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Hoffmann H, Kirchhoff P. Adhesions After Laparoscopic IPOM-How Serious Is the Problem? JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2025; 4:14126. [PMID: 40206847 PMCID: PMC11978498 DOI: 10.3389/jaws.2025.14126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Accepted: 03/20/2025] [Indexed: 04/11/2025]
Abstract
Although laparoscopic IPOM is still the gold standard in ventral hernia repair, it is subject of a slow but constant decline, while new minimally invasive techniques are increasingly used, as well as open retromuscular repairs. One of the reasons are the intraperitoneal mesh position and its suspected higher risk for creating intraabdominal adhesions, compared to extraperitoneal mesh positions. In potential subsequent operations (e.g., in recurrent ventral hernia repair) adhesions usually must be taken down, which is a known risk factor for complications such as inadvertent enterotomies, surgical site infections and prolonged hospital stay. In this review we evaluate the incidence of intraabdominal adhesions after ventral hernia repair and their potential impact on surgical outcome in subsequent operations. Special attention is paid to the impact of mesh position in developing adhesions.
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Affiliation(s)
- Henry Hoffmann
- ZweiChirurgen GmbH, Center for Hernia Surgery and Proctology, Basel, Switzerland
- Faculty of Medicine, University Basel, Basel, Switzerland
- Merian Iselin Clinic, Clinic for Orthopedics and Surgery, Basel, Switzerland
| | - Philipp Kirchhoff
- ZweiChirurgen GmbH, Center for Hernia Surgery and Proctology, Basel, Switzerland
- Faculty of Medicine, University Basel, Basel, Switzerland
- Merian Iselin Clinic, Clinic for Orthopedics and Surgery, Basel, Switzerland
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Ma Y, Sun T, Ren K, Ma R, Min T, Wang X, Yuan Y, Xie X, Zhang B, Deng X, Peng Y, Liu Y, Nan Y, Wang W, Zhou Z, Xu G, Li K, Zhu K, Hao N, Dang C, Zhang G, Zhang H. Plasma-activated solutions prevent peritoneal adhesion formation by regulating eNOS expression in mesothelial cells. J Adv Res 2025:S2090-1232(25)00122-5. [PMID: 40020874 DOI: 10.1016/j.jare.2025.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Revised: 02/02/2025] [Accepted: 02/20/2025] [Indexed: 03/03/2025] Open
Abstract
INTRODUCTION Peritoneal adhesions cause significant morbidity due to limited therapeutic options. Current strategies are limited by inconsistent efficacy and potential side effects. Plasma-activated solutions (PAS) exhibit anti-inflammatory and healing promoting properties with good safety, their efficacy in preventing peritoneal adhesions remains further investigation. OBJECTIVES This study aimed to investigate the therapeutic potential of PAS in preventing peritoneal adhesion formation and to elucidate its mechanisms. METHODS Two murine peritoneal adhesion models ("ischemic button" and "cecum-peritoneum abrasion") were established. Human peritoneal mesothelial cell was treated with LPS or TGF-β1 to model apoptosis and mesothelial-to-mesenchymal transition (MMT) in vitro. Apoptosis was quantified via flow cytometry and western blotting; ROS levels were assessed using immunofluorescence staining. MMT markers (western blotting) and inflammatory cytokines (ELISA) were analyzed. Histological evaluation included Masson's trichrome and immunofluorescence staining. RESULTS PAS-2 min significantly reduced adhesion scores compared to PBS controls (ischemic button: 6.250 ± 1.389 vs. 2.5 ± 2.268; abrasion: 7.333 ± 1.033 vs. 1.633 ± 1.333, p < 0.01). In vitro, PAS treatment decreased LPS-induced apoptosis in mesothelial cells by 8.14 % (flow cytometry: 39.10 % ± 1.47 % vs. 30.96 % ± 1.73 %, p < 0.01) and suppressed MMT markers, with N-cadherin and Vimentin expression reduced by 1.46-fold (p < 0.05) and 1.62-fold (p < 0.05). PAS also attenuated oxidative stress, decreasing general ROS levels by 3-fold (p < 0.001) and mitochondrial ROS (mtROS) by 2-fold (p < 0.01). Mechanistically, reactive nitrogen species (RNS) in PAS restored eNOS expression, attenuating apoptosis and MMT in mesothelial cells. CONCLUSION This study demonstrates that PAS prevents peritoneal adhesions via RNS-mediated eNOS restoration, suppressing oxidative stress, apoptosis, and MMT. These findings position PAS as a novel and promising therapy for adhesion prevention, warranting clinical translation.
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Affiliation(s)
- Yuyi Ma
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Tuanhe Sun
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China; State Key Laboratory of Electrical Insulation and Power Equipment, School of Electrical Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China
| | - Kaijie Ren
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Rulan Ma
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Tianhao Min
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Xueni Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Yue Yuan
- Department of Hematology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Xin Xie
- Department of Nuclear Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Bo Zhang
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China; State Key Laboratory of Electrical Insulation and Power Equipment, School of Electrical Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China
| | - Xiaoyuan Deng
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Yuanchang Peng
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Yuanyuan Liu
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Yanglong Nan
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Wei Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Zhangjian Zhou
- Department of Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, China
| | - Guimin Xu
- State Key Laboratory of Electrical Insulation and Power Equipment, School of Electrical Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China
| | - Kang Li
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Kun Zhu
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Nan Hao
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Chengxue Dang
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Guanjun Zhang
- State Key Laboratory of Electrical Insulation and Power Equipment, School of Electrical Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China.
| | - Hao Zhang
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China.
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Alharbi RM, Almutairi AM, Alsharari KK, Almarwani WK, Hussamuldin AB, Alsaadi FM, Alhazmi WM. Awareness of Anti-adhesive Barriers Among Surgeons in Saudi Arabia. Cureus 2024; 16:e57942. [PMID: 38738085 PMCID: PMC11082479 DOI: 10.7759/cureus.57942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 05/14/2024] Open
Abstract
Introduction Post-operative adhesions present a number of difficulties, including intestinal obstruction and infertility, and they frequently require readmission due to adhesion-related problems. Notwithstanding these ramifications, there are surprisingly few thorough national surveys that address surgeons' awareness of adhesives. By assessing Saudi surgeons' knowledge of post-operative adhesions and their use of anti-adhesive medications, this study aims to close this knowledge gap. Methods This study is a cross-sectional observational research study aimed at Saudi Arabian surgeons utilizing a self-administered, semi-structured online questionnaire. The questionnaire was distributed to participants via social media and in-person email using basic random selection. It included adhesion morbidity and prevalence, pre-operative informed consent issues, adhesion preventive viewpoints, and anti-adhesive chemical use. Results There were 111 participants in total, of 41% were experienced surgeons with more than five years of experience. According to the survey, the majority of surgeons occasionally employed anti-adhesive compounds, especially during laparotomies (28%), and 38% never used them during laparoscopies. The study found that participants varied in what they informed patients regarding adhesion complications: 25% of participants informed 5%-10% of the patients about the possible adhesion complications in laparotomy procedures, whereas 26% of participants informed 10-25% of the patients in laparoscopic procedures. Compared with their specialist peers, general surgeons agreed more on the clinical significance of adhesions and prevention. Notably, three-quarters of participants were unclear about when to use anti-adhesive compounds. Conclusion While acknowledging the clinical significance of post-operative adhesions and recognizing the potential for prevention, most surveyed surgeons did not include adhesions as a post-operative complication in informed consent. The study underscores a belief in the efficacy of anti-adhesives yet reveals a widespread lack of clarity regarding specific indications for their use. Recommendations include implementing educational sessions during surgical training to heighten awareness of adhesions as a major post-operative complication and to encourage the appropriate utilization of available barriers and pharmacological anti-adhesive products.
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Affiliation(s)
| | | | | | - Wejdan K Almarwani
- College of Medicine, Jordan University of Science and Technology, Irbid, JOR
| | | | - Fahad M Alsaadi
- College of Medicine, Jordan University of Science and Technology, Irbid, JOR
| | - Wedyan M Alhazmi
- Department of General Surgery, King Fahad General Hospital, Jeddah, SAU
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Pawar A, Warikoo V, Salunke A, Sharma M, Pandya S, Bhardwaj A, KS S, Aaron J. Outcomes of minimal access cytoreductive surgery (M-CRS) and HIPEC/EPIC vs. open cytoreductive surgery (O-CRS) and HIPEC/EPIC in patients with peritoneal surface malignancies: a meta-analysis. Pleura Peritoneum 2024; 9:1-13. [PMID: 38558870 PMCID: PMC10980983 DOI: 10.1515/pp-2023-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/15/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Minimal Access Surgery (MAS) has shown better peri-operative outcomes with equivalent oncological outcomes in gastrointestinal and thoracic oncology. Open CRS (O-CRS) procedure accompanies inevitable and significant surgical morbidity in patients. The aim of the review article is to compare outcomes of M-CRS and HIPEC/EPIC with open procedure in peritoneal surface malignancies. Content Comprehensive search of databases was done and total 2,807 articles were found (2793-PubMed and 14-Cochrane review). PRISMA flow chart was prepared and 14 articles were selected. Meta-analysis was performed according to PRISMA guidelines using random-effects model (DerSimonian Laird) and fixed effect model. Publication bias was tested with Funnel plot and Egger's regression test. Quality of studies was assessed by Newcastle-Ottawa scale. Summary and Outlook Patients in both groups [total (732), M-CRS(319), O-CRS(413)] were similar in demographic characteristics. Peri-operative outcomes were significantly better in M-CRS group in terms of blood loss SMD=-2.379, p<0.001 (95 % CI -2.952 to -1.805), blood transfusion RR=0.598, p=0.011 (95 % CI 0.402 to 0.889), bowel recovery SMD=-0.843, p=0.01 (95 % CI -1.487 to -0.2), hospital stay SMD=-2.348, p<0.001 (95 % CI -3.178 to -1.519) and total morbidity RR=0.538, p<0.001 (95 % CI 0.395 to 0.731). Duration of surgery SMD=-0.0643 (95 % CI -0.993 to 0.865, p=0.892) and CC0 score RR=1.064 (95 % CI 0.992 to 1.140, p=0.083) had no significant difference. Limited studies which evaluated survival showed similar outcomes. This meta-analysis shows that M-CRS and HIPEC/EPIC is feasible and has better peri-operative outcomes compared to open procedure in patients with limited peritoneal carcinoma index (PCI) peritoneal surface malignancies. Survival outcomes were not calculated. Further studies are warranted in this regard.
