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Wen J, Liu K, Bu Y, Zhang Y, Zheng Y, He J, Huang Y, Hu D, Wang K. An injectable and antifouling hydrogel prevents the development of abdominal adhesions by inhibiting the CCL2/CCR2 interaction. Biomaterials 2024; 311:122661. [PMID: 38875883 DOI: 10.1016/j.biomaterials.2024.122661] [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: 01/18/2024] [Revised: 06/03/2024] [Accepted: 06/07/2024] [Indexed: 06/16/2024]
Abstract
Abdominal adhesion, a serious complication of abdominal surgery, often resists mitigation by current drug administration and physical barriers. To address this issue, we developed an injectable, antifouling hydrogel through the free-radical polymerization of methacrylate chondroitin sulfate (CS-GMA) and 2-methacryloyloxyethyl phosphorylcholine (MPC) monomers, dubbed the CGM hydrogel. We systematically analyzed its physicochemical properties, including rheological strength, biocompatibility, and antifouling capabilities. A rat abdominal cecum adhesion model was constructed to assess the effectiveness of CGM hydrogel in preventing postoperative adhesion and recurrent adhesion. In addition, multi-omics analyses identified the relationship between adhesion development and CCL2/CCR2 interaction. Notably, CGM hydrogel can thwart the recruitment and aggregation of fibroblasts and macrophages by inhibiting the CCL2/CCR2 interaction. Moreover, CGM hydrogel significantly dampens the activity of fibrosis-linked cytokines (TGF-βR1) and recalibrates extracellular matrix deposition-related cytokines (t-PA and PAI-1, Col Ⅰ and MMP-9). Cumulatively, the dual action of CGM hydrogel-as a physical barrier and cytokine regulator-highlights its promising potential in clinical application for abdominal adhesion prevention.
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Affiliation(s)
- Jinpeng Wen
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Kailai Liu
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yizhuo Bu
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yuchen Zhang
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yunhe Zheng
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Jiangchuan He
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yu Huang
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Datao Hu
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Ke Wang
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China.
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Deng K, Li E, Li G, Ren Y, Shen T, Jiang Z, Li X, Zhou C. Research landscape of abdominal adhesions from 2004 to 2023: A bibliometric analysis. Heliyon 2024; 10:e30343. [PMID: 38707325 PMCID: PMC11068820 DOI: 10.1016/j.heliyon.2024.e30343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 03/22/2024] [Accepted: 04/24/2024] [Indexed: 05/07/2024] Open
Abstract
Adhesions are the most common complication of abdominal or pelvic surgery and remain a challenging problem. To better understand the development tendency of abdominal adhesions, we performed a comprehensive bibliometric analysis of the field of abdominal adhesions. In total, 2219 articles regarding abdominal adhesions were screened and analyzed from 3410 manuscripts indexed in the Web of Science-indexed manuscripts regarding abdominal adhesion from 2004 to 2023. A bibliometric analysis was performed, and CiteSpace [version 6.2. R3 (64-bit)] and VOSviewer (version 1.6.19) were used to visualize the results. The number of annual publications showed slight growth before 2019, and the USA contributed the most publications. The most prolific author in this domain was Diamond, while the publications from Ten Broek had the strongest influence. The most popular journal in this field was the Journal of Surgical Research, and the most frequently co-cited journal was Fertility and Sterility. After analyzing the keywords, "prevention", "surgery" and "peritoneal adhesion" were the 3 most co-cited keywords, while "adhesive small bowel obstruction" was the strongest keyword in the citation burst. Here, for the first time, we used bibliometric methods to study abdominal adhesions over the past ten years. By summarizing the characteristics of publications and predicting future research prospects, we established a framework for researchers and provided a basis for subsequent research.
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Affiliation(s)
- Kai Deng
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Enmeng Li
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Gan Li
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Yiwei Ren
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Tianli Shen
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Zhengdong Jiang
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Xuqi Li
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
- Department of Talent Highland, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Cancan Zhou
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
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Ensan B, Bathaei P, Nassiri M, Khazaei M, Hassanian SM, Abdollahi A, Ghorbani HR, Aliakbarian M, Ferns GA, Avan A. The Therapeutic Potential of Targeting Key Signaling Pathways as a Novel Approach to Ameliorating Post-Surgical Adhesions. Curr Pharm Des 2022; 28:3592-3617. [PMID: 35466868 DOI: 10.2174/1381612828666220422090238] [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: 11/27/2021] [Revised: 01/24/2022] [Accepted: 02/04/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Peritoneal adhesions (PA) are a common complication of abdominal operations. A growing body of evidence shows that inhibition of inflammation and fibrosis at sites of peritoneal damaging could prevent the development of intra-abdominal adhesions. METHODS A search of PubMed, Medline, CINAHL and Embase databases was performed using the keywords 'postsurgical adhesion', 'post-operative adhesion', 'peritoneal adhesion', 'surgery-induced adhesion' and 'abdominal adhesion'. Studies detailing the use of pharmacological and non-pharmacological agents for peritoneal adhesion prevention were identified, and their bibliographies were thoroughly reviewed to identify further related articles. RESULTS Several signaling pathways, such as tumor necrosis factor-alpha, tissue plasminogen activator, and type 1 plasminogen activator inhibitor, macrophages, fibroblasts, and mesothelial cells play a key part in the development of plasminogen activator. Several therapeutic approaches based on anti-PA drug barriers and traditional herbal medicines have been developed to prevent and treat adhesion formation. In recent years, the most promising method to prevent PA is treatment using biomaterial-based barriers. CONCLUSION In this review, we provide an overview of the pathophysiology of adhesion formation and various agents targeting different pathways, including chemical agents, herbal agents, physical barriers, and clinical trials concerning this matter.
