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Davies SW, Gillen JR, Guidry CA, Newhook TE, Pope NH, Hranjec T, Sawyer RG, Hallowell PT. A Comparative Analysis between Laparoscopic and Open Adhesiolysis at a Tertiary Care Center. Am Surg 2020. [DOI: 10.1177/000313481408000321] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Laparotomy has been the favored approach regarding surgical management of small bowel obstruction (SBO); however, laparoscopy may offer improved outcomes. Patients undergoing laparoscopic lysis of adhesions (LOA) at our institution for SBO will have lower postoperative morbidity and 30-day mortality. Patients undergoing LOA at our institution, from 2000 to 2011, were reviewed. Categorical data were analyzed with χ2or Fisher's exact tests. Continuous data were analyzed with Student's t test or Wilcoxon rank sum. One hundred two (38 laparoscopic, 64 open) LOA cases were selected. Perioperative contamination and conservative management were higher in the open group. Open cases had a greater incidence of intensive care unit (ICU) admissions and longer length of stay. Stratified analysis determined a strong association between perioperative contamination and a higher incidence of ICU admission, perioperative contamination and longer LOS, and conservative management and longer LOS. Finally, patient outcome did not differ between those treated by surgeons trained in minimally invasive surgery (MIS) compared with those not trained in MIS. Careful consideration of surgical approach and timing is called for in all patients with SBO; however, whenever possible, laparoscopic preference should be given to most patients in an expeditious fashion irrespective of MIS training.
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Affiliation(s)
- Stephen W. Davies
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Jake R. Gillen
- University of Virginia School of Medicine, Charlottesville, Virginia
| | | | | | - Nicolas H. Pope
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Tjasa Hranjec
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Robert G. Sawyer
- University of Virginia School of Medicine, Charlottesville, Virginia
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Manno S, Dell'Atti L, Cicione A, Spasari A. Safety and efficacy of transperitoneal laparoscopic nephron sparing surgery in patients with previous abdominal surgery. Urologia 2020; 88:14-20. [PMID: 32484072 DOI: 10.1177/0391560320921728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The aim of this study is to assess the safety and feasibility of the transperitoneal laparoscopic approach during nephron sparing surgery in patients with previous abdominal surgery. PATIENTS AND METHODS We retrospectively analyzed patients undergoing transperitoneal laparoscopic partial nephrectomy for renal masses. All patients had received a diagnosis of cT1a renal exophytic mass (⩽5 cm). Patients were divided into two groups, those with and without previous abdominal surgery. Patients with solitary kidney or major previous abdominal surgery were excluded in this study. The operative time, estimated blood loss, length of stay, surgical complications, and positive surgical margins were recorded to compare outcomes among two groups. RESULTS Of the 157 patients who were included in our study, 71 (45.3%) had a history of abdominal surgery (Group 1), while the remaining 86 (54.7%) had not (Group 2). Cholecystectomy was the most common previous surgery performed near the renal fossa. Patients with previous abdominal surgery experienced increased operative time (111.5 vs 83.2 min; p = 0.001). However, no statistically significant difference was found in estimated blood loss (122.1 vs 114.4 mL; p = 0.363), length of stay (4.1 vs 3.8 days; p = 0.465), rate of conversion to open surgery (2.8% vs 2.3%; p = 0.234), and rate of complications (p = 0.121). However, operative time (p = 0.003) and length of stay (p < 0.001) were greater in patients with versus those without previous open cholecystectomy. CONCLUSION Our results suggest that laparoscopic partial nephrectomy after minor previous abdominal surgery is safe and feasible in selected patients affected by renal masses with low nephrometry score. However, previous cholecystectomy results in an increased risk of conversion to open surgery and longer hospital stay in patients undergoing right laparoscopic partial nephrectomy.