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Affiliation(s)
- Ajinkya Pawar
- Department of Surgical Oncology, GCRI, Ahmedabad, India
| | - Vikas Warikoo
- Department of Surgical Oncology, GCRI, Ahmedabad, India
| | | | - Mohit Sharma
- Department of Surgical Oncology, GCRI, Ahmedabad, India
| | | | - Amol Bhardwaj
- Department of Surgical Oncology, GCRI, Ahmedabad, India
| | - Sandeep KS
- Department of Surgical Oncology, GCRI, Ahmedabad, India
| | - Jebin Aaron
- Department of Surgical Oncology, GCRI, Ahmedabad, India
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Krielen P, Kranenburg LP, Stommel MW, Bouvy ND, Tanis PJ, Willemsen JJ, Migchelbrink J, de Ree R, Bormans EM, van Goor H, ten Broek RP. Variation in the management of adhesive small bowel obstruction in the Netherlands: a prospective cross-sectional study. Int J Surg 2023; 109:2185-2195. [PMID: 37288588 PMCID: PMC10442142 DOI: 10.1097/js9.0000000000000471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/08/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND ASBO is a frequent abdominal surgical emergency and a leading cause of morbidity and mortality in emergency surgery. The aim of this study is to provide insight into the current management of adhesive small bowel obstruction (ASBO) and associated outcomes. METHODS AND MATERIALS A nationwide prospective cross-sectional cohort study was conducted. All patients with clinical signs of ASBO admitted to participating Dutch hospitals were included during a 6 months inclusion period between April 2019 and December 2020. Ninety-day clinical outcomes were described and compared for nonoperative management (NOM) and laparoscopic and open surgery. RESULTS In 34 participating hospitals, 510 patients were included, of whom 382 (74.9%) had a definitive diagnosis of ASBO. Initial management consisted of emergency surgery in 71 (18.6%) patients and NOM in 311 (81.4%) patients, 119 (31.1%) of whom required delayed surgery after failure of NOM. Surgical interventions started laparoscopically in 51.1%, of which 36.1% were converted to laparotomy. Intentional laparoscopy resulted in shorter hospital stays compared with open surgery (median 8.0 vs. 11.0 days; P <0.001) and comparable hospital mortality (5.2 vs. 4.3%; P =1.000). Oral water-soluble contrast use was associated with a decreased length of stay ( P =0.0001). Hospital stay for surgical patients was shorter in patients who were operated on within 72 h of admission ( P <0.001). CONCLUSION This nationwide cross-sectional study demonstrates shorter hospital stay in ASBO patients who received water-soluble contrast, were operated within 72 h of admission or were operated with minimally invasive techniques. Results may support the standardization of ASBO treatment.
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Affiliation(s)
- Pepijn Krielen
- Department of Surgery, Radboud University Medical Center
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen
| | | | | | - Nicole D. Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht
| | - Pieter J. Tanis
- Department of Surgery, Erasmus Medical Centre, Rotterdam
- Department of Surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | | | | | - Rick de Ree
- Department of Surgery, Radboud University Medical Center
| | | | - Harry van Goor
- Department of Surgery, Radboud University Medical Center
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Tazeoğlu D, Benli S, Tikici D, Esmer AC, Dirlik MM. Can minimally invasive surgical techniques reduce
the incidence of postoperative adhesions? POLISH JOURNAL OF SURGERY 2022; 94:23-30. [DOI: 10.5604/01.3001.0015.7342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<br><b>Introduction:</b> Postoperative intra-abdominal adhesions are a clinical condition that may develop after any abdominal surgery and constitute the leading cause of mechanical small bowel obstructions.</br>
<br><b>Aim:</b> This study investigates factors which influence the formation of postoperative adhesion and evaluates the efficiency of applying minimally invasive surgical techniques in reducing adhesion.</br>
<br><b>Material and methods:</b> Patients who underwent surgery to diagnose obstructive ileus in our clinic between January 2015 and January 2020 were analyzed retrospectively. Demographic data of the patients, operation details time between the operations and history of hospitalizations, postoperative mortality and morbidity, as well as the severity of complications were recorded. The patients included in the study were divided into groups according to the surgical technique applied in the first operation (laparoscopy/ laparotomy), the abdominal incision line (upper/lower/total), and the etiology of the primarily operated lesion (benign/malignant).</br>
<br><b>Results:</b> One hundred eighteen (118) patients were included in the study. The mean age of patients was 61.2 ± 10.8 (39–82) years. Age, ileus history, time to the onset of ileus, length of hospital stay and the number of complications were shorter in the laparoscopy group as compared to the laparotomy group and the difference was found to be statistically significant. In addition, when patients were categorized according to the abdominal incision line, fewer hospitalizations and more frequent postoperative complications due to ileus were observed in the sub-umbilical incision group (p < 0.05).</br>
<br><b>Conclusions:</b> Postoperative adhesion formation is currently one of the clinical conditions which pose a challenge to both the patient and the clinician due to its incidence and recurrence. However, adhesion formation can be reduced by applying minimally invasive surgical methods, especially laparoscopic surgery and precise maneuvers during surgery.</br>
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Affiliation(s)
- Deniz Tazeoğlu
- Department of General Surgery, Faculty of Medicine Mersin University, Mersin, Turkey
| | - Sami Benli
- Department of General Surgery, Faculty of Medicine Mersin University, Mersin, Turkey
| | - Deniz Tikici
- Department of General Surgery, Faculty of Medicine Mersin University, Mersin, Turkey
| | - Ahmet Cem Esmer
- Department of General Surgery, Faculty of Medicine Mersin University, Mersin, Turkey
| | - Mustafa Musa Dirlik
- Department of General Surgery, Faculty of Medicine Mersin University, Mersin, Turkey
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Chong Y, Koh YX, Teo JY, Cheow PC, Chow PK, Chung AY, Chan CY, Goh BKP. Impact of non-liver-related previous abdominal surgery on the difficulty of minimally invasive liver resections: a propensity score-matched controlled study. Surg Endosc 2022; 36:591-597. [PMID: 33569726 DOI: 10.1007/s00464-021-08321-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 01/09/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The presence of previous abdominal surgery (PAS) has traditionally been considered to add difficulty to and increase risk of complications of laparoscopic procedures. This study aims to analyse the impact of non-liver-related PAS on the difficulty of minimally invasive liver resections (MILRs). MATERIALS AND METHODS After exclusion of patients with concomitant major surgical procedures as well as previous liver resections, 515 consecutive patients undergoing MILR in Singapore General Hospital from 2006 to 2019 were analysed, consisting of 161 MILR in patients with previous abdominal surgery (WPAS) and 354 MILR in patients without previous abdominal surgery (WOPAS). Propensity score-matched (PSM) comparison was performed between WPAS and WOPAS groups. In addition, subgroup analysis was made comparing previous upper or lower abdominal surgery and open versus minimally invasive approach of PAS. Outcomes measured include those associated with operative difficulty such as open conversion rates, operative time, blood loss, as well as morbidity and mortality rates. RESULTS MILR outcomes in patients WPAS are not inferior to those WOPAS. Overall open conversion rate was 8.2%, higher in patients WOPAS compared to patients WPAS (11.9% versus 3.5%, p = 0.015). Operating time (p = 0.942), blood loss (p = 0.063), intraoperative blood transfusion (p = 0.750), length of hospital stay (p = 0.206), morbidity (p = 0.217) and 30- and 90-day mortality (p = 1 & p = 0.367) were comparable between the two groups and subgroup analysis. CONCLUSION Outcomes of MILR in patients with previous non-liver-related abdominal surgery are not inferior to patients without previous abdominal surgery.
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Affiliation(s)
- Yvette Chong
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Level 5, 20 College Road, Academia, Singapore, 169856, Singapore
| | - Ye-Xin Koh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Level 5, 20 College Road, Academia, Singapore, 169856, Singapore
| | - Jin-Yao Teo
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Level 5, 20 College Road, Academia, Singapore, 169856, Singapore
| | - Peng-Chung Cheow
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Level 5, 20 College Road, Academia, Singapore, 169856, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Pierce K Chow
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Level 5, 20 College Road, Academia, Singapore, 169856, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Alexander Y Chung
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Level 5, 20 College Road, Academia, Singapore, 169856, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Chung-Yip Chan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Level 5, 20 College Road, Academia, Singapore, 169856, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Level 5, 20 College Road, Academia, Singapore, 169856, Singapore.
- Duke-National University of Singapore Medical School, Singapore, Singapore.
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Zindel J, Mittner J, Bayer J, April-Monn SL, Kohler A, Nusse Y, Dosch M, Büchi I, Sanchez-Taltavull D, Dawson H, Gomez de Agüero M, Asahina K, Kubes P, Macpherson AJ, Stroka D, Candinas D. Intraperitoneal microbial contamination drives post-surgical peritoneal adhesions by mesothelial EGFR-signaling. Nat Commun 2021; 12:7316. [PMID: 34916513 PMCID: PMC8677808 DOI: 10.1038/s41467-021-27612-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/01/2021] [Indexed: 12/19/2022] Open
Abstract
Abdominal surgeries are lifesaving procedures but can be complicated by the formation of peritoneal adhesions, intra-abdominal scars that cause intestinal obstruction, pain, infertility, and significant health costs. Despite this burden, the mechanisms underlying adhesion formation remain unclear and no cure exists. Here, we show that contamination of gut microbes increases post-surgical adhesion formation. Using genetic lineage tracing we show that adhesion myofibroblasts arise from the mesothelium. This transformation is driven by epidermal growth factor receptor (EGFR) signaling. The EGFR ligands amphiregulin and heparin-binding epidermal growth factor, are sufficient to induce these changes. Correspondingly, EGFR inhibition leads to a significant reduction of adhesion formation in mice. Adhesions isolated from human patients are enriched in EGFR positive cells of mesothelial origin and human mesothelium shows an increase of mesothelial EGFR expression during bacterial peritonitis. In conclusion, bacterial contamination drives adhesion formation through mesothelial EGFR signaling. This mechanism may represent a therapeutic target for the prevention of adhesions after intra-abdominal surgery.
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Affiliation(s)
- Joel Zindel
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Department of Pharmacology and Physiology and Snyder Institute for Chronic Diseases and Department of Microbiology, Immunology & Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Jonas Mittner
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Julia Bayer
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon L April-Monn
- Clinical Pathology Division and Translational Research Unit, Institute of Pathology, University of Bern, Bern, Switzerland
| | - Andreas Kohler
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ysbrand Nusse
- Department of Pharmacology and Physiology and Snyder Institute for Chronic Diseases and Department of Microbiology, Immunology & Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michel Dosch
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Isabel Büchi
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Sanchez-Taltavull
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Heather Dawson
- Clinical Pathology Division and Translational Research Unit, Institute of Pathology, University of Bern, Bern, Switzerland
| | - Mercedes Gomez de Agüero
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kinji Asahina
- Southern California Research Center for Alcoholic Liver and Pancreatic Diseases and Cirrhosis and Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
- Central Research Laboratory, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Paul Kubes
- Department of Pharmacology and Physiology and Snyder Institute for Chronic Diseases and Department of Microbiology, Immunology & Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrew J Macpherson
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Deborah Stroka
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Wang SY, Yeh CN, Jan YY, Chen MF. Management of Gallstones and Acute Cholecystitis in Patients with Liver Cirrhosis: What Should We Consider When Performing Surgery? Gut Liver 2021; 15:517-527. [PMID: 32921635 PMCID: PMC8283297 DOI: 10.5009/gnl20052] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/19/2020] [Accepted: 07/27/2020] [Indexed: 02/06/2023] Open
Abstract
Acute cholecystitis and several gallbladder stone-related conditions, such as impacted common bile duct stones, cholangitis, and biliary pancreatitis, are common medical conditions in daily practice. An early cholecystectomy or drainage procedure with delayed cholecystectomy is the current standard of treatment based on published clinical guidelines. Cirrhosis is not only a condition of chronically impaired hepatic function but also has systemic effects in patients. In cirrhotic individuals, several predisposing factors, including changes in the bile acid composition, increased nucleation of bile, and decreased motility of the gallbladder, contribute to the formation of biliary stones and the possibility of symptomatic cholelithiasis, which is an indication for surgical treatment. In addition to these predisposing factors for cholelithiasis, systemic effects and local anatomic consequences related to cirrhosis lead to anesthesiologic risks and perioperative complications in cirrhotic patients. Therefore, the treatment of the aforementioned biliary conditions in cirrhotic patients has become a challenging issue. In this review, we focus on cholecystectomy for cirrhotic patients and summarize the surgical indications, risk stratification, surgical procedures, and surgical outcomes specific to cirrhotic patients with symptomatic cholelithiasis.
