Effect of Malva sylvestris Extract on Postoperative Peritoneal Adhesion in Rats

Postoperative peritoneal adhesion occurs in more than 90% of intra-abdominal surgeries and can lead to intestinal obstruction, infertility, abdominal and pelvic pain. The extract of Malva sylvestris has shown to be safe and non-toxic with a wide range of biological activities. This study was designed to evaluate the effect of intraperitoneal nebulization of M. sylvestris in the healing process of postoperative intra-abdominal adhesion for the first time. For creating intra-abdominal adhesions, the rats were anesthetized to undergo surgery. Four lavage solutions including saline, ethanolic extract, hydroalcoholic extract, and aqueous extract of M. sylvestris were used for 2 min, and then the abdomen was closed. After 15 days, the rats underwent surgery and cecum and peritoneal samples were obtained for histopathological analysis. The severity of peritoneal adhesions based on the histopathological analysis and serum levels of TNF-α and Il-1β were compared in different groups. The aqueous and hydroalcoholic extracts of M. sylvestris decreased significantly microscopic and macroscopic peritoneal adhesion while the ethanolic extract just reduced it microscopically. The aqueous and hydroalcoholic extracts were more potent than the ethanolic extract in the healing process. The concentrations of inflammatory biomarkers including IL-1β and TNF-α did not change significantly. The extract of M. sylvestris could decrease the severity of peritoneal adhesion compared to the control group but it could not decrease the level of systemic inflammatory mediators.