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Affiliation(s)
- Stefano Manno
- Urology Unit, Hospital "Pugliese Ciaccio," Catanzaro, Italy
| | - Lucio Dell'Atti
- Institute of Urology, University Hospital "Ospedali Riuniti," Marche Polytechnic University, Ancona, Italy
| | - Antonio Cicione
- Institute of Urology, University Hospital "S. Andrea," Roma, Italy
| | - Angelo Spasari
- Urology Unit, Hospital "Pugliese Ciaccio," Catanzaro, Italy
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Saban A, Shoham-Vardi I, Yohay D, Weintraub AY. Peritoneal adhesions during cesarean delivery are an independent risk factor for peri-partum hemorrhagic complications. Eur J Obstet Gynecol Reprod Biol 2020; 251:188-193. [PMID: 32526613 DOI: 10.1016/j.ejogrb.2020.05.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/18/2020] [Accepted: 05/26/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate whether the presence of peritoneal adhesions at the second cesarean delivery (CD) are associated with peri-partum hemorrhagic complications. STUDY DESIGN A retrospective cohort study was undertaken, comparing hemorrhagic complications in the second CD, between women with and without adhesions. All women with two CDs who delivered a singleton in their second CD between the years 1988-2016 at a large regional medical center in Israel were included. Women with adhesions diagnosed at the first CD and women with a history of other abdominal or pelvic surgery, pelvic infection or inflammatory disease, endometriosis, uterine Mullerian anomalies and fetal chromosomal or structural abnormalities were excluded from the analysis, resulting in a sample of 7925 women. Peri-partum hemorrhagic complications were defined as a composite of vessel ligation, B lynch procedure during the CD or uterine rupture, third stage or immediate postpartum hemorrhage, blood component transfusion, hemorrhagic shock and maternal anemia [hemoglobin (Hb) levels prior to maternal discharge below 9.0 g\dl]. In order to identify variables that are independently associated with the composite peri-partum hemorrhagic complications a multivariate logistic regression analysis was performed, to control for potential confounders. In addition, a linear regression model was constructed with Hb levels as the outcome variable. RESULTS During the study period, 32.6 % of patients (n = 2581) suffered from adhesions during the second CD. After adjusting for potential confounders, peri-partum hemorrhagic complications were found to be significantly associated with the presence of peritoneal adhesions (adjusted OR 1.18, CI 1.04-1.33, P = 0.008). A multivariate linear regression analysis revealed that peritoneal adhesions were independently associated with a decline in post-partum Hb levels (β=-0.055, P < 0.001). CONCLUSION Adhesions attributable to a previous CD increase the risk for hemorrhagic complications. Interventions aimed at preventing adhesions formation during the primary CD may have a role in reducing hemorrhagic complications in subsequent CDs.
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Affiliation(s)
- Alla Saban
- Faculty of Health Sciences, Department of Epidemiology and Health Services Evaluation, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Ilana Shoham-Vardi
- Faculty of Health Sciences, Department of Epidemiology and Health Services Evaluation, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - David Yohay
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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Clinical adhesion score (CLAS): development of a novel clinical score for adhesion-related complications in abdominal and pelvic surgery. Surg Endosc 2020; 35:2159-2168. [PMID: 32410083 PMCID: PMC8057995 DOI: 10.1007/s00464-020-07621-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/02/2020] [Indexed: 02/07/2023]
Abstract
Background Adhesions are a major cause of long-term postsurgical complications in abdominal and pelvic surgery. Existing adhesion scores primarily measure morphological characteristics of adhesions that do not necessarily correlate with morbidity. The aim of this study was to develop a clinical adhesion score (CLAS) measuring overall clinical morbidity of adhesion-related complications in abdominal and pelvic surgery. Methods An international Delphi study was performed to identify relevant score items for adhesion-related complications, including small bowel obstruction, female infertility, chronic abdominal or pelvic pain, and difficulties at reoperation. The CLAS includes clinical outcomes, related to morbidity of adhesions, and weight factors, to correct the outcome scores for the likelihood that symptoms are truly caused by adhesions. In a pilot study, two independent researchers retrospectively scored the CLAS in 51 patients to evaluate inter-observer reliability, by calculating the Intraclass correlation coefficient. During a feasibility assessment, we evaluated whether the CLAS completely covered different clinical scenarios of adhesion-related morbidity. Results Three Delphi rounds were performed. 43 experts agreed to participate, 38(88%) completed the first round, and 32 (74%) the third round. Consensus was reached on 83.4% of items. Inter-observer reliability for the CLAS was 0.95 (95% CI 0.91–0.97). During feasibility assessment, six items were included. As a result, the CLAS includes 22 outcomes and 23 weight factors. Conclusion The CLAS represents a promising scoring system to measure and monitor the clinical morbidity of adhesion-related complications. Further studies are needed to confirm its utility in clinical practice. Electronic supplementary material The online version of this article (10.1007/s00464-020-07621-5) contains supplementary material, which is available to authorized users.