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Affiliation(s)
- Shang Yu Wang
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chun Nan Yeh
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yi Yin Jan
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Miin Fu Chen
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Effect of hyaluronate-based bioresorbable membrane (Seprafilm) on outcomes of abdominal surgery: a meta-analysis and trial sequential analysis of randomised controlled trials. Updates Surg 2021; 74:865-881. [PMID: 34148173 DOI: 10.1007/s13304-021-01117-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/14/2021] [Indexed: 01/18/2023]
Abstract
We aimed to evaluate comparative outcomes of abdominal surgery with and without hyaluronate-based bioresorbable membrane (Seprafilm).We conducted a systematic search of electronic databases and bibliographic reference lists with application of a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits. Small bowel obstruction, anastomotic leak, surgical site infections, ileus, and severity of adhesions were the evaluated outcome measures. Thirteen randomised controlled trials reporting a total of 3665 patients evaluating outcomes of abdominal surgeries with (n = 1800) or without (n = 1865) use of Seprafilm were identified. Use of Seprafilm was associated with significantly lower risk of small bowel obstruction (RR 0.53, 95% CI 0.38-0.73, P = 0.0001) but significantly higher rate of anastomotic leak (RR 1.85, 95% CI 1.15-3.00 P = 0.01). Moreover, while Seprafilm resulted in significantly more adhesions-free patients (RR 5.57, 95% CI 3.37-9.19, P < 0.0001) compared to no Seprafilm, its use was associated with significantly lower grade 2 (RR 0.57, 95% CI 0.35-0.95, P = 0.003) or 3 (RR 0.31, 95% CI 0.17-0.55, P < 0.0001) adhesions. There was no significant difference in surgical site infection (RR: 1.21, 95 CI 0.86-1.70, P = 0.28), intra-abdominal abscess (RR 1.46, 95 CI 0.92-2.32, P = 0.11) or paralytic ileus (RR 0.97, 95 CI 0.68-1.38, P = 0.87) between two groups. The trial sequential analysis demonstrated that the meta-analysis findings are conclusive. Our meta-analysis demonstrated that Seprafilm reduces the risk of small bowel obstruction and severity of adhesions after abdominal surgery. However, it may increase the risk of anastomotic leak. We recommend use of Seprafilm in any abdominal surgery which does not involve an anastomosis.
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11
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Groeneweg JW, Roze JF, Veldhuis WB, Ruurda JP, Gerestein CG, Zweemer RP. Robot-assisted laparoscopic debulking surgery for recurrent adult granulosa cell tumors. Gynecol Oncol Rep 2021; 37:100783. [PMID: 34041344 PMCID: PMC8141516 DOI: 10.1016/j.gore.2021.100783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/25/2021] [Accepted: 04/30/2021] [Indexed: 12/21/2022] Open
Abstract
Despite an often early diagnosis and effective initial surgical management, one third of adult granulosa cell tumors (aGCTs) eventually, and often repeatedly, recurs. Debulking surgery remains the preferred treatment modality for recurrent aGCT, although the risk of intraoperative complications increases with repeated laparotomy. Minimally invasive surgery may limit the risk of complications. We aim to share our initial experience with robotic debulking surgery for recurrent aGCT. Clinical and surgical data of patients with recurrent aGCT who underwent robotic cytoreductive surgery over a three-year period at a tertiary referral center were retrospectively collected and analyzed. Between 2017 and 2020, three patients underwent robotic debulking surgery for recurrent aGCT at our institution. Complete cytoreduction was achieved in all patients. No intraoperative or postoperative complications were reported. This small pilot series at a single academic institution suggests that robot-assisted laparoscopy may be feasible and safe in selected patients with recurrent aGCT. A minimally invasive approach could reduce the complexity of successive surgeries for aGCT relapse.
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Affiliation(s)
- Jolijn W Groeneweg
- Department of Gynecologic Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joline F Roze
- Department of Gynecologic Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Wouter B Veldhuis
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Cornelis G Gerestein
- Department of Gynecologic Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ronald P Zweemer
- Department of Gynecologic Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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12
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Shamir SK, Singh A, Mayhew PD, Runge JJ, Case JB, Steffey MA, Balsa IM, Culp WTN, Giuffrida MA, Kilkenny JJ, Zur Linden A. Evaluation of minimally invasive small intestinal exploration and targeted abdominal organ biopsy with use of a wound retraction device in dogs: 27 cases (2010-2017). J Am Vet Med Assoc 2020; 255:78-84. [PMID: 31194657 DOI: 10.2460/javma.255.1.78] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe surgical technique, biopsy sample quality, and short-term outcome of minimally invasive small intestinal exploration and targeted abdominal organ biopsy (MISIETB) with use of a wound retraction device (WRD) in dogs. ANIMALS 27 client-owned dogs that underwent MISIETB with a WRD at 1 of 4 academic veterinary hospitals between January 1, 2010, and May 1, 2017. PROCEDURES Medical records were retrospectively reviewed, and data collected included signalment; medical history; findings from physical, ultrasonographic, laparoscopic, cytologic, and histologic evaluations; surgical indications, procedures, duration, and complications; and short-term (14-day) outcomes. The Shapiro-Wilk test was used to evaluate the normality of continuous variables, and descriptive statistics were calculated for numeric variables. RESULTS Laparoscopic exploration was performed through a multicannulated single port (n = 18), multiple ports (5), or a single 6-mm cannula (4). Median length of the incision for WRD placement was 4 cm (interquartile [25th to 75th percentile] range, 3 to 6 cm). All biopsy samples obtained had sufficient diagnostic quality. The 2 most common histologic diagnoses were lymphoplasmacytic enteritis (n = 14) and intestinal lymphoma (5). Twenty-five of 27 (93%) dogs survived to hospital discharge, and 3 (12%) dogs had postsurgical abnormalities unrelated to surgical technique. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that MISIETB with WRD was an effective method for obtaining diagnostic biopsy samples of the stomach, small intestine, pancreas, liver, and mesenteric lymph nodes in dogs. Prospective comparison between MISIETB with WRD and traditional laparotomy for abdominal organ biopsy in dogs is warranted.
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13
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Li M, Tao Y, Shen S, Song L, Suo T, Liu H, Wang Y, Zhang D, Ni X, Liu H. Laparoscopic common bile duct exploration in patients with previous abdominal biliary tract operations. Surg Endosc 2020; 34:1551-1560. [PMID: 32072280 PMCID: PMC7093335 DOI: 10.1007/s00464-020-07429-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/10/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND A history of abdominal biliary tract surgery has been identified as a relative contraindication for laparoscopic common bile duct exploration (LCBDE), and there are very few reports about laparoscopic procedures in patients with a history of abdominal biliary tract surgery. METHODS We retrospectively reviewed the clinical outcomes of 227 consecutive patients with previous abdominal biliary tract operations at our institution between December 2013 and June 2019. A total of 110 consecutive patients underwent LCBDE, and 117 consecutive patients underwent open common bile duct exploration (OCBDE). Patient demographics and perioperative variables were compared between the two groups. RESULTS The LCBDE group performed significantly better than the OCBDE group with respect to estimated blood loss [30 (5-700) vs. 50 (10-1800) ml; p = 0.041], remnant common bile duct (CBD) stones (17 vs. 28%; p = 0.050), postoperative hospital stay [7 (3-78) vs. 8.5 (4.5-74) days; p = 0.041], and time to oral intake [2.5 (1-7) vs. 3 (2-24) days; p = 0.015]. There were no significant differences in the operation time [170 (60-480) vs. 180 (41-330) minutes; p = 0.067]. A total of 19 patients (17%) in the LCBDE group were converted to open surgery. According to Clavien's classification of complications, the LCBDE group had significantly fewer postoperative complications than the OCBDE group (40 vs. 57; p = 0.045). There was no mortality in either group. Multiple previous operations (≥ 2 times), a history of open surgery, and previous biliary tract surgery (including bile duct or gallbladder + bile duct other than cholecystectomy alone) were risk factors for postoperative adhesion (p = 0.000, p = 0.000, and p = 0.000, respectively). CONCLUSION LCBDE is ultimately the least invasive, safest, and the most effective treatment option for patients with previous abdominal biliary tract operations and is especially suitable for those with a history of cholecystectomy, few previous operations (< 2 times), or a history of laparoscopic surgery.
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Affiliation(s)
- Min Li
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180, Fenglin Road, Shanghai, 200032, China
| | - Ying Tao
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180, Fenglin Road, Shanghai, 200032, China
| | - Sheng Shen
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180, Fenglin Road, Shanghai, 200032, China
| | - Lujun Song
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180, Fenglin Road, Shanghai, 200032, China
| | - Tao Suo
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180, Fenglin Road, Shanghai, 200032, China
| | - Han Liu
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180, Fenglin Road, Shanghai, 200032, China
| | - Yueqi Wang
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180, Fenglin Road, Shanghai, 200032, China
| | - Dexiang Zhang
- Department of General Surgery, Xuhui Central Hospital, Shanghai, 200031, China
| | - Xiaoling Ni
- Department of General Surgery, Xuhui Central Hospital, Shanghai, 200031, China
| | - Houbao Liu
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180, Fenglin Road, Shanghai, 200032, China.
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Wang J, Le K, Guo X, Yan F, Guo Y, Zhang T, Ren Y, Zhang J, Zhu B. Platelet-rich fibrin prevents postoperative intestinal adhesion. J Biomed Mater Res A 2020; 108:1077-1085. [PMID: 31943765 DOI: 10.1002/jbm.a.36883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/31/2022]
Abstract
Platelet-rich fibrin (PRF) was prepared from the blood of BALB/C inbred mice to explore potential effects on postoperative intestinal adhesion. A murine model of intestinal adhesion characterized by abdominal wall defect/and cecum damage was established by scraping caecum serosa and cutting peritoneum and muscles in the abdominal wall. The wound was covered with PRF (group A), sodium hyaluronate (group B), or left alone (blank control; group C). All animals were monitored for 28 days. The incidence of adhesion was 35.0, 66.7, and 73.7% in groups A, B, and C, respectively. The incidence of adhesion in group A was significantly lower than that in group C (p < .05). Histopathologically, severity of fibrosis and the number of fibroblasts or inflammatory cells in group A were lower than those in groups B and C (p < .05), whereas the number of mesothelial cells was higher (p = .001). Furthermore, the severity of fibrosis and number of fibroblasts or inflammatory cells were lower in low grade than those in high grade of adhesion (p < .05), whereas the number of mesothelial cells was higher (p < .05). Collectively, PRF applied to abdominal surgery may reduce the incidence of intestinal adhesion by promoting proliferation of mesothelial cells whereas inhibiting proliferation of fibroblasts and infiltration of inflammatory cells.
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Affiliation(s)
- Jia Wang
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Kai Le
- Department of General Surgery, Beijing Shijitan Hospital, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Xu Guo
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Fengcai Yan
- Department of Pathology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yifan Guo
- Department of General Surgery, Beijing Shijitan Hospital, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Tao Zhang
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yu Ren
- Department of Breast Surgery, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Jianlu Zhang
- Department of General Surgery, Beijing Shijitan Hospital, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Bin Zhu
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Enhanced postoperative recovery with minimally invasive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal surface malignancies of gastrointestinal origin. Surg Oncol 2019; 33:38-42. [PMID: 32561097 DOI: 10.1016/j.suronc.2019.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/23/2019] [Accepted: 12/18/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are the treatment of choice for select patients with peritoneal surface malignancies; however, the traditional open approach may be associated with significant morbidity. We evaluated postoperative outcomes with minimally invasive (MI) CRS and HIPEC. METHODS Review of our institutional database identified 47 patients who underwent optimal cytoreduction (CC0 or CC1). Those with a PCI ≤ 15 and primary malignancy of gastrointestinal origin were then selected for subgroup analysis. Multivariable regression was performed to identify factors impacting postoperative outcomes. RESULTS Demographic data did not significantly differ between open (n = 24) and minimally invasive (n = 9) groups. The MI group had a mean age of 57.34 ± 14.92, BMI of 27.03 ± 4.27, Charlson comorbidity score of 1.78 ± 1.72, and PCI of 5.56 ± 5.08. Mean time to flatus (days) was 2.78 in the MI group and 5.04 in the open group (p < 0.001), and mean length of IV analgesic use (days) was 3.11 in the MI group compared to 6.00 in the open group (p = 0.006). Mean length of stay (days) was 5.11 in the MI group and 8.67 in the open group (p = 0.033). Surgical approach (p = 0.037) and BMI (p = 0.039) were the only factors impacting length of stay. CONCLUSIONS Minimally invasive CRS and HIPEC is an excellent option for low volume peritoneal disease of gastrointestinal origin. A minimally invasive approach yields faster return of bowel function, reduced postoperative analgesia requirements, and shorter hospital stay.
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Norrbom C, Steding-Jessen M, Agger CT, Osler M, Krabbe-Sorensen M, Settnes A, Nilas L, Loekkegaard ECL. Risk of adhesive bowel obstruction after abdominal surgery. A national cohort study of 665,423 Danish women. Am J Surg 2018; 217:694-703. [PMID: 30420091 DOI: 10.1016/j.amjsurg.2018.10.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/01/2018] [Accepted: 10/12/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Adhesive bowel obstruction is associated with considerable morbidity and mortality, but the magnitude of the risk is debated. METHOD In a national cohort of all Danish women with an abdominal operation (N = 665,423) between 1977 and 2013, the risk of adhesive bowel obstruction was assessed by Cox multiple regression. Covariates were the number of abdominal operations, the surgical methods, the anatomical site involved, and the calendar year. RESULTS In the cohort, 1.4% experienced an episode of adhesive bowel obstruction. The risk increased 33-43% during the study period, was lower after gynecological and obstetrical procedures compared to gastrointestinal (HR 0.36 [0.34-0.38]), lower after laparoscopic compared to laparotomic surgery (HR 0.51 [0.48-0.54]) and increased proportionally after each additional operation. CONCLUSIONS The risk of adhesive bowel obstruction after abdominal operations depends on the site of earlier operations, the method of access and the number of earlier operations.
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Affiliation(s)
- Christina Norrbom
- Department of Obstetrics and Gynecology, North Zealand Hospital Hilleroed, Dyrehavevej 29, 3400, Hilleroed, Denmark.
| | - Marianne Steding-Jessen
- The Danish Clinical Registries, Department. for Cancer and Cancer Screening, Central Region of Denmark, Frederiksberg Hospital, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark.
| | - Carsten Thye Agger
- Center for Clinical Research and Disease Prevention, Frederiksberg and Bispebjerg Hospitals, Denmark, Hovedvejen, indgang 5, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark.
| | - Merete Osler
- Center for Clinical Research and Disease Prevention, Frederiksberg and Bispebjerg Hospitals, Denmark, Hovedvejen, indgang 5, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark; Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Postboks 2099, 1014, København K, Denmark.
| | - Marie Krabbe-Sorensen
- Stork Fertility Clinique, Copenhagen, Store Kongensgade 40H, 1. sal, 1264, København K, Denmark.
| | - Annette Settnes
- Department of Obstetrics and Gynecology, North Zealand Hospital Hilleroed, Dyrehavevej 29, 3400, Hilleroed, Denmark.
| | - Lisbeth Nilas
- Gynecological Department, Hvidovre Hospital, Denmark
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Han WH, Eom BW, Yoon HM, Kim YW, Ryu KW. Clinical characteristics and surgical outcomes of internal hernia after gastrectomy in gastric cancer patients: retrospective case control study. Surg Endosc 2018; 33:2873-2879. [PMID: 30421082 DOI: 10.1007/s00464-018-6584-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 11/07/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although the internal hernia is rare after gastric cancer surgery, it is a serious complication, and prompt surgical treatment is essential. However, internal hernia has not been studied because of low incidence and difficulty of diagnosis. This study investigated the clinical characteristics and proper management of internal hernia after gastrectomy. METHODS From June 2001 to June 2016, patients who underwent gastrectomy, either open or laparoscopic (robotic) surgery, with potential internal hernia defect were enrolled. The hernia defect was not closed in any of the enrolled patients. The clinicopathological data of internal hernia patients were compared to patients without internal hernia to identify risk factors. Surgical outcomes of internal hernia were compared between patients who underwent early and late intervention group according to time interval from symptom onset to operation. RESULTS Of 5777 patients who underwent gastrectomy with possible internal hernia, 24 (0.4%) underwent emergency or scheduled surgery for internal hernia. Internal hernia through the Petersen space was observed in 15 cases, and through the jejunojejunostomy mesenteric defect in 9 cases. Low body mass index (odds ratio [OR] 4.403, p = 0.003) and laparoscopic approach (OR 6.930 p < 0.001) were statistically significant factors in multivariate analysis. Postoperative complication rate (16.7% vs. 50% p = 0.083) and mortality rate (8.3% vs. 25.0% p = 0.273) were slightly higher in the late intervention group. CONCLUSIONS Although internal hernia is a rare complication, it is difficult to diagnose and cause serious complications. To prevent internal hernia, the necessity of hernia defect closure should be investigated in the further studies. Early surgical treatment is necessary when it is suspected.
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Affiliation(s)
- Won Ho Han
- Center for Gastric Cancer, National Cancer Center, Goyang, 410-769, Republic of Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, National Cancer Center, Goyang, 410-769, Republic of Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, National Cancer Center, Goyang, 410-769, Republic of Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, 410-769, Republic of Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Goyang, 410-769, Republic of Korea.
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 410-769, Republic of Korea.
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Sebastian A, Stupart D, Watters DA. Loop ileostomy reversal after laparoscopic versus open rectal resection. ANZ J Surg 2018; 89:E52-E55. [DOI: 10.1111/ans.14879] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 08/23/2018] [Accepted: 08/25/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Arie Sebastian
- Department of Surgery; University Hospital Geelong; Geelong Victoria Australia
| | - Douglas Stupart
- Department of Surgery; University Hospital Geelong; Geelong Victoria Australia
- Department of Surgery, Deakin University; Geelong Victoria Australia
| | - David A. Watters
- Department of Surgery; University Hospital Geelong; Geelong Victoria Australia
- Department of Surgery, Deakin University; Geelong Victoria Australia
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Baron J, Giuffrida M, Mayhew PD, Singh A, Case JB, Culp WTN, Holt DE, Mayhew KN, Runge JJ. Minimally invasive small intestinal exploration and targeted abdominal organ biopsy with a wound retraction device in 42 cats (2005-2015). Vet Surg 2017; 46:925-932. [DOI: 10.1111/vsu.12693] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/07/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Jessica Baron
- Department of Surgery, Cummings School of Veterinary Medicine; Tufts University; North Grafton Massachusetts
| | - Michelle Giuffrida
- Department of Surgical and Radiological Sciences; University of California-Davis; Davis California
| | - Philipp D. Mayhew
- Department of Surgical and Radiological Sciences; University of California-Davis; Davis California
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College; University of Guelph; Guelph, Ontario Canada
| | - J. Brad Case
- Department of Small Animal Clinical Sciences; Small Animal Hospital at the University of Florida; Gainesville Florida
| | - William T. N. Culp
- Department of Surgical and Radiological Sciences; University of California-Davis; Davis California
| | - David E. Holt
- Department of Clinical Studies, Section of Surgery Veterinary Hospital; University of Pennsylvania; Philadelphia Pennsylvania
| | | | - Jeffrey J. Runge
- Department of Clinical Studies, Section of Surgery Veterinary Hospital; University of Pennsylvania; Philadelphia Pennsylvania
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Ouellet S, Sabbagh R, Jeldres C. Transperitoneal laparoscopic nephrectomy: Assessing complication risk in cases of previous abdominal surgery. Can Urol Assoc J 2017; 11:131-135. [PMID: 28515813 DOI: 10.5489/cuaj.4107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION We aimed to assess the effect of previous abdominal surgery on perioperative outcomes in patients undergoing transperitoneal laparoscopic partial (LPN) or radical (LRN) nephrectomy for renal masses. METHODS We retrospectively reviewed all cases of LPN and LRN for renal masses at our institution between 2008 and 2014. Patients were divided in two groups, those with and without prior abdominal surgery. Four perioperative outcomes were compared, namely, operative time (OT), estimated blood loss (EBL), length of stay (LOS), and 30-days complications rate. A subanalysis was performed to address the impact of previous open cholecystectomy on right LPN or LRN. RESULTS Of 293 patients identified, 146 (49.8%) had previous abdominal surgery. In univariate analysis, no differences in operative time (136 vs. 144 minutes; p=0.154), EBL (88 vs. 100 mL; p=0.211), or 30-day complication rate (24 vs. 14%; p=0.069) were recorded between the groups. Only LOS favoured patients without previous abdominal surgery (3 vs. 4 days; p=0.001). In multivariate analysis, prior abdominal surgery was not associated with an increased OT, EBL, LOS, or complication rate. The analysis of right nephrectomies showed increased OT (148 vs. 128 minutes; p=0.049) and complication rate (42 vs. 16%; p=0.004) for patients with past open cholecystectomy compared to those without. Multivariate analysis revealed that prior open cholecystectomy was associated with a longer LOS (ORmedian=2.7 [1.2-8.0]) and an increased risk of complications (ORmedian=4.5 [1.6-10.5]). CONCLUSIONS In this cohort, previous abdominal surgery was not associated with worse perioperative outcomes after transperitoneal LPN and LRN for renal masses. However, previous open cholecystectomy resulted in a higher risk of complication and a longer LOS in patients undergoing right laparoscopic nephrectomy.