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Affiliation(s)
- Behzad Ensan
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Parsa Bathaei
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammadreza Nassiri
- Recombinant Proteins Research Group, The Research Institute of Biotechnology, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Majid Khazaei
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Mahdi Hassanian
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Abdollahi
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Reza Ghorbani
- Orology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Aliakbarian
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon A Ferns
- Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, Sussex, BN1 9PH, UK
| | - Amir Avan
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Basic Sciences Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Medical Genetics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Seo SH, Choi GJ, Lee OH, Kang H. Effect of methylene blue on experimental postoperative adhesion: A systematic review and meta-analysis. PLoS One 2022; 17:e0268178. [PMID: 35588404 PMCID: PMC9119438 DOI: 10.1371/journal.pone.0268178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/24/2022] [Indexed: 11/23/2022] Open
Abstract
Adhesion is a primary challenge following surgery, and the anti-adhesive effect of methylene blue (MB) has been investigated. This systematic review and meta-analysis aimed to evaluate the effect of MB on postoperative adhesions in experimental studies. We initially searched OVID-MEDLINE, EMBASE, and Google Scholar in February 2021, and then in May 2021. The anti-adhesive efficacy of MB was compared with that of the control (either placebo or nothing) after the surgical procedure. The primary and secondary outcomes were the macroscopic and microscopic adhesion scores, respectively. Traditional meta-analysis, meta-regression, and trial sequential analysis (TSA) were performed to analyze the retrieved outcomes. We included 13 experimental studies of 367 rats (200 rats received MB and 167 rats received placebo or nothing). The macroscopic adhesion scores were significantly lower in the MB-administered group than in the control group (standardized mean difference, 2.313; 95% confidence interval, 1.104 to3.523; I2 = 94.0%, Tau = 2.059). Meta-regression analysis showed that macroscopic adhesion tended to decrease with an increase in MB dose. TSA demonstrated that the cumulative Z curve crossed both the conventional test and trial sequential monitoring boundary for the macroscopic adhesion score. MB had a beneficial effect on intraperitoneal adhesion following laparotomy, and adhesions decreased with increase in dose.
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Affiliation(s)
- Su Hyun Seo
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Geun Joo Choi
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Oh Haeng Lee
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Hyun Kang
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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Guzmán-Valdivia Gómez G, Tena-Betancourt E, Angulo Trejo M. Different doses of enoxaparin in the prevention of postoperative abdominal adhesions. Experimental study. Ann Med Surg (Lond) 2021; 73:103132. [PMID: 34917351 PMCID: PMC8666521 DOI: 10.1016/j.amsu.2021.103132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 11/29/2022] Open
Abstract
Background Postoperative abdominal adhesions (PAAs) are present in more than 90% of patients undergoing abdominal surgery. They are a cause of chronic pain, hospitalizations, multiple surgeries, and infertility in women of reproductive age. The participation of three processes have been recognized: coagulation, fibrinolysis, and inflammation. The usefulness of subcutaneous enoxaparin in their prevention has been established. The objective is to establish the safest and most efficient dose for PAA prevention by testing five different doses of subcutaneous enoxaparin (0.25, 0.5, 1, 1.5, and 2 mg/kg/day) given in one dose/day for seven days. Material and methods Fifty Sprague-Dawley rats were studied, 10 in each group. Adhesions were induced through controlled rubbing of the cecum and suturing of an incision in the terminal ileum. Two independent observers recorded the degree of adhesion formation at 14 days and histologically studied the adhesions. Statistical analysis ANOVA compared group averages. The nonparametric Kruskal-Wallis test was used to identify group differences. Results The 0.5 mg/kg/day group had greater formation of adhesions (p < 0.001). There was no significant difference between the 1.5 and 2 mg/kg/day groups, though the latter group had an incidence of 27.2% of bleeding in the abdominal cavity. The degree of adhesions in the histological sections coincided with the macroscopic findings. The interobserver agreement was kappa = 0.88 (very good). Conclusion The safe and effective dose of subcutaneous enoxaparin to prevent PAA formation was 0.5–1.5 mg/kg/day for seven days.
Postoperative abdominal adhesions are the cause of clinical alterations that require significant economic expenses. Activation of the coagulation cascade is a component in the formation of adhesions. Enoxaparin reduces the appearance of postoperative abdominal adhesions. The prophylactic dose of enoxaparin is sufficient to prevent adhesions.
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Affiliation(s)
| | - Eduardo Tena-Betancourt
- Animal Facility Services and Experimental Surgery, Facultad Mexicana de Medicina, Universidad La Salle, Mexico
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Fatehi Hassanabad A, Zarzycki AN, Jeon K, Dundas JA, Vasanthan V, Deniset JF, Fedak PWM. Prevention of Post-Operative Adhesions: A Comprehensive Review of Present and Emerging Strategies. Biomolecules 2021; 11:biom11071027. [PMID: 34356652 PMCID: PMC8301806 DOI: 10.3390/biom11071027] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 02/06/2023] Open
Abstract
Post-operative adhesions affect patients undergoing all types of surgeries. They are associated with serious complications, including higher risk of morbidity and mortality. Given increased hospitalization, longer operative times, and longer length of hospital stay, post-surgical adhesions also pose a great financial burden. Although our knowledge of some of the underlying mechanisms driving adhesion formation has significantly improved over the past two decades, literature has yet to fully explain the pathogenesis and etiology of post-surgical adhesions. As a result, finding an ideal preventative strategy and leveraging appropriate tissue engineering strategies has proven to be difficult. Different products have been developed and enjoyed various levels of success along the translational tissue engineering research spectrum, but their clinical translation has been limited. Herein, we comprehensively review the agents and products that have been developed to mitigate post-operative adhesion formation. We also assess emerging strategies that aid in facilitating precision and personalized medicine to improve outcomes for patients and our healthcare system.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Anna N. Zarzycki
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Kristina Jeon
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R7, Canada;
| | - Jameson A. Dundas
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Vishnu Vasanthan
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Justin F. Deniset
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
- Department of Physiology and Pharmacology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Paul W. M. Fedak
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
- Correspondence:
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Peritoneal adhesions: Occurrence, prevention and experimental models. Acta Biomater 2020; 116:84-104. [PMID: 32871282 DOI: 10.1016/j.actbio.2020.08.036] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 12/20/2022]
Abstract
Peritoneal adhesions (PA) are a postoperative syndrome with high incidence rate, which can cause chronic abdominal pain, intestinal obstruction, and female infertility. Previous studies have identified that PA are caused by a disordered feedback of blood coagulation, inflammation, and fibrinolysis. Monocytes, macrophages, fibroblasts, and mesothelial cells are involved in this process, and secreted signaling molecules, such as tumor necrosis factor alpha (TNF-α), interleukin-10 (IL-10), tissue plasminogen activator (tPA), and type 1 plasminogen activator inhibitor (PAI-1), play a key role in PA development. There have been many attempts to prevent PA formation by anti-PA drugs, barriers, and other therapeutic methods, but their effectiveness has not been widely accepted. Treatment by biomaterial-based barriers is believed to be the most promising method to prevent PA formation in recent years. In this review, the pathogenesis, treatment approaches, and animal models of PA are summarized and discussed to understand the challenges faced in the biomaterial-based anti-PA treatments.