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Uslu Yuvaci H, Cevrioğlu AS, Gündüz Y, Akdemir N, Karacan A, Erkorkmaz Ü, Keskin A. Does applied ultrasound prior to laparoscopy predict the existence of intra-abdominal adhesions? Turk J Med Sci 2020; 50:304-311. [PMID: 31905491 PMCID: PMC7164757 DOI: 10.3906/sag-1910-61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/01/2020] [Indexed: 01/24/2023] Open
Abstract
Background/aim The purpose of this study was to evaluate the efficacy of trans-abdominal ultrasonography (USG), a noninvasive diagnostic tool, in predicting the presence of intraabdominal adhesions, especially near the trocar entry area, to provide safe surgical access to the abdomen. Materials and methods Fifty-nine women with a previous history of open abdominal surgery (group A) and a group of 91 women with no previous history of surgery (group B) underwent dynamic ultrasound evaluation of the abdominal fields before laparoscopic operations. The anterior abdominal wall was divided into six quadrants: right upper, right lower, left upper, left lower, suprapubic, and umbilical. Adhesions were evaluated by surgeons during the operation and by radiologists using USG prior to the operation. Visceral organ movements greater than 1 cm was defined as normal visceral slide (positive test), with less than 1 cm of movement defined as abnormal visceral slide (negative test). Sliding test measures movements of omental echogenicity or a stable echogenic focus that corresponds to intestine peritoneal echogenicity that underlies abdominal wall during exaggerated inspiration and expiration. Adhesions observed during surgery were evaluated on a four-point scale, with 0 indicating no adhesions present, 1 indicating the presence of a thin, filmy avascular adhesion, 2 indicating the presence of a dense and vascular adhesion, and 3 indicating adhesions that connect surrounding organs with the overlying peritoneal surfaces. The McNemar test was used to compare the results of USG and laparoscopy for each measure. Results We found that preoperative USG was successful in identifying adhesions [sensitivity, 96.39% (95% CI 89.8–99.2); specificity, 97.43%] Conclusion Preoperative ultrasound examination of the abdominal wall may enhance the safety of abdominal entry during laparoscopic operations.
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Affiliation(s)
- Hilal Uslu Yuvaci
- Department of Obstetrics and Gynecology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Arif Serhan Cevrioğlu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Yasemin Gündüz
- Department of Radiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Nermin Akdemir
- Department of Obstetrics and Gynecology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Alper Karacan
- Department of Radiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Ünal Erkorkmaz
- Department of Biostatistics, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Abdurrahim Keskin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
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Mayes SM, Davis J, Scott J, Aguilar V, Zawko SA, Swinnea S, Peterson DL, Hardy JG, Schmidt CE. Polysaccharide-based films for the prevention of unwanted postoperative adhesions at biological interfaces. Acta Biomater 2020; 106:92-101. [PMID: 32097711 PMCID: PMC8552357 DOI: 10.1016/j.actbio.2020.02.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 02/14/2020] [Accepted: 02/18/2020] [Indexed: 01/05/2023]
Abstract
Postoperative adhesions protect, repair, and supply nutrients to injured tissues; however, such adhesions often remain permanent and complicate otherwise successful surgeries by tethering tissues together that are normally separated. An ideal adhesion barrier should not only effectively prevent unwanted adhesions but should be easy to use, however, those that are currently available have inconsistent efficacy and are difficult to handle or to apply. A robust hydrogel film composed of alginate and a photo-crosslinkable hyaluronic acid (HA) derivative (glycidyl methacrylate functionalized hyaluronic acid (GMHA)) represents a solution to this problem. A sacrificial porogen (urea) was used in the film manufacture process to impart macropores that yield films that are more malleable and tougher than equivalent films produced without the sacrificial porogen. The robust mechanical behavior of these templated alginate/GMHA films directly facilitated handling characteristics of the barrier film. In a rat peritoneal abrasion model for adhesion formation, the polysaccharide films successfully prevented adhesions with statistical equivalence to the leading anti-adhesion technology on the market, Seprafilm®. STATEMENT OF SIGNIFICANCE: Postoperative adhesions often remain permanent and complicate otherwise successful surgeries by tethering tissues together that are normally separated and pose potentially significant challenges to patients. Therefore, the generation of adhesion barriers that are easy to deploy during surgery and effectively prevent unwanted adhesions is a big challenge. In this study robust hydrogel films composed of alginate and a photo-crosslinkable hyaluronic acid (HA) derivative (glycidyl methacrylate functionalized HA, GMHA) were fabricated and investigated for their potential to act as a solution to this problem using a rat peritoneal abrasion model for adhesion formation. We observed the polysaccharide films successfully prevented adhesions with statistical equivalence to the leading anti-adhesion technology on the market, Seprafilm®, suggesting that such films represent a promising strategy for the prevention of postoperative adhesions.