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Affiliation(s)
- Simon Ouellet
- Division of Urology, Departments of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Robert Sabbagh
- Division of Urology, Departments of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Claudio Jeldres
- Division of Urology, Departments of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada
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Liu K, Chen Y, Wu X, Huang Z, Lin Z, Jiang J, Tan W, Zhang L. Laparoscopic liver re-resection is feasible for patients with posthepatectomy hepatocellular carcinoma recurrence: a propensity score matching study. Surg Endosc 2017; 31:4790-4798. [DOI: 10.1007/s00464-017-5556-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 04/01/2017] [Indexed: 12/28/2022]
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Wu BY, Gu C, Yan XY, Yu HY, You Z, Wang H, Wen LC, Ren JZ, Zhang YT. Clinical Treatment and Analysis of Laparoscopic Enterolysis Surgery. Indian J Surg 2016; 77:698-702. [PMID: 26730092 DOI: 10.1007/s12262-013-0991-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 10/07/2013] [Indexed: 10/26/2022] Open
Abstract
This work aims to explore the application value and clinical efficacy of laparoscopic enterolysis surgery for the treatment of adhesive intestinal obstruction. A total of 126 inpatient cases of intestinal adhesion were selected. In order to observe the effects and complications of surgery, the patients were randomly assigned into laparoscopic and laparotomy groups, with 63 cases in each group. The operative time, blood loss, postoperative ambulation time, exhaustion time, postoperative analgesia number of patients, and hospital days of the patients in the laparoscopic group were compared with those in the control group, and the differences were all statistically significant (p < 0.05). In the laparoscopy group, two patients experienced rupture of the small intestine during the surgery, but recovered well after endoscopic suture repair, although there was one case of postoperative pulmonary infection. The difference was statistically significant in the laparotomy group of patients, with one case of intestinal fistula, two cases of surgical wound infection, one case of incisional hernia, three cases of postoperative pulmonary infection, and one case of urinary tract infection. Compared with laparotomy, laparoscopic enterolysis surgery has shorter operative time, less blood loss, faster postoperative recovery, and fewer complications.
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Affiliation(s)
- Bao-Yin Wu
- Department of General Surgery, Liangxiang Hospital of Fangshan District of Beijing, No. 45, Liangxiang, Gongchen North Street, Fangshan District, Beijing, 102401 China
| | - Chao Gu
- Department of General Surgery, Jinshan Hospital, Fudan University, Shanghai, 201508 China
| | - Xiu-Yun Yan
- Department of Oncology, Liangxiang Hospital of Fangshan District of Beijing, Beijing, 102401 China
| | - Hai-Yang Yu
- Department of General Surgery, Liangxiang Hospital of Fangshan District of Beijing, No. 45, Liangxiang, Gongchen North Street, Fangshan District, Beijing, 102401 China
| | - Zhen You
- Department of General Surgery, Liangxiang Hospital of Fangshan District of Beijing, No. 45, Liangxiang, Gongchen North Street, Fangshan District, Beijing, 102401 China
| | - Hao Wang
- Department of General Surgery, Liangxiang Hospital of Fangshan District of Beijing, No. 45, Liangxiang, Gongchen North Street, Fangshan District, Beijing, 102401 China
| | - Li-Chao Wen
- Department of General Surgery, Liangxiang Hospital of Fangshan District of Beijing, No. 45, Liangxiang, Gongchen North Street, Fangshan District, Beijing, 102401 China
| | - Ji-Zong Ren
- Department of General Surgery, Liangxiang Hospital of Fangshan District of Beijing, No. 45, Liangxiang, Gongchen North Street, Fangshan District, Beijing, 102401 China
| | - Yu-Tie Zhang
- Department of General Surgery, Liangxiang Hospital of Fangshan District of Beijing, No. 45, Liangxiang, Gongchen North Street, Fangshan District, Beijing, 102401 China
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Kössi J. The Extent and Severity of Adhesions Are Reduced After Major Laparoscopic Colorectal Surgery: A Pilot Study. J Laparoendosc Adv Surg Tech A 2016; 26:6-10. [PMID: 26566012 DOI: 10.1089/lap.2015.0165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Jyrki Kössi
- Departments of Surgery, Kanta-Häme Central Hospital, Päijät-Häme Central Hospital, and University of Turku, Hämeenlinna, Finland
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Zago M, Mariani D, Kurihara H, Baiocchi G, Vettoretto N, Bergamini C, Campanile FC, Agresta F. Laparoscopy in Small Bowel Obstruction. EMERGENCY LAPAROSCOPY 2016:117-135. [DOI: 10.1007/978-3-319-29620-3_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Jafari MD, Jafari F, Foe-Paker JE, Phelan MJ, Carmichael JC, Pigazzi A, Mills S, Stamos MJ. Adhesive Small Bowel Obstruction in the United States: Has Laparoscopy Made an Impact? Am Surg 2015. [DOI: 10.1177/000313481508101023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Adhesions account for 74 per cent of admissions for small bowel obstruction (SBO). There is a lack of data regarding the usage and outcomes of laparoscopy (LS) for SBO. A retrospective review of urgent admissions for SBO using the Nationwide Inpatient Sample 2001 to 2011 was conducted. Among the estimated 3,948,987 SBO admissions, 36.7 per cent underwent operative management and LS was performed in 26.5 per cent with a 22.5 per cent conversion rate. Admissions increased by 3.1 per cent annually, whereas nonoperative management increased by 3.8 per cent annually. Operative management increased by 1.8 per cent annually, whereas LS increased by 8.9 per cent annually and open surgery decreased by 0.6 per cent annually. LS small bowel resection increased by a mean of 25 per cent annually. LS was associated with a 24.4 per cent in-hospital morbidity with intra-abdominal abscess/enteric fistulas (8.3%) and ileus (8.9%) as the most common complications. In-hospital mortality was 0.9 per cent with length of stay of 13 ± 9 days and a hospital charge of $80,080 ± 6,634. The majority of patients were operated on hospital day (HD) 1 (43.0%). Patients who underwent LS on HD >7 had a higher risk-adjusted mortality compared with earlier HD (odds ratio = 2.63; 95% confidence interval: 2.40–2.89; P < 0.01). There has been an increase in admissions for SBO and an increase in LS over the past 11 years. There seems to be an increase in mortality and morbidity with a later HD operation.
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Affiliation(s)
- Mehraneh D. Jafari
- Department of Surgery, University of California, Irvine, Orange, California
| | - Fariba Jafari
- Department of Surgery, University of California, Irvine, Orange, California
| | | | - Michael J. Phelan
- Department of Surgery, University of California, Irvine, Orange, California
| | | | - Alessio Pigazzi
- Department of Surgery, University of California, Irvine, Orange, California
| | - Steven Mills
- Department of Surgery, University of California, Irvine, Orange, California
| | - Michael J. Stamos
- Department of Surgery, University of California, Irvine, Orange, California
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Correa-Rovelo JM, Villanueva-López GC, Medina-Santillan R, Carrillo-Esper R, Díaz-Girón-Gidi A. [Intestinal obstruction secondary to postoperative adhesion formation in abdominal surgery. Review]. CIR CIR 2015; 83:345-51. [PMID: 26116038 DOI: 10.1016/j.circir.2015.05.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 07/03/2014] [Indexed: 01/09/2023]
Abstract
The development of intestinal obstruction after upper and lower abdominal surgery is part of the daily life of each every surgeon. Despite this, there are very few good quality studies that allow enable assessment of the frequency of intestinal obstruction to be assessed, even although postoperative adhesions are the cause of considerable direct and indirect morbidity and its prevention can be considered a public health problem. And yet, in Mexico, at this time, there is no validated recommendation validated on the prevention of adhesions, or more particularly, in connection with the use of a variety of anti-adhesion commercial products which have been marketed for at least a decade. Intraperitoneal adhesions develop between surfaces without peritoneum of the abdominal organs, mesentery, and abdominal wall. The most common site of adhesions is between the greater omentum and anterior abdominal wall previous. Despite the frequency of adhesions and their direct and indirect consequences, just there is only one published a recommendation (from gynaecological literature), regarding peritoneal adhesion prevention. As regards of colorectal surgery, performed more than 250,000 colorectal resections are performed annually in the United States, and from 24% to 35% of them will develop a complication. The clinical and economic financial burden of these complications is enormous, and surgeries colorectal surgery been specifically highlighted as a potential point prevention point of surgical morbidity.
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Affiliation(s)
| | | | - Roberto Medina-Santillan
- Departamento de Investigación y Posgrado, Escuela Superior de Medicina IPN, México, D.F., México
| | - Raúl Carrillo-Esper
- Unidad de Cuidados Intensivos, Hospital y Fundación Clinica Médica Sur, México, D.F., México
| | - Alejandro Díaz-Girón-Gidi
- Residente de Cirugía Genral, Facultad Mexicana de Medicina, Universidad La Salle, México, D.F., México
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Inagaki NF, Inagaki FF, Kokudo N, Miyajima A. Cell-based therapy for preventing postoperative adhesion and promoting regeneration after hepatectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2015; 22:524-30. [PMID: 25877017 DOI: 10.1002/jhbp.247] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 03/12/2015] [Indexed: 12/31/2022]
Abstract
Postoperative adhesion is a critical clinical issue after almost all abdominal or pelvic surgeries including liver surgery. Postoperative adhesion causes several complications, such as small bowel obstruction and chronic abdominal pain. Furthermore, it makes reoperation much more difficult, leading to increased mortality and morbidity rate. Postoperative adhesion is particularly problematic for repeated hepatectomy, since hepatic malignant neoplasm recurs frequently and repeated hepatectomy is widely used as one of the most curative treatments. Several treatments to reduce postoperative adhesion have been developed, which include laparoscopic surgery, administration of pharmacological agents and use of prophylactic barrier materials. However, none of them are optimal. We have proposed a novel treatment using a cell sheet of fetal liver mesothelial cells (FL-MCs) to prevent postoperative adhesion in a novel mouse model. Besides adhesion, repeated hepatectomy has another serious problem; although the liver has a remarkable ability to regenerate, the recovery of liver mass and function of the remnant liver after multiple repeated hepatectomy is limited. The FL-MC cell sheet enhances proliferation of hepatocytes after hepatectomy by providing growth factors for hepatocytes. Thus the FL-MC sheet could simultaneously solve the two problems associated with repeated hepatectomy.
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Affiliation(s)
- Natsuko F Inagaki
- Institute of Molecular and Cellular Biosciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo, 113-0032, Japan
| | - Fuyuki F Inagaki
- Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Atsushi Miyajima
- Institute of Molecular and Cellular Biosciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo, 113-0032, Japan.
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Berdah SV, Mariette C, Denet C, Panis Y, Laurent C, Cotte E, Huten N, Le Peillet Feuillet E, Duron JJ. A multicentre, randomised, controlled trial to assess the safety, ease of use, and reliability of hyaluronic acid/carboxymethylcellulose powder adhesion barrier versus no barrier in colorectal laparoscopic surgery. Trials 2014; 15:413. [PMID: 25348087 PMCID: PMC4233044 DOI: 10.1186/1745-6215-15-413] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 10/08/2014] [Indexed: 01/21/2023] Open
Abstract
Background Intra-peritoneal adhesions are frequent following abdominal surgery and are the most common cause of small bowel obstructions. A hyaluronic acid/carboxymethylcellulose (HA/CMC) film adhesion barrier has been shown to reduce adhesion formation in abdominal surgery. An HA/CMC powder formulation was developed for application during laparoscopic procedures. Methods This was an exploratory, prospective, randomised, single-blind, parallel-group, Phase IIIb, multicentre study conducted at 15 hospitals in France to assess the safety of HA/CMC powder versus no adhesion barrier following laparoscopic colorectal surgery. Subjects ≥18 years of age who were scheduled for colorectal laparoscopy (Mangram contamination class I‒III) within 8 weeks of selection were eligible, regardless of aetiology. Participants were randomised 1:1 to the HA/CMC powder or no adhesion barrier group using a centralised randomisation list. Patients assigned to HA/CMC powder received a single application of 1 to 10 g on adhesion-prone areas. In the no adhesion barrier group, no adhesion barrier or placebo was applied. The primary safety assessments were the incidence of adverse events, serious adverse events, and surgical site infections (SSIs) for 30 days following surgery. Between-group comparisons were made using Fisher’s exact test. Results Of those randomised to the HA/CMC powder (n = 105) or no adhesion barrier (n = 104) groups, one patient in each group discontinued prior to the study end (one death in each group). Adverse events were more frequent in the HA/CMC powder group versus the no adhesion barrier group (63% vs. 39%; P <0.001), as were serious adverse events (28% vs. 11%; P <0.001). There were no statistically significant differences between the HA/CMC powder group and the no adhesion barrier group in SSIs (21% vs. 14%; P = 0.216) and serious SSIs (12% vs. 9%; P = 0.38), or in the most frequent serious SSIs of pelvic abscess (5% and 2%; significance not tested), anastomotic fistula (3% and 4%), and peritonitis (2% and 3%). Conclusions This exploratory study found significantly higher rates of adverse events and serious adverse events in the HA/CMC powder group compared with the no adhesion barrier group in laparoscopic colorectal resection. Trial registration ClinicalTrials.gov NCT00813397. Registered 19 December 2008.
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Affiliation(s)
- Stéphane V Berdah
- Chirurgie Digestive, Hôpital Nord, CERC (Centre d'Enseignement et de Recherche Chirurgical), Aix-Marseille Université, Chemin des Bourrellys, 13915 Marseille, Cedex 20, France.
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Laparoscopic versus open Ladd's procedure for intestinal malrotation in adults. Surg Endosc 2014; 29:1598-604. [PMID: 25294535 DOI: 10.1007/s00464-014-3849-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/15/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Intestinal malrotation results from errors in fetal intestinal rotation and fixation. While most patients are diagnosed in childhood, some present as adults. Laparoscopic Ladd's procedure is an accepted alternative to laparotomy in children but has not been well-studied in adults. This study was designed to investigate outcomes for adults undergoing laparoscopic Ladd's repair for malrotation. METHODS We performed a single-institution retrospective chart review over 11 years. Data collected included patient age, details of pre-operative work-up and diagnosis, surgical management, complications, rates of re-operation, and symptom resolution. Patients were evaluated on an intent-to-treat basis based on their planned operative approach. Categorical data were analyzed using Fisher's exact test. Continuous data were analyzed using Student's t test. RESULTS Twenty-two patients were identified (age range 18-63). Fifteen were diagnosed pre-operatively; of the remaining seven patients, four received an intra-operative malrotation diagnosis during elective surgery for another problem. Most had some type of pre-operative imaging, with computed tomography being the most common (77.3 %). Comparing patients on an intent-to-treat basis, the two groups were similar with respect to age, operative time, and estimated blood loss. Six patients underwent successful laparoscopic repair; three began laparoscopically but were converted to laparotomy. There was a statistically significant difference in hospital length of stay (LOS) (5.0 ± 2.5 days vs 11.6 ± 8.1 days, p = 0.0148) favoring the laparoscopic approach. Three patients required re-operation: two underwent side-to-side duodeno-duodenostomy and one underwent a re-do Ladd's procedure. Ultimately, three (two laparoscopic, one open) had persistent symptoms of bloating (n = 2), constipation (n = 2), and/or pain (n = 1). CONCLUSION Laparoscopic repair appears to be safe and effective in adults. While a small sample size limits the power of this study, we found a statistically significant decrease in LOS and a trend toward decreased postoperative nasogastric decompression. There were no significant differences in complication rates, re-operation, or persistence of symptoms between groups.
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Trigui A, Frikha F, Rejab H, Ben Ameur H, Triki H, Ben Amar M, Mzali R. Ileal pouch-anal anastomosis: Points of controversy. J Visc Surg 2014; 151:281-8. [PMID: 24999229 DOI: 10.1016/j.jviscsurg.2014.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Restorative proctocolectomy with ileal pouch-anal anastomosis has become the most commonly used procedure for elective treatment of patients with ulcerative colitis and familial adenomatous polyposis. Since its original description, the procedure has been modified in order to obtain optimal functional results with low morbidity and mortality, and yet provide a cure for the disease. In this review of the literature of restorative proctocolectomy with ileal pouch-anal anastomosis, we discuss these technical modifications, limiting our discussion to the current points of controversy. The current "hot topics" for debate are: indications for ileal pouch-anal or ileo-rectal anastomosis, indications for pouch surgery in the elderly, indeterminate colitis and Crohn's disease, the place of the laparoscopic approach, transanal mucosectomy with hand-sewn anastomosis vs. the double-stapled technique, the use of diverting ileostomy and the issue of the best route for delivery of pregnant women. Longer follow-up of patients and increased knowledge and experience with pouch surgery, coupled with ongoing prospective evaluation of the procedure are required to settle these issues.
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Affiliation(s)
- A Trigui
- Department of general and digestive surgery, Habib Bourguiba Teaching Hospital, 3029 Sfax, Tunisia.
| | - F Frikha
- Department of general and digestive surgery, Habib Bourguiba Teaching Hospital, 3029 Sfax, Tunisia
| | - H Rejab
- Department of general and digestive surgery, Habib Bourguiba Teaching Hospital, 3029 Sfax, Tunisia
| | - H Ben Ameur
- Department of general and digestive surgery, Habib Bourguiba Teaching Hospital, 3029 Sfax, Tunisia
| | - H Triki
- Department of general and digestive surgery, Habib Bourguiba Teaching Hospital, 3029 Sfax, Tunisia
| | - M Ben Amar
- Department of general and digestive surgery, Habib Bourguiba Teaching Hospital, 3029 Sfax, Tunisia
| | - R Mzali
- Department of general and digestive surgery, Habib Bourguiba Teaching Hospital, 3029 Sfax, Tunisia
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Mais V. Peritoneal adhesions after laparoscopic gastrointestinal surgery. World J Gastroenterol 2014; 20:4917-4925. [PMID: 24803803 PMCID: PMC4009523 DOI: 10.3748/wjg.v20.i17.4917] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 01/11/2014] [Accepted: 02/16/2014] [Indexed: 02/06/2023] Open
Abstract
Although laparoscopy has the potential to reduce peritoneal trauma and post-operative peritoneal adhesion formation, only one randomized controlled trial and a few comparative retrospective clinical studies have addressed this issue. Laparoscopy reduces de novo adhesion formation but has no efficacy in reducing adhesion reformation after adhesiolysis. Moreover, several studies have suggested that the reduction of de novo post-operative adhesions does not seem to have a significant clinical impact. Experimental data in animal models have suggested that CO₂ pneumoperitoneum can cause acute peritoneal inflammation during laparoscopy depending on the insufflation pressure and the surgery duration. Broad peritoneal cavity protection by the insufflation of a low-temperature humidified gas mixture of CO₂, N₂O and O₂ seems to represent the best approach for reducing peritoneal inflammation due to pneumoperitoneum. However, these experimental data have not had a significant impact on the modification of laparoscopic instrumentation. In contrast, surgeons should train themselves to perform laparoscopy quickly, and they should complete their learning curves before testing chemical anti-adhesive agents and anti-adhesion barriers. Chemical anti-adhesive agents have the potential to exert broad peritoneal cavity protection against adhesion formation, but when these agents are used alone, the concentrations needed to prevent adhesions are too high and could cause major post-operative side effects. Anti-adhesion barriers have been used mainly in open surgery, but some clinical data from laparoscopic surgeries are already available. Sprays, gels, and fluid barriers are easier to apply in laparoscopic surgery than solid barriers. Results have been encouraging with solid barriers, spray barriers, and gel barriers, but they have been ambiguous with fluid barriers. Moreover, when barriers have been used alone, the maximum protection against adhesion formation has been no greater than 60%. A recent small, randomized clinical trial suggested that the combination of broad peritoneal cavity protection with local application of a barrier could be almost 100% effective in preventing post-operative adhesion formation. Future studies should confirm the efficacy of this global strategy in preventing adhesion formation after laparoscopy by focusing on clinical end points, such as reduced incidences of bowel obstruction and abdominal pain and increased fertility.
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de Vries A, Mårvik R, Kuhry E. To perform operative procedures in an optimized local atmosphere: can it reduce post-operative adhesion formation? Int J Surg 2013; 11:1118-22. [PMID: 24080114 DOI: 10.1016/j.ijsu.2013.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 09/10/2013] [Accepted: 09/12/2013] [Indexed: 01/12/2023]
Abstract
BACKGROUND Adhesion formation is a major problem following abdominal surgery as it creates a considerable economic burden in addition to an increased risk for complications. In the present study, an effort was made to reduce post-operative adhesion formation by creating an artificial atmosphere within and around the abdominal cavity during an open surgical procedure. METHODS 82 Wistar male rats (Clr:WI) (200 gr, 7 weeks) were randomized into two groups. The abdominal cavity of the control group was exposed to the normal atmosphere of the operating-theatre during surgery (21% O₂, 21 °C, 40-47% relative humidity (RH)), while the abdominal cavity of the study group was exposed to an artificial atmosphere during surgery (3-6% O₂, >75% CO₂, 95-100% RH, 37 °C). Adhesion induction consisted of a laparotomy along linea-alba, four lesions in the anterior abdominal-wall, blood from the tail vein dripped inside the abdominal cavity and exposure to the atmosphere around the wound by use of self-retaining retractors. In addition, a liquid-sample for quantitative bacteriologic cultivation and bacterial load (CFU/ml) calculation was taken just before closure. After 3 weeks the abdominal cavity was scored for the extent, tenacity and severity of adhesions before the rats were euthanized. The two-sample-Wilcoxon-rank-sum test was used in the analysis. RESULTS Highly significant differences in postoperative total adhesion score, extent-, severity- and tenacity-score were found (P < 0.01). No differences were found between the two groups regarding mean bacterial load (P > 0.05). CONCLUSIONS The rats exposed to the warmed and humidified artificial atmosphere consisting of more than 75% carbon dioxide and 3-4% oxygen during surgery had more severe and more post-operative adhesions compared to the rats that were exposed to the ambient air during surgery.
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Affiliation(s)
- Arild de Vries
- Norwegian University of Science and Technology (NTNU), Department of Cancer Research and Molecular Medicine, Trondheim, Norway.
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Jeong WK, Park JW, Choi HS, Jeong SY, Oh JH. Comparison of Peristomal Adhesion Formation Between Laparoscopic and Open Low Anterior Resection of Rectal Cancer. World J Surg 2013; 37:2683-7. [DOI: 10.1007/s00268-013-2165-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Adhesions after abdominal surgery: a systematic review of the incidence, distribution and severity. Surg Today 2013; 44:405-20. [PMID: 23657643 DOI: 10.1007/s00595-013-0591-8] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 02/07/2013] [Indexed: 12/20/2022]
Abstract
Abdominal adhesions are associated with increased postoperative complications, cost and workload. We performed a systematic review with statistical pooling to estimate the formation rate, distribution and severity of postoperative adhesions in patients undergoing abdominal surgery. A literature search was carried out for all articles reporting on the incidence, distribution and severity of adhesions between January 1990 and July 2011. Twenty-five articles fulfilled the inclusion criteria. The weighted mean formation rate of adhesions after abdominal surgery was 54 % (95 % confidence interval [CI] 40-68 %), and was 66 % (95 % CI 38-94 %) after gastrointestinal surgery, 51 % (95 % CI 40-63 %) after obstetric and gynaecological surgery and 22 % (95 % CI 7-38 %) after urological surgery. The mean overall severity score was 1.11 ± 0.98 according to the Operative Laparoscopy Study Group classification. Laparoscopic surgery reduced the adhesion formation rate by 25 % and decreased the adhesion severity score (laparoscopic; 0.36 ± 0.69 vs. open; 2.14 ± 0.84) for gastrointestinal surgery. Our results demonstrate that the incidence and severity of abdominal adhesions varies between surgical specialties and procedures. An increased awareness of adhesions can help in identifying the underlying mechanisms of adhesion formation and novel therapeutic approaches, while also improving the surgical consent process.
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Preliminary study with SprayShield™ Adhesion Barrier System in the prevention of abdominal adhesions. Wideochir Inne Tech Maloinwazyjne 2013; 8:301-9. [PMID: 24501599 PMCID: PMC3908634 DOI: 10.5114/wiitm.2011.34884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Revised: 10/15/2012] [Accepted: 03/25/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Peritoneal adhesions, the fibrotic bands that form between the surfaces in the peritoneal cavity following surgery, still pose a difficult clinical challenge. AIM To evaluate the SprayShield™ Adhesion Barrier System (PEG ester amine solution and a buffer solution) in reducing post-operative adhesion formation. MATERIAL AND METHODS This was a prospective, multi-center, randomized, single blind study. A total of 11 subjects diagnosed with ulcerative colitis (UC) or familial adenomatous polyposis (FAP) were randomized: 8 to the SprayShield™ arm and 3 to the control arm. SprayShield™ was applied on the viscera directly under the midline peritoneal incision and at the site of ileostomy. During the follow-up surgery, the incidence, extent, and severity of post-operative adhesion formation were evaluated, as well as the time required to mobilize the ileal loop. RESULTS In patients who received SprayShield™ the time required to mobilize the ileal loop at the ileostomy closure was slightly shorter and the incidence and severity of adhesions were somewhat lower vs. control subjects (NS). CONCLUSIONS SprayShield™ was found to be easy to use, safe, and quick to apply, and performed well in adherence and conformity. The incidence and severity of adhesions were lower for SprayShield™ subjects vs. control subjects, but due to the limited number of patients there are not enough data to confirm the effectiveness of the SprayShield™ Adhesion Barrier System in prevention of adhesions.
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Coccolini F, Ansaloni L, Manfredi R, Campanati L, Poiasina E, Bertoli P, Capponi MG, Sartelli M, Di Saverio S, Cucchi M, Lazzareschi D, Pisano M, Catena F. Peritoneal adhesion index (PAI): proposal of a score for the "ignored iceberg" of medicine and surgery. World J Emerg Surg 2013; 8:6. [PMID: 23369320 PMCID: PMC3573980 DOI: 10.1186/1749-7922-8-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 01/29/2013] [Indexed: 12/24/2022] Open
Abstract
Peritoneal adhesions describe a condition in which pathological bonds form between the omentum, the small and large bowels, the abdominal wall, and other intra-abdominal organs. Different classification systems have been proposed, but they do not resolve the underlying problem of ambiguity in the quantification and definition of adhesions. We therefore propose a standardized classification system of adhesions to universalize their definition based on the macroscopic appearance of adhesions and their diffusion to different regions of the abdomen. By scoring with these criteria, the peritoneal adhesion index (PAI) can range from 0 to 30, unambiguously specifying precise adhesion scenarios. The standardized classification and quantification of adhesions would enable different studies to more meaningfully integrate their results, thereby facilitating a more comprehensive approach to the treatment and management of this pathology.
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Affiliation(s)
- Federico Coccolini
- General and Emergency Surgery department, Papa Giovanni XXIII hospital, Piazza OMS-Organizzazione Mondiale della Sanità 1, 24128, Bergamo, Italy.
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Takagi K, Araki M, Fukuoka H, Takeshita H, Hidaka S, Nanashima A, Sawai T, Nagayasu T, Hyon SH, Nakajima N. Novel powdered anti-adhesion material: preventing postoperative intra-abdominal adhesions in a rat model. Int J Med Sci 2013; 10:467-74. [PMID: 23470962 PMCID: PMC3590608 DOI: 10.7150/ijms.5607] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 02/28/2013] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Although laparoscopic surgery has decreased postoperative adhesions, complications induced by adhesions are still of great concern. The aim of this study was to investigate the anti-adhesive effects of a novel powdered anti-adhesion material that can be applied during laparoscopic surgery in comparison with other anti-adhesion materials. METHODS Our novel powdered anti-adhesion material is composed of aldehyde dextran and ε-poly(L-lysine). In 40 male rats, a 2.5×2.0-cm abdominal wall resection and cecum abrasion were performed. The rats were randomized into four groups based on the anti-adhesion treatments: normal saline; Seprafilm(®); Interceed(®); and novel powdered anti-adhesion material. The animals were euthanized on days 7 and 28 to evaluate the adhesion severity, area of adhesion formation, gross appearance, and pathological changes. RESULTS The adhesion severities on both days 7 and 28 were significantly lower for all anti-adhesion material groups compared with the normal saline group (p<0.05). Pathologically, all groups showed inflammatory cell infiltration on day 7 and complete regeneration of the peritoneum on day 28. CONCLUSIONS Our novel powdered anti-adhesion material was found to be effective for reducing postoperative intra-abdominal adhesions and showed equivalent efficacy to commercial anti-adhesion materials.
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Affiliation(s)
- Katsunori Takagi
- Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
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Dayton MT, Dempsey DT, Larson GM, Posner AR. New paradigms in the treatment of small bowel obstruction. Curr Probl Surg 2012; 49:642-717. [PMID: 23057861 DOI: 10.1067/j.cpsurg.2012.06.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Merril T Dayton
- Department of Surgery, SUNY Buffalo, Kaleida Health System, Buffalo, NY, USA
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Oetzmann von Sochaczewski C, Petersen C, Ure BM, Osthaus A, Schubert KP, Becker T, Lehner F, Kuebler JF. Laparoscopic versus conventional Kasai portoenterostomy does not facilitate subsequent liver transplantation in infants with biliary atresia. J Laparoendosc Adv Surg Tech A 2012; 22:408-11. [PMID: 22577810 DOI: 10.1089/lap.2012.0077] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The benefit of laparoscopic Kasai portoenterostomy remains controversial. With the progression of the disease, significant numbers of patients require liver transplantation. It has been reported that reduced internal scarring and fewer adhesions could facilitate the subsequent liver transplantation and thus represent a potential advantage of the laparoscopic technique. SUBJECTS AND METHODS All patients undergoing liver transplantation in our hospital between 2006 to 2008 after a laparoscopic or conventional Kasai procedure were included in this retrospective analysis. Primary outcome measure was duration of liver explantation. Secondary outcome measures were total duration of transplantation, amount of blood transfusion, and need for reoperation within the first year. RESULTS In total, 19 patients were included: 11 patients after open Kasai and 8 patients after laparoscopic Kasai. There was no significant difference in patient characteristics. The mean duration of liver explantation was comparable in laparoscopic (125±8 minutes) and conventional (116±6 minutes) (P>.05) patients. Moreover, we did not identify any significant difference in the need for blood transfusions, total liver transplantation duration, and need for reoperation. CONCLUSIONS We did not detect any measurable benefit of laparoscopic compared with conventional portoenterostomy for subsequent liver transplantation. Thus, prevention of adhesion formation and facilitating subsequent liver transplantation are not rationales for laparoscopic Kasai portoenterostomy.
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ten Broek R, Kok- Krant N, Bakkum E, Bleichrodt R, van Goor H. Different surgical techniques to reduce post-operative adhesion formation: a systematic review and meta-analysis. Hum Reprod Update 2012; 19:12-25. [DOI: 10.1093/humupd/dms032] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Arung W, Drion P, Cheramy JP, Honoré P, Meurisse M, Defraigne JO, Detry O. Intraperitoneal adhesions after open or laparoscopic abdominal procedure: an experimental study in the rat. J Laparoendosc Adv Surg Tech A 2012; 22:651-7. [PMID: 22746150 DOI: 10.1089/lap.2012.0102] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Adhesion formation is common after abdominal surgery. The incidence and severity of adhesion formation following open or laparoscopic surgery remain controversial. The role of CO(2) pneumoperitoneum is also widely discussed. This study aimed to compare adhesion formation following peritoneal injury by electrocoagulation performed through open or laparoscopic procedures in a rat model. MATERIALS AND METHODS Sixty male rats were randomized to undergo a 1.5-cm peritoneal injury with unipolar cautery under general anesthesia: open surgery (Group A, n=20), laparoscopic surgery with CO(2) pneumoperitoneum (Group B, n=20), and laparoscopic surgery with air pneumoperitoneum (Group C, n=20). Duration of the procedures was fixed at 90 minutes in all groups, and pneumoperitoneum pressure was kept at 10 mm Hg. Ten days later, the animals underwent a secondary laparotomy to score peritoneal adhesions using qualitative and quantitative parameters. RESULTS Forty-five rats developed at least one adhesion: 95% in Group A, 83% in Group B, and 55% in Group C (P<.01; Group C versus Group A, P<.01). According to number, thickness, tenacity, vascularization, extent, type, and grading according to the Zühkle classification, no significant difference was observed between Groups A and B. The distribution of adhesions after open surgery was significantly different than after laparoscopic surgery (P<.001). It is interesting that Group C rats developed significantly fewer adhesions at the traumatized site, and their adhesions had less severe qualitative scores compared with those after open surgery (P<.01). CONCLUSIONS In this animal model, CO(2) laparoscopic surgery did not decrease the formation of postoperative adhesion, compared with open surgery. The difference with the animals operated on with air pneumoperitoneum emphasizes the role of CO(2) in peritoneal injury leading to adhesion formation.
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Affiliation(s)
- Willy Arung
- Department of General Surgery, University of Lubumbashi Clinics, University of Lubumbashi, Lubumbashi, Katanga Province, Democratic Republic of Congo
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When Will Video-assisted and Robotic-assisted Endoscopy Replace Almost All Open Surgeries? J Minim Invasive Gynecol 2012; 19:238-43. [DOI: 10.1016/j.jmig.2011.12.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 12/23/2011] [Indexed: 11/19/2022]
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Ouaïssi M, Gaujoux S, Veyrie N, Denève E, Brigand C, Castel B, Duron JJ, Rault A, Slim K, Nocca D. Post-operative adhesions after digestive surgery: their incidence and prevention: review of the literature. J Visc Surg 2012; 149:e104-14. [PMID: 22261580 DOI: 10.1016/j.jviscsurg.2011.11.006] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Post-operative adhesions after gastrointestinal surgery are responsible for significant morbidity and constitute an important public health problem. The aim of this study was to review the surgical literature to determine the incidence, consequences and the variety of possible countermeasures to prevent adhesion formation. METHODS A systematic review of English and French language surgical literature published between 1995 and 2009 was performed using the keywords "adhesion" and "surgery". RESULTS Peritoneal adhesions are reported as the cause of 32% of acute intestinal obstruction and 65-75% of all small bowel obstructions. It is estimated that peritoneal adhesions develop after 93-100% of upper abdominal laparotomies and after 67-93% of lower abdominal laparotomies. Nevertheless, only 15-18% of these adhesions require surgical re-intervention. The need for re-intervention for adhesion-related complications varies depending on the initial type of surgery, the postoperative course and the type of incision. The laparoscopic approach appears to decrease the risk of adhesion formation by 45% and the need for adhesion-related re-intervention to 0.8% after appendectomy and to 2.5% after colorectal surgery. At the present time, only one product consisting of hyaluronic acid applied to a layer of carboxymethylcellulose (Seprafilm(®)) has been shown to significantly reduce the incidence of postoperative adhesion formation; but this product is also associated with a significant increase in the incidence of anastomotic leakage when the membrane is applied in direct contact with the anastomosis. The use of this product has not been shown to decrease the risk of re-intervention for bowel obstruction. CONCLUSIONS The prevention of postoperative adhesions is an important public health goal, particularly in light of the frequency of this complication. The routine use of anti-adhesion products is not recommended given the lack of studies with a high level of evidence concerning their efficacy and safety of use.
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Affiliation(s)
- M Ouaïssi
- Service de chirurgie digestive et viscérale, hôpital Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
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Atta HM. Prevention of peritoneal adhesions: a promising role for gene therapy. World J Gastroenterol 2011; 17:5049-58. [PMID: 22171139 PMCID: PMC3235588 DOI: 10.3748/wjg.v17.i46.5049] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 07/14/2011] [Accepted: 07/21/2011] [Indexed: 02/06/2023] Open
Abstract
Adhesions are the most frequent complication of abdominopelvic surgery, yet the extent of the problem, and its serious consequences, has not been adequately recognized. Adhesions evolved as a life-saving mechanism to limit the spread of intraperitoneal inflammatory conditions. Three different pathophysiological mechanisms can independently trigger adhesion formation. Mesothelial cell injury and loss during operations, tissue hypoxia and inflammation each promotes adhesion formation separately, and potentiate the effect of each other. Studies have repeatedly demonstrated that interruption of a single pathway does not completely prevent adhesion formation. This review summarizes the pathogenesis of adhesion formation and the results of single gene therapy interventions. It explores the promising role of combinatorial gene therapy and vector modifications for the prevention of adhesion formation in order to stimulate new ideas and encourage rapid advancements in this field.
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Abstract
The rapid in development of surgical technology has had a major effect in surgical treatment of colorectal cancer. Laparoscopic colon cancer surgery has been proven to provide better short-term clinical and oncologic outcomes. However this quickly accepted surgical approach is still performed by a minority of colorectal surgeons. The more technically challenging procedure of laparoscopic rectal cancer surgery is also on its way to demonstrating perhaps similar short-term benefits. This article reviews current evidences of both short-term and long-term outcomes of laparoscopic colorectal cancer surgery, including the overall costs comparison between laparoscopic surgery and conventional open surgery. In addition, different surgical techniques for laparoscopic colon and rectal cancer are compared. Also the relevant future challenge of colorectal cancer robotic surgery is reviewed.
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Caruso C, La Torre M, Benini B, Catani M, Crafa F, De Leo A, Neri T, Sacchi M. Is Laparoscopy Safe and Effective in Nontraumatic Acute Abdomen? J Laparoendosc Adv Surg Tech A 2011; 21:589-93. [DOI: 10.1089/lap.2011.0030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carlo Caruso
- Department of Biosciences, Tecnopolo di Castel Romano, Rome, Italy
| | - Marco La Torre
- Department of Biosciences, Tecnopolo di Castel Romano, Rome, Italy
| | - Bruno Benini
- Department of Emergency Surgery, Ospedale S. Camillo, Rome, Italy
| | - Marco Catani
- Department of Emergency Surgery, Policlinico Umberto I, “Sapienza” University of Rome, Rome, Italy
| | - Francesco Crafa
- Department of General Surgery, Ospedale Vannini, Rome, Italy
| | - Antonio De Leo
- Department of General Surgery, Ospedale Sandro Pertini, Rome, Italy
| | - Tiziano Neri
- Department of General Surgery, Ospedale Regina Apostolorum, Albano, Italy
| | - Marco Sacchi
- Department of General Surgery, Ospedale S. Maria Goretti, Latina, Italy
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Lopez M, Kalfa N, Forgues D, Guibal MP, Galifer RB, Allal H. Early laparoscopic Kasai's procedure in a low weight newborn. J Minim Access Surg 2011; 3:66-9. [PMID: 21124655 PMCID: PMC2980724 DOI: 10.4103/0972-9941.33276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Accepted: 02/22/2007] [Indexed: 01/30/2023] Open
Abstract
The authors present an early laparoscopic treatment in a newborn with biliary atresia. They describe the technical details of the Kasai laparoscopic procedure. A 10-day-old girl, weight 2.4 kg, was admitted with a history of jaundice and fecal acholia since birth, with elevated total bilirubin and abnormal hepatic test. Abdominal ultrasound showed a small gallbladder with hyperechogenicity in porta hepatis and absence of biliary principal duct. Other metabolic and hematological tests were normal. The procedure was performed at 20-day-old by laparoscopy. The cholangiography confirmed the biliary atresia and Kasai's procedure was continued by laparoscopy and transumbilical extracorporeal Roux-Y approach. The duration of the procedure was 220 min, with good tolerance of pneumoperitoneum due to the laparoscopy. Feedings of breast milk began on the third day postoperative, presenting normal colored stools, with normalization of the hepatic test. A 20 months follow-up was without complications.
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Affiliation(s)
- M Lopez
- Department of Visceral Pediatric Surgery, Lapeyronie Hospital, Montpellier, France
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Hackethal A, Sick C, Szalay G, Puntambekar S, Joseph K, Langde S, Oehmke F, Tinneberg HR, Muenstedt K. Intra-abdominal adhesion formation: does surgical approach matter? Questionnaire survey of South Asian surgeons and literature review. J Obstet Gynaecol Res 2011; 37:1382-90. [PMID: 21599803 DOI: 10.1111/j.1447-0756.2011.01543.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIM The impact of postsurgical intra-abdominal adhesions, which represent a considerable burden for patients and health services, is often underestimated. Various factors influence adhesion formation, including the surgical approach. This study aimed to further understand the condition by investigating surgeons' perceptions of adhesion formation, particularly differences after laparoscopic and open surgery, and by performing a selective literature review. MATERIALS AND METHODS South Asian surgeons attending endoscopy symposia in India and in Germany completed Likert-scale-based questionnaires on awareness of adhesion formation and associated consequences in gynecology. MEDLINE and PubMed were searched for articles published in 2000-2010 comparing laparoscopy and laparotomy in relation to adhesion formation. The results of the questionnaire study were then considered in view of findings from this review. RESULTS In total, 43.1% (97/225) of questionnaires were completed. Respondents considered that laparoscopy caused fewer adhesions than laparotomy for all gynecological procedures. Although they believed their knowledge of adhesion formation was satisfactory, they widely underestimated the risk, giving estimated rates of 12.5% after laparoscopy and 36.3% after laparotomy. Twenty-eight studies were identified in the review. Most concluded that laparoscopy was less likely to cause adhesions than laparotomy but further statistical analysis was precluded because so many different definitions and classifications of adhesions had been used. CONCLUSIONS The risk of adhesion formation was widely underestimated in the study group. Both the questionnaire study and the review concluded that laparoscopy results in less adhesion than laparotomy but further statistical comparison necessitates the development of standard definitions and classifications of adhesions.
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Affiliation(s)
- Andreas Hackethal
- Department of Obstetrics and Gynaecology, Justus-Liebig-University of Giessen, Giessen, Germany.
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Abstract
PURPOSE OF REVIEW Despite the benefits of minimally invasive surgery, its use in oncological resections has been adopted slowly. We highlight the differences in short-term and long-term outcomes between laparoscopic and open surgery for colorectal and gastric cancer. Furthermore, we review the relevance of postoperative fast-track methodologies in improving surgical outcomes after laparoscopic resections. RECENT FINDINGS Numerous randomized controlled trials demonstrate equivalent short-term and long-term outcomes (including oncologic outcomes) after laparoscopic colon resection. Though recent retrospective studies demonstrate its safety in rectal and gastric cancer resection, large-scale randomized controlled trials demonstrating its safe use in this setting are pending. Additionally, evidence to support the use of fast-track postoperative care modalities in gastrointestinal surgery continues to increase. These fast-track protocols should be implemented in conjunction with laparoscopic techniques to enhance patient recovery, reduce postoperative ileus and length of hospital stay. SUMMARY Laparoscopic techniques are safe and at least equivalent to open surgery for colon cancer resections. Studies evaluating the role of laparoscopic techniques in rectal and gastric cancer resection are ongoing. Additionally, fast-track postoperative care methodologies improve recovery after surgery and should be applied to the clinical setting to enhance outcomes after laparoscopic surgery.
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