Effects of Ankaferd Blood Stopper® on Postoperative Intra-abdominal Adhesion Formation: Clinical, Histopathological, and Serological Evaluation in a Rat Model

There is a lack of data regarding plant-derived hemostatic agents for the prevention of clinically significant postoperative intra-abdominal adhesions. This experimental study investigated the effects of Ankaferd Blood Stopper® (ABS), a plant-based hemostatic agent composed of Thymus vulgaris , Glycyrrhiza glabra , Vitis vinifera , Alpinia officinarum , and Urtica dioica , on the prevention of postoperative intra-abdominal adhesions in a rat model. A total of 120 rats were randomly allocated into three surgical groups (laparotomy alone, laparotomy with cecal abrasion, and laparotomy with uterine horn suturing), each further subdivided according to intraperitoneal treatment (0.9% NaCl, ABS, untreated, or 4% icodextrin). Adhesion formation was evaluated macroscopically and microscopically 21 days postoperatively. Histopathological examination assessed fibroblastic activity, the degree of inflammatory cell infiltration, and vascular proliferation, while biochemical markers of adhesion pathophysiology were analyzed by ELISA. Macroscopically, according to the adhesion scoring system of Bothin et al. (2001) and Evans et al. (1993), a significant difference was observed between the groups that underwent laparotomy ( p =0.040, p =0.001), laparotomy + cecal abrasion ( p <0.001, p <0.001), and laparotomy + cornu uteri suturing ( p =0.002, p =0.001) in terms of intraabdominal adhesions. According to the Hooker et al. (1999) adhesion scoring system, a significant difference was observed between the laparotomy ( p <0.001, p <0.001, p <0.001, respectively), laparotomy + cecal abrasion ( p =0.001, p =0.008, p <0.001, respectively), and laparotomy + cornu uteri suturing ( p =0.010, p =0.001, p =0.001, respectively) groups in terms of microscopic fibrosis, inflammation, and neovascularization formation. Histopathological findings also revealed increased tissue damage and inflammatory response associated with ABS application. Our results suggested that ABS® is not effective in preventing postoperative intra-abdominal adhesions. Further research is warranted to elucidate the mechanisms underlying adhesion formation and to identify safe and effective preventive agents.