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Affiliation(s)
- Sarah M Mayes
- Department of Biomedical Engineering, University of Texas at Austin, 107W Dean Keeton St, Austin, TX 78712, USA.
| | - Jessica Davis
- Department of Biomedical Engineering, University of Texas at Austin, 107W Dean Keeton St, Austin, TX 78712, USA.
| | - Jessica Scott
- Department of Biomedical Engineering, University of Texas at Austin, 107W Dean Keeton St, Austin, TX 78712, USA.
| | - Vanessa Aguilar
- Department of Biomedical Engineering, University of Texas at Austin, 107W Dean Keeton St, Austin, TX 78712, USA
| | - Scott A Zawko
- Department of Chemical Engineering, University of Texas at Austin, 200 E Dean Keeton St, Austin, TX 78712, USA
| | - Steve Swinnea
- Department of Chemical Engineering, University of Texas at Austin, 200 E Dean Keeton St, Austin, TX 78712, USA.
| | - Daniel L Peterson
- Department of Biomedical Engineering, University of Texas at Austin, 107W Dean Keeton St, Austin, TX 78712, USA.
| | - John G Hardy
- Department of Biomedical Engineering, University of Texas at Austin, 107W Dean Keeton St, Austin, TX 78712, USA; J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Biomedical Sciences Building JG-53, P.O. Box 116131, Gainesville, FL 32611-6131, USA.
| | - Christine E Schmidt
- Department of Biomedical Engineering, University of Texas at Austin, 107W Dean Keeton St, Austin, TX 78712, USA; J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Biomedical Sciences Building JG-53, P.O. Box 116131, Gainesville, FL 32611-6131, USA.
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Nishiguchi A, Kurihara Y, Taguchi T. Hemostatic, Tissue-Adhesive Colloidal Wound Dressing Functionalized by UV Irradiation. ACS APPLIED BIO MATERIALS 2020; 3:1705-1711. [DOI: 10.1021/acsabm.0c00015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Akihiro Nishiguchi
- Biomaterials Field, Research Center for Functional Materials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan
| | - Yukari Kurihara
- Biomaterials Field, Research Center for Functional Materials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan
| | - Tetsushi Taguchi
- Biomaterials Field, Research Center for Functional Materials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan
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Rosendorf J, Horakova J, Klicova M, Palek R, Cervenkova L, Kural T, Hosek P, Kriz T, Tegl V, Moulisova V, Tonar Z, Treska V, Lukas D, Liska V. Experimental fortification of intestinal anastomoses with nanofibrous materials in a large animal model. Sci Rep 2020; 10:1134. [PMID: 31980716 PMCID: PMC6981151 DOI: 10.1038/s41598-020-58113-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 01/09/2020] [Indexed: 12/14/2022] Open
Abstract
Anastomotic leakage is a severe complication in gastrointestinal surgery. It is often a reason for reoperation together with intestinal passage blockage due to formation of peritoneal adhesions. Different materials as local prevention of these complications have been studied, none of which are nowadays routinely used in clinical practice. Nanofabrics created proved to promote healing with their structure similar to extracellular matrix. We decided to study their impact on anastomotic healing and formation of peritoneal adhesions. We performed an experiment on 24 piglets. We constructed 3 hand sutured end-to-end anastomoses on the small intestine of each pig. We covered the anastomoses with a sheet of polycaprolactone nanomaterial in the first experimental group, with a sheet of copolymer of polylactic acid with polycaprolactone in the second one and no fortifying material was used in the Control group. The animals were sacrificed after 3 weeks of observation. Clinical, biochemical and macroscopic signs of anastomotic leakage or intestinal obstