Comparative Effects of Intraperitoneal Natural and Biological Agents on Postoperative Peritoneal Adhesion Formation: An Experimental Rat Study

Aim: Postoperative peritoneal adhesions are driven by inflammatory and oxidative pathways, and effective prevention remains challenging. This study evaluated the comparative effects of intraperitoneal natural and biological agents on adhesion formation in a rat model.Material and methods: Fifty-six male Wistar rats were randomly assigned to eight groups (n=7 per group). A standardized cecal abrasion model was used to induce adhesions. Treatment groups received intraperitoneal synovial fluid, honey, water-extracted propolis, vitamin E, olive oil, or vitamin E plus olive oil. The alcohol group was excluded due to early mortality. On postoperative day 14, adhesions were evaluated macroscopically (Nair score), histopathologically (fibrosis, inflammation, vascular proliferation), and biochemically (IL-6, glutathione, HSP-70).Results: Macroscopic adhesion scores differed significantly among groups (p<0.001), with the lowest scores observed in the vitamin E plus olive oil group and the highest in the propolis group. Vitamin E plus olive oil and olive oil alone significantly reduced adhesion compared with control and propolis (p<0.001). Fibrosis scores were significantly lower in the vitamin E group compared with propolis (p=0.040). IL-6 levels were lower in the honey and synovial fluid groups compared with propolis (p=0.001), while glutathione levels were higher in the synovial fluid group (p=0.031). HSP-70 levels were lower in the honey group compared with control (p=0.011).Conclusion: Vitamin E and olive oil, particularly in combination, were associated with the greatest reduction in macroscopic adhesion formation. Honey and synovial fluid demonstrated favorable anti-inflammatory and antioxidant profiles, whereas water-extracted propolis did not provide protective benefit. Further studies are required to clarify optimal dosing and translational applicability.