a new medical approach. But further studies need to evaluate the effects.