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Cui N, Liu J, Tan H. Comparison of laparoscopic surgery versus traditional laparotomy for the treatment of emergency patients. J Int Med Res 2019; 48:300060519889191. [PMID: 31847654 PMCID: PMC7604990 DOI: 10.1177/0300060519889191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective To investigate the clinical efficacy of laparoscopic gastrointestinal
emergency surgery and postoperative complications. Methods Data for 604 patients undergoing emergency gastrointestinal surgery between
January 2013 and December 2018 were analyzed retrospectively. Treatment
efficacy and postoperative complications were compared between 300 patients
(control group) undergoing traditional laparotomy and 304 patients
(observation group) undergoing laparoscopic surgery. Results Clinical features were significantly better in the observation group than in
the control group, including duration of surgery (59.12 ± 10.31 minutes
vs. 70.34 ± 12.83 minutes), intraoperative blood loss
(41.21 ± 10.45 mL vs. 61.38 ± 9.97 mL), postoperative pain
score (1.25 ± 0.25 points. vs. 5.13 ± 0.43 points), length
of hospital stay (5.13 ± 0.24 days vs. 7.05 ± 0.13 days),
and time to free activity (13 ± 2.96 hours vs. 22 ± 3.02
hours). The total complication incidence in the observation group was 3.9%,
compared with 16% in the control group (16%). No significant differences in
direct medical costs were recorded between the observation and control
groups. Conclusions For patients undergoing emergency gastrointestinal surgery, laparoscopic
surgery resulted in better clinical outcomes than traditional laparotomy
without incurring additional costs. The potential clinical benefits of
emergency laparoscopic gastrointestinal surgery warrant further study.
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Affiliation(s)
- Ning Cui
- Renmin Hospital of Wuhan University, Wuhan, Hubei, P. R. China
| | - Jun Liu
- Renmin Hospital of Wuhan University, Wuhan, Hubei, P. R. China
| | - Haiyan Tan
- Renmin Hospital of Wuhan University, Wuhan, Hubei, P. R. China
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Wang B, Feng C, Dang J, Niu L, Shen C, Yang X, Zhang T, Zhang X. Anti-Adhesive, Platelet Gathering Effects of c-RGD Modified Poly(p-dioxanone-co-l-Phe) Electrospun Membrane and Its Comprehensive Application in Intestinal Anastomosis. Macromol Biosci 2019; 20:e1900344. [PMID: 31854121 DOI: 10.1002/mabi.201900344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/05/2019] [Indexed: 11/06/2022]
Abstract
Intestinal resection and anastomosis are performed in over a million people with various bowel diseases annually. Excessive fibrosis and anastomotic site leakage are the main complications of anastomosis surgery, despite great improvements in operative technique and equipment in recent years. In this study, cRGD modified poly(p-dioxanone-co-l-Phe) (PDPA) membranes are designed and applied in intestinal anastomosis to simultaneously solve the two aforementioned complications. cRGD is modified onto PDPA membranes through both physical absorption and π-π accumulation between d-Phe of cRGD and l-Phe of PDPA. Although cRGD modification enhanced the biocompatibility of PDPA membranes, cRGD modified PDPA membrane suppresses fibroblast proliferation both in vitro and in vivo as a result of degradation and subsequent release of fibroblast suppressive l-Phe from PDPA. Meanwhile, platelets are entrapped by cRGD modified PDPA membranes through the specific binding of cRGD and platelet GPIIbIIIa . cRGD modified PDPA membranes are applied in rat intestinal anastomosis, and both adhesion and stenosis are successfully prevented at anastomotic sites. At the same time, bursting pressure, which represents healing intensity at anastomotic sites, is promoted. The gathering and activation of platelets on PDPA membranes induce secretion of autologous PDGF and VEGF to facilitate angiogenesis and subsequent healing of anastomotic sites.
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Affiliation(s)
- Bing Wang
- Sichuan Key Laboratory of Medical Imaging & Department of Chemistry, School of Preclinical Medicine, North Sichuan Medical College, Nanchong, 637000, China
| | - Chengmin Feng
- Department of Clinical Medicine, North Sichuan Medical College & Department of Otolaryngology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Jiafeng Dang
- Department of Clinical Medicine, North Sichuan Medical College & Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Lijing Niu
- Department of Pathology, School of Preclinical Medicine, North Sichuan Medical College, Nanchong, 637000, China
| | - Chengyi Shen
- Sichuan Key Laboratory of Medical Imaging & Institute of Morphological Research, North Sichuan Medical College, Nanchong, 637000, China
| | - Xiaomei Yang
- Department of Clinical Medicine, North Sichuan Medical College, Nanchong, 637000, China
| | - Ting Zhang
- Department of Clinical Medicine, North Sichuan Medical College, Nanchong, 637000, China
| | - Xiaoming Zhang
- Sichuan Key Laboratory of Medical Imaging & Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
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Niu L, Feng C, Shen C, Wang B, Zhang X. PLGA/PLCA casting and PLGA/PDPA electrospinning bilayer film for prevention of postoperative adhesion. J Biomed Mater Res B Appl Biomater 2018; 107:2030-2039. [PMID: 30548816 DOI: 10.1002/jbm.b.34294] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/14/2018] [Accepted: 11/23/2018] [Indexed: 01/04/2023]
Abstract
Postoperative adhesion is a common complication and preventing adhesions during or immediately after operation is particularly important. The application of solid barrier materials represents the most successful clinical strategy to prevent postoperative adhesion. However, a simple physical barrier effect might be insufficient in preventing adhesion satisfactorily. Multilayered structures can be designed with an outer layer as the barrier and an inner layer to respond to relative drug release. In this article, bilayer film composed of a PLGA/PLCA casting layer as barrier and PLGA/PDPA electrospinning layer to respond to the release of anti-fibrosis drug l-Phe was designed and synthesized. The adhesion prevention effect of the above PLGA/PLCA/PDPA bilayer film was examined and compared with single PLGA/PLCA casting film and single PLGA/PDPA electrospinning film by applying rabbit sidewall defect-cecum abrasion model. As demonstrated by histological observation and immunohistochemical analysis, the bilayer film was the most effective of the three films in postoperative adhesion prevention in terms of both physical barrier effect and anti-fibrosis effect of the PDPA macromolecular prodrug. Besides anti-fibrosis effect, PDPA could also suppress excess proliferation of vascular endothelial cells and microvessel caused by long-term stimulation of implantation materials to the surrounding tissues. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 2030-2039, 2019.
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Affiliation(s)
- Lijing Niu
- Department of Pathology, School of Preclinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Chengmin Feng
- Department of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Chengyi Shen
- Sichuan Key Laboratory of Medical Imaging and Institute of Morphological Research, North Sichuan Medical College, Nanchong, China
| | - Bing Wang
- Sichuan Key Laboratory of Medical Imaging and Department of Chemistry, School of Preclinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Xiaoming Zhang
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Biocompatible, drug-loaded anti-adhesion barrier using visible-light curable furfuryl gelatin derivative. Int J Biol Macromol 2018; 120:915-920. [DOI: 10.1016/j.ijbiomac.2018.07.180] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 07/11/2018] [Accepted: 07/29/2018] [Indexed: 11/23/2022]
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12
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Kim SW, Kim JW, Noh SH, Kim EH, Ito Y, Nah JW, Son TI. Application of visible light curable furfuryl-low molecular chitosan derivative as an anti-adhesion agent. J IND ENG CHEM 2018. [DOI: 10.1016/j.jiec.2018.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Bento SV, Nunes TA, Araújo ID, Silva RCOE, Vidigal PVT, Carvalhais RM. Hyperbaric oxygenation on adhesions prevention after laparotomy in rats. Acta Cir Bras 2018; 33:824-833. [DOI: 10.1590/s0102-865020180090000011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/26/2018] [Indexed: 03/09/2023] Open
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Abu-Elhasan AM, Abdellah MS, Hamed HO. Safety and efficacy of postoperative continuous intra-peritoneal wash with lactated Ringer's for minimizing post-myomectomy pelvic adhesions: a pilot clinical trial. Eur J Obstet Gynecol Reprod Biol 2014; 183:78-82. [PMID: 25461357 DOI: 10.1016/j.ejogrb.2014.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 08/15/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To assess efficacy and safety of post-operative intra-peritoneal wash with lactated Ringer's for 48h after myomectomy in reduction of adhesions compared to routine intra-operative irrigation. Study design A prospective, randomized trial that included 52 eligible participants who had undergone abdominal myomectomy. Participants were randomly allocated to a treatment group (n=26) which was subjected to continuous peritoneal wash for 48h via two intraperitoneal drains, and a control group (n=26). The incidence of de novo adhesions and their severity and extent were scored at a second-look laparoscopy 8-10 weeks postoperatively. Adhesions were graded using the local adhesion barrier scoring system score. Adverse effects were also assessed and reported. RESULTS There was no statistically significant difference in duration of hospital stay or in the incidence of adverse events. A significantly higher proportion of adhesion-free patients was found in the treatment group [11/23, 47.8%] compared to the control group [4/21, 19%] (P<0.01). The mean number of pelvic sites covered by adhesions was significantly lower in the treatment group than in the control group (2.2±0.3 versus 4.6±0.8, P<0.05). The total adhesion score was significantly lower in the treatment group than in the control group (2.1±0.5 versus 4.8±1.4, P<0.05) and the adhesion score was significantly lower at most of the individual anatomical sites. CONCLUSIONS Application of postoperative intraperitoneal wash with lactated Ringer's solution for 48h may have reasonable safety and efficacy in minimizing postoperative pelvic de novo adhesions following abdominal myomectomy.
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Affiliation(s)
- Ahmad M Abu-Elhasan
- Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt.
| | - Mohamad S Abdellah
- Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt.
| | - Hossam O Hamed
- Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt; Department of Obstetrics and Gynecology, Qassim University, Burraidah, Saudi Arabia.
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Correia AR. Adhesion Prevention in Laparoscopic Surgery. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2013.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- André Reis Correia
- Department of Gynaecology/Obstetrics–Hospital D. Estefânia, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
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17
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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: 42] [Impact Index Per Article: 3.8] [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: 02/17/2014] [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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Alonso JDM, Alves ALG, Watanabe MJ, Rodrigues CA, Hussni CA. Peritoneal response to abdominal surgery: the role of equine abdominal adhesions and current prophylactic strategies. Vet Med Int 2014; 2014:279730. [PMID: 24587939 PMCID: PMC3918701 DOI: 10.1155/2014/279730] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 11/22/2013] [Indexed: 12/27/2022] Open
Abstract
Intra-abdominal adhesions constitute a significant clinical and surgical problem that can lead to complications such as pain and bowel occlusion or subocclusion. These adhesions are frustrating and potentially fatal, representing a major postoperative complication in abdominal surgery. It is estimated that 32% of horses undergoing laparotomy will present clinical symptoms due to adhesions, but the true prevalence is not known because a large proportion of animals with postoperative recurrent colics are medically treated or submitted to euthanasia without necropsy. Adhesions are highly cellular, vascularized, dynamic structures that are influenced by complex signaling mechanisms. Understanding their pathogenesis could assist in applying better therapeutic strategies and in developing more effective antiadhesion products. Currently, there are no definitive strategies that prevent adhesion formation, and it is difficult to interpret the results of existing studies due to nonstandardization of an induction model and evaluation of their severity. The best clinical results have been obtained from using minimally traumatic surgical techniques, anti-inflammatory agents, antimicrobials, anticoagulants, and mechanical separation of serosal surfaces by viscous intraperitoneal solutions or physical barriers. This paper aims to review adhesion formation pathogenesis, guide the understanding of major products and drugs used to inhibit adhesion formation, and address their effectiveness in the equine species.
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Affiliation(s)
- Juliana de Moura Alonso
- School of Veterinary Medicine and Animal Science, UNESP, University Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Ana Liz Garcia Alves
- School of Veterinary Medicine and Animal Science, UNESP, University Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Marcos Jun Watanabe
- School of Veterinary Medicine and Animal Science, UNESP, University Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Celso Antonio Rodrigues
- School of Veterinary Medicine and Animal Science, UNESP, University Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Carlos Alberto Hussni
- School of Veterinary Medicine and Animal Science, UNESP, University Estadual Paulista, Botucatu, São Paulo, Brazil
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Raiffort C, Benabdallah F, Paillasseur JL, Gangner Y, Leutenegger E, Sockeel P. Patient eligibility criteria for a surgical treatment that enhances tissue sealing by use of a medicated sponge: observational study ELITE. SPRINGERPLUS 2013; 2:613. [PMID: 24307983 PMCID: PMC3847034 DOI: 10.1186/2193-1801-2-613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 11/08/2013] [Indexed: 11/23/2022]
Abstract
Rationale The application of a haemostatic agent in general surgery, in addition to its effect on bleeding, also provides tissue sealing and adhesion. A sponge drug is used with some actions of resection and wide dissection, without knowledge of the eligibility of patients. In this study, we sought to identify clusters of patients for which the medicated sponge enhances tissue sealing. Methods Observational study (ELITE), from a panel of selected surgeons from hospitals in France in several surgical areas: abdominal, gynaecology, urology and thoracic. The survey identified the criteria for using the sponge TachoSil® in their surgical practices involving n = 683 patients. A multiple correspondence analysis (MCA) followed by an ascending hierarchical classification (AHC) was used in order to identify the eligibility criteria for the application of the sponge for tissue sealing in addition to hemostasis. Results The most relevant classification was based on 9 groups of patients for which the sponge was used. 6 of them are mainly linked with the kind of lesion, 2 with the site of application and the latest one with the type of operation. Conclusions The ELITE study revealed that the TachoSil® sponge was used mainly during surgery, requiring a reinforcement of the resection tissue sealing. The expected objective was successfully reached in 97% of the cases. Electronic supplementary material The online version of this article (doi:10.1186/2193-1801-2-613) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cyril Raiffort
- General and Gynaecologic Surgery, University Hospital of Lariboisière, 2 rue Amboise Paré, 75475 Paris, Cedex 10, France
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Preventing intra-abdominal adhesions with a sodium hyaluronate carboxymethylcellulose membrane enabled visualization of hepatic microcirculation. Int J Surg 2013; 11:935-43. [PMID: 23831750 DOI: 10.1016/j.ijsu.2013.06.842] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 06/25/2013] [Indexed: 11/22/2022]
Abstract
We aimed to evaluate whether using sodium hyaluronate carboxymethylcellulose membrane (Seprafilm™) can facilitate assessment of hepatic microcirculation via orthogonal polarization spectroscopy (OPS) by preventing intra-abdominal adhesions and whether Seprafilm™ as a foreign material can evoke local or systemic inflammatory reactions. After the right median hepatic vein was ligated, rats received either placement of Seprafilm™ or untreated with observation of 1 or 4 weeks (n = 6/group). Hepatic microcirculation was visualized. Systemic and local inflammatory reactions were evaluated by blood count, histology and immunohistochemical staining for CD68. Seprafilm™ significantly (P < 0.05) prevented intra-abdominal adhesion formation compared to non-Seprafilm™ groups (adhesion score: 0 vs 1.3 ± 0.5 at POW1 and 0.3 ± 0.5 vs 3.5 ± 1.4 at POW4). Placement of Seprafilm™ provided sufficient liver surface for acquisition of OPS videos during the harvest procedure. Adhesiolysis in non-Seprafilm™ groups prevented visualization of hepatic microcirculation. A severe local foreign body reaction with formation of a "fibrin-like" membrane containing CD68-positive inflammatory histiocytic cells and mesothelial cells was observed in Seprafilm™ groups even at POW4. Use of Seprafilm™ conferred visualization of hepatic microcirculation after long term observation in experimental setting. In clinical situation, we would suggest being very cautious in immuno-compromised patients because of an ongoing local foreign body reaction caused by Seprafilm™.
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Wang H, Li M, Hu J, Wang C, Xu S, Han CC. Multiple Targeted Drugs Carrying Biodegradable Membrane Barrier: Anti-Adhesion, Hemostasis, and Anti-Infection. Biomacromolecules 2013; 14:954-61. [DOI: 10.1021/bm301997e] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Heran Wang
- State Key Laboratory
of Polymer Physics and Chemistry, Joint Laboratory
of Polymer Science and Materials, Beijing
National Laboratory for Molecular Sciences, Institute
of Chemistry, Chinese Academy of Sciences, Beijing 100190, P. R. China
- Graduate School of Chinese Academy of Sciences, Beijing 100049, P. R.
China
| | - Min Li
- The First Affiliated Hospital of Soochow University, Suzhou 215000, P. R.
China
| | - Jianming Hu
- The First Affiliated Hospital of Soochow University, Suzhou 215000, P. R.
China
| | - Chenhong Wang
- State Key Laboratory
of Polymer Physics and Chemistry, Joint Laboratory
of Polymer Science and Materials, Beijing
National Laboratory for Molecular Sciences, Institute
of Chemistry, Chinese Academy of Sciences, Beijing 100190, P. R. China
- Graduate School of Chinese Academy of Sciences, Beijing 100049, P. R.
China
| | - Shanshan Xu
- State Key Laboratory
of Polymer Physics and Chemistry, Joint Laboratory
of Polymer Science and Materials, Beijing
National Laboratory for Molecular Sciences, Institute
of Chemistry, Chinese Academy of Sciences, Beijing 100190, P. R. China
| | - Charles C Han
- State Key Laboratory
of Polymer Physics and Chemistry, Joint Laboratory
of Polymer Science and Materials, Beijing
National Laboratory for Molecular Sciences, Institute
of Chemistry, Chinese Academy of Sciences, Beijing 100190, P. R. China
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23
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Park JH, Jeong SH, Lee YJ, Choi SK, Hong SC, Jung EJ, Jeong CY, Ju YT, Ha WS. Current status of the use of antiadhesive agents for gastric cancer surgery: a questionnaire survey in South Korea. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 84:160-7. [PMID: 23487148 PMCID: PMC3594643 DOI: 10.4174/jkss.2013.84.3.160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 12/31/2012] [Accepted: 01/13/2013] [Indexed: 01/08/2023]
Abstract
PURPOSE The aim of this study was to investigate the current status of the use of antiadhesive agents (AAdAs) via a questionnaire and to discuss the availability of AAdAs. METHODS The survey was sent to a list of members that was approved by the Korean Gastric Association. The survey included questions on AAdA use by surgeons, the type of AAdAs used, and the reasons for not using AAdAs. Surgeons were also asked to describe complications related to AAdAs, and the reliability of its use. RESULTS The response rate was 21%. The rates of frequent use stratified by procedure were 26.9% (14/52) for open gastrectomy, 5.9% (3/51) for laparoscopic gastrectomy, and 31.5% (17/54) for surgery for postoperative bowel obstruction (P < 0.01). After including data from the occasional use group, the corresponding values were 51.9% (27/52), 19.6% (10/51), and 70.4% (38/54), respectively (P < 0.01). Sefrafilm and Guardix were most commonly used for open procedures. Guardix and Interceed were most commonly used for laparoscopic surgery. The primary reasons for nonuse of AAdAs were ineffectiveness and high cost. Ten percent (4/40) of surgeons observed complications associated with AAdAs. A minority (17.3%, 9/52) had positive attitudes toward AAdAs. The majority of respondents expressed neutral (73.1%, 38/52) or negative (9.6%, 5/52) attitudes toward AAdAs. CONCLUSION The low use rates of AAdAs in gastric cancer surgery may be attributable to perceptions that AAdAs are ineffective, unreliable, and costly. We anticipate the emergence of promising antiadhesive strategies that reach far beyond the limitations of current products.
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Affiliation(s)
- Ji-Ho Park
- Department Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
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Abstract
Adhesions are abnormal fibrous connections, joining tissue surfaces in abnormal locations. Adhesions form after any trauma involving the peritoneum and the injured tissue surface or directly between the injured tissue surfaces. The ideal anti-adhesion agent should be safe, efficacious, easy to use in all types of surgery, and economical. It should prevent adhesions at the site of surgery as well as throughout the peritoneal cavity. Needless to say, the ideal agent is still elusive.
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Affiliation(s)
- Bhaskar Pal
- Senior Consultant, Obstetrics and Gynecology, Apollo Gleneagles Hospital, Kolkata, India
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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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Bates GW, Shomento S. Adhesion prevention in patients with multiple cesarean deliveries. Am J Obstet Gynecol 2011; 205:S19-24. [PMID: 22114994 DOI: 10.1016/j.ajog.2011.09.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 08/09/2011] [Accepted: 09/29/2011] [Indexed: 11/18/2022]
Abstract
Adhesion formation is a well-known complication of abdominal surgery. Although one third of all deliveries in the United States are by cesarean delivery (CD), little is known about adhesions in the obstetric setting. Various surgical techniques for reducing adhesion formation following CD have been investigated. The relative benefits of peritoneal closure and single-layer uterine closure are areas of continued research and debate. Adhesion prevention products are also becoming more commonplace in gynecologic surgery. Two membrane/adhesion barriers have been approved in the United States. A barrier consisting of oxidized regenerated cellulose (Interceed absorbable adhesion barrier) has been shown to reduce adhesions during microsurgery. Its use may be limited following CD because complete hemostasis is crucial to its efficacy. Seprafilm adhesion barrier, composed of hyaluronic acid and carboxymethylcellulose, is approved for use in abdominal or pelvic laparotomy. Preliminary data suggest that it may be effective for reducing adhesions following CD. This article discusses what is currently known about adhesion prevention in the obstetric population and highlights the paucity of level I evidence available to clinicians in this setting.
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Affiliation(s)
- Gordon Wright Bates
- Department of Obstetrics and Gynecology, University of Alabama-Birmingham, Birmingham, AL 35233, USA.
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Di Cicco MF, Bennett RA, Ragetly C, Sippel KM. Segmental jejunal entrapment, volvulus, and strangulation secondary to intra-abdominal adhesions in a dog. J Am Anim Hosp Assoc 2011; 47:e31-5. [PMID: 21531970 DOI: 10.5326/jaaha-ms-5516] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 4 yr old, castrated male dachshund was presented for lethargy, restlessness, a "hunched" posture, and a painful abdomen. A gastric foreign body had been surgically removed 24 mo previously. Exploratory celiotomy revealed a devitalized segment of jejunum with twisted mesentery. Several adhesions and fibrous bands were present within the abdomen, presumptively from the previous gastric foreign body surgery. Histopathology determined that a fibrous tissue band caused entrapment of the segment of intestine and its mesentery resulting in volvulus and ischemic necrosis of the intestine. This case is unique because it involved a focal area of the jejunum that was incarcerated in fibrous adhesions.
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Affiliation(s)
- Michael F Di Cicco
- Department of Internal Medicine, North Carolina State University College of Veterinary Medicine, Raleigh, NC, USA.
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Barrier methods used to prevent pelvic adhesions in videolaparoscopy: experimental study in female rabbits. Surg Endosc 2011; 25:2637-42. [DOI: 10.1007/s00464-011-1617-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Accepted: 02/06/2011] [Indexed: 11/27/2022]
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Ward BC, Panitch A. Abdominal Adhesions: Current and Novel Therapies. J Surg Res 2011; 165:91-111. [DOI: 10.1016/j.jss.2009.09.015] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 08/17/2009] [Accepted: 09/04/2009] [Indexed: 12/20/2022]
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Balbinotto RP, Trindade MRM, Muller ALL, Nunes AG, Da Silva R, Meyer FS, Cerski CTS. Experimental model of the formation of pelvic adhesions by videolaparoscopic in female rabbits. Acta Cir Bras 2010; 25:34-6. [PMID: 20126885 DOI: 10.1590/s0102-86502010000100009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 11/18/2009] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To verify the frequency of postsurgical pelvic adhesion formation in an experimental animal model using videolaparoscopy. METHODS Experimental study in a sample of 11 non-pregnant female rabbits, aged 5 to 7 months. After general anesthesia, access to the abdominal cavity was performed by an open puncture technique, with 10mm optics, placing two other 5 mm trochars under direct visualization, in the iliac fossae. Then a fragment of peritoneum was resected, followed by electrocauterization. In 21 days, the videolaparoscopy was repeated, and adhesion formation and score was looked at, with biopsies at the surgical site. RESULTS 54 % of adhesion formation was observed, and the median score of adhesions was 6 (minimum of 3 and maximum of 10), all of them found in the bladder and the anterior abdominal wall. CONCLUSION The method used presents a high frequency of intra-abdominal adhesion formation.
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Guo H, Leung JCK, Cheung JS, Chan LYY, Wu EX, Lai KN. Non-viral Smad7 gene delivery and attenuation of postoperative peritoneal adhesion in an experimental model. Br J Surg 2009; 96:1323-35. [PMID: 19847872 DOI: 10.1002/bjs.6722] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Postoperative intra-abdominal adhesion is associated with high morbidity and mortality. Smad7, a protein that occupies a strategic position in fibrogenesis, inhibits the transforming growth factor (TGF) beta/Smad signalling pathway. In this study the therapeutic potential of exogenous Smad7 in preventing fibrogenesis in postoperative intra-abdominal adhesion was investigated. METHODS Intra-abdominal adhesion was induced in a rodent model by peritoneal abrasion. Smad7 was delivered into the peritoneal cavity by a non-viral ultrasound-microbubble-mediated naked gene transfection system. The effect of Smad7 transgene on adhesion formation was studied by measuring changes in TGF-beta, fibrogenic factors, alpha-SMA and Smad2/3 activation in the anterior abdominal wall. RESULTS Four weeks after surgical abrasion, all rats developed significant peritoneal adhesion with enhanced TGF-beta expression, increased levels of extracellular matrix components and activated myofibroblasts, accompanied by decreased Smad7 expression and increased Smad2/3 activation. In rats treated with the Smad7 transgene, the incidence and severity of peritoneal adhesion were significantly reduced, with biochemical downregulation of fibrogenic factors and inhibition of Smad2/3 activation. Serial quantitation using magnetic resonance imaging revealed a significant reduction in adhesion areas from day 14 onwards. CONCLUSION Ultrasound-microbubble-mediated gene transfection provides timely targeted gene delivery for the treatment of postoperative peritoneal adhesions.
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Affiliation(s)
- H Guo
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
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Jaenigen BM, Weis C, Odermatt EK, Hopt UT, Obermaier R. The new adhesion prophylaxis membrane A-part--from in vitro testing to first in vivo results. J Biomed Mater Res B Appl Biomater 2009; 89:293-299. [PMID: 18837454 DOI: 10.1002/jbm.b.31215] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Formation of postoperative intra-abdominal adhesions is a severe problem in surgery. Apart from standard surgical procedures, a variety of different substances is available to prevent adhesions, but no universal method has been developed so far. A membrane consisting of polyvinyl alcohol (PVA) and carboxymethylcellulose (CMC) has been demonstrated to be antiadhesive. Here, the in vitro testing and first in vivo results in a rabbit sidewall model are reported. MATERIALS AND METHODS A-part membrane contains a PVA/CMC mixture in a thickness of 40 microm. The composition, dissolution, tensile strength, and elasticity were examined to characterize the membrane in vitro. Experiments in vivo were carried out using a 'rabbit sidewall model' in which a standardized peritoneal trauma was covered with a 5 x 6 cm A-part membrane. Adhesion formation in A-part-treated animals was compared with that in Adept (15 mL/kg body weight) and untreated controls. RESULTS An 80/20 PVA/CMC mixture forms a stable, elastic, transparent membrane, which can easily be placed intraoperatively. The dissolution shows a half-life of about 2 weeks [day 15: (45.1 +/- 4.9)% SD], which affords good adhesion protection during the initial critical phase of adhesion formation. In wet conditions, the membrane follows abdominal movements without tearing (tensile strength 5.0 +/- 4.2 N/cm SD; elasticity 29.5%). In a rabbit sidewall model, A-part membrane significantly reduced adhesion development by (83.1 +/- 31.5)% SD compared with the control and the Adept group (p < 0.001). CONCLUSION The properties of the A-part membrane suggest that it may be useful as an antiadhesive in surgery. A-part is effective in in vivo testing as determined in a rabbit sidewall model.
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Affiliation(s)
- Bernd Martin Jaenigen
- Department of General and Visceral Surgery, Albert-Ludwigs University of Freiburg, Freiburg, Germany
| | | | | | - Ulrich Theodor Hopt
- Department of General and Visceral Surgery, Albert-Ludwigs University of Freiburg, Freiburg, Germany
| | - Robert Obermaier
- Department of General and Visceral Surgery, Albert-Ludwigs University of Freiburg, Freiburg, Germany
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Ates U, Ata B, Ortakuz S, Seyhan A, Urman B. Prevention of adhesion formation following ovarian surgery in a standardized animal model: comparative study of Interceed and double layer Surgicell. J Obstet Gynaecol Res 2008; 34:12-7. [PMID: 18226123 DOI: 10.1111/j.1447-0756.2007.00684.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Comparison of antiadhesive performances of double layer Surgicell and single layer Interceed following ovarian surgery in a rabbit model. METHODS Prospective randomized controlled trial performed at the animal laboratory of a university. Thirty-nine New Zealand White female rabbits of reproductive age were included. Ovaries were bivalved with a no. 15 scalpel. One of the ovaries was covered with a single layer of Interceed while the other was covered with a double layer of Surgicell. In the control group no adhesion barriers were used. Four weeks later adhesions were scored macroscopically. Following oophorectomy specimens were evaluated microscopically for mesothelial proliferation. The macroscopic adhesion score according to Blauer's criteria and the number of mesothelial cell layers were compared. RESULTS AND CONCLUSION The control group had significantly higher adhesion scores than the barrier groups. Macroscopic adhesion scores were not different among the barrier groups. The average number of mesothelial cell layers was 1.77+/-2.68, 1.69+/-2.58 (range 0-8) and 2.04+/-2.84 (range 0-10) for ovaries in the control, Interceed and Surgicell groups, respectively: the difference was not significant. Our results demonstrate that a double layer of Surgicell is as effective as Interceed in reducing postoperative adhesion formation in a rabbit model.
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Affiliation(s)
- Ugur Ates
- Vakif Gureba Training Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkish Republic
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Nappi C, Di Spiezio Sardo A, Greco E, Guida M, Bettocchi S, Bifulco G. Prevention of adhesions in gynaecological endoscopy. Hum Reprod Update 2007; 13:379-94. [PMID: 17452399 DOI: 10.1093/humupd/dml061] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Adhesions resulting from gynaecological endoscopic procedures are a major clinical, social and economic concern, as they may result in pelvic pain, infertility, bowel obstruction and additional surgery to resolve such adhesion-related complications. Although the minimally invasive endoscopic approach has been shown to be less adhesiogenic than traditional surgery, at least with regard to selected procedures, it does not totally eliminate the problem. Consequently, many attempts have been made to further reduce adhesion formation and reformation following endoscopic procedures, and a wide variety of strategies, including surgical techniques, pharmacological agents and mechanical barriers have been advocated to address this issue. The present review clearly indicates that there is no single modality proven to be unequivocally effective in preventing post-operative adhesion formation either for laparoscopic or for hysteroscopic surgery. Furthermore, the available adhesion-reducing substances are rather expensive. Since excellent surgical technique alone seems insufficient, further research is needed on an adjunctive therapy for the prevention and/or reduction of adhesion formation following gynaecological endoscopic procedures.
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Affiliation(s)
- C Nappi
- Department of Gynaecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples 'Federico II', Via Pansini 5, Naples, Italy
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Ait Menguellet S, Collinet P, Cosson M, Mariette C, Triboulet JP, Vinatier D. Intérêt des produits antiadhérentiels en chirurgie gynécologique. ACTA ACUST UNITED AC 2007; 35:290-6. [PMID: 17337231 DOI: 10.1016/j.gyobfe.2007.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Accepted: 02/05/2007] [Indexed: 01/17/2023]
Abstract
Adhesion barriers are intraperitoneal agents, solid or fluid, developed in order to prevent postoperative adhesions. In this article, we evaluate the efficiency of these new barrier agents for adhesion prevention in gynaecologic surgery, undertaking a review of controlled clinical trials published. Several human clinical trials demonstrated the safety and efficiency of both Interceed and Seprafilm. As far as other barrier agents are concerned, data are still insufficient to recommend them for clinical use. There is a need for other randomised controlled trials in order to evaluate functional efficiency of anti adhesion agents.
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Affiliation(s)
- S Ait Menguellet
- Clinique de gynécologie, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire (CHRU) de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
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Walsh WR, Evans RON, Iliopoulos J, Cornwall GB, Thomas KA. Evaluation of a bioresorbable polylactide sheet for the reduction of pelvic soft tissue attachments in a porcine animal model. J Biomed Mater Res B Appl Biomater 2006; 79:166-75. [PMID: 16544295 DOI: 10.1002/jbm.b.30527] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In an adult porcine model, the effectiveness of a bioresorbable film to minimize soft tissue attachment to the pelvic viscera was evaluated at 4-week and 12-week endpoints. Following a transperitoneal laparotomy through a midline incision, the bladder and uterus were abraded in all animals to promote soft tissue attachment to the viscera. Control animals received no further treatment. The experimental group animals were treated with bioresorbable polylactide (PLa) sheets, 0.02 mm thick, one between the bladder and the abdominal wall, and a second sheet between the bladder and the uterus. Quantitative assessment of the severity and location of soft tissue attachments, and qualitative histologic assessment were performed at 4 and 12 weeks post-operatively. Statistically significant differences in the quantitative soft tissue attachment scores were observed in comparing the PLa film treated animals versus the control animals, at both the 4-week and 12-week time points. In the control animals, the formation of numerous thick fibrous bands was observed at both time points. Histology revealed no adverse reaction to the bioresorbable PLa barrier film. The bioresorbable PLa sheet provided an effective barrier between adjacent anatomical structures and minimized soft tissue attachments to the device when in contact with the viscera as compared to the control groups. Surgical dissection planes between the abdominal wall and adjacent soft tissues were maintained with the use of the PLa sheet at both time points.
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Affiliation(s)
- William R Walsh
- Orthopaedic Research Laboratories, Division of Surgery, University of New South Wales, Prince of Wales Hospital, Sydney, 2031 Australia
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Hammoud A, Gago LA, Diamond MP. Adhesions in patients with chronic pelvic pain: A role for adhesiolysis? Fertil Steril 2004; 82:1483-91. [PMID: 15589847 DOI: 10.1016/j.fertnstert.2004.07.948] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2003] [Revised: 07/28/2004] [Accepted: 07/28/2004] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To review the relation between adhesions and pelvic pain and the effectiveness of adhesiolysis in pain control. DESIGN Selective review of the literature. PATIENT(S) Patients with pelvic pain and/or undergoing adhesiolysis for pain control. RESULT(S) Intraabdominal adhesions are accepted as etiologic factors for infertility and small bowel obstruction; however, the contribution of adhesions to pelvic pain is less clear. The most common laparoscopic findings in patients with and without pelvic pain were endometriosis and adhesions. Immunohistologic studies also have shown evidence of nerve fibers in adhesions that had been removed from patients with and without pelvic pain. Multiple adhesiolysis techniques have been employed, with outcome of surgical procedures ranging from no pain relief to pain relief in 90% of patients. However, randomized trials have shown that adhesiolysis is ineffective in improving the outcome of the treatment of pelvic pain, possibly because of adhesion reformation. Interestingly, adhesions are usually not described as an etiologic factor for pelvic pain in men; this might be related to a gender difference in pain perception or the possibility that adhesions per se do not cause pain. CONCLUSION(S) The correlation between pelvic pain and adhesions is uncertain. Adhesiolysis has not been shown to be effective in achieving pain control in randomized clinical studies.
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Affiliation(s)
- Ahmad Hammoud
- Department of Obstetrics and Gynecology, Wayne State University/The Detroit Medical Center, Detroit, Michigan, USA
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Affiliation(s)
- Gavin Sacks
- Department of Reproductive Medicine, Hammersmith Hospital, London, UK
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Bothin C, Midtvedt T, Perbeck L. Orally delivered antibiotics which lower bacterial numbers decrease experimental intra-abdominal adhesions. Langenbecks Arch Surg 2003; 388:112-5. [PMID: 12712341 DOI: 10.1007/s00423-003-0369-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2002] [Accepted: 01/20/2003] [Indexed: 11/29/2022]
Abstract
BACKGROUND Postsurgical adhesion formation is a common occurrence after most surgical procedures and is still a major cause of postoperative morbidity because no satisfactory treatment or prophylaxis has yet been developed. Further elucidation of the basic mechanisms of postsurgical adhesion formation is needed. Recent studies using germfree rats have found the indigenous bowel flora to be important in the adhesive response. The present study examined whether antibiotic treatment affects intra-abdominal adhesion formation. METHODS Using the cecal crush model to inflict adhesions, groups of rats ( n=12) were treated with placebo or amoxicillin/clavulanic acid in the drinking water. Treatment started 3 days before operation and continued until evaluation. Adhesion scores were recorded after 7 days. Bacterial counts were made from cultures of fecal samples on operation day and at termination. RESULTS Amoxicillin/clavulanic acid decreased adhesion score compared to placebo. Adhesion incidence was 50% in the treatment group and 92% in the placebo group. Bacterial numbers were lower in the treatment group. CONCLUSIONS Antibiotic treatment which lowers bacterial numbers can decrease adhesions.
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Affiliation(s)
- C Bothin
- Department of Medical Microbial Ecology, Karolinska Institute, 14186, Stockholm, Sweden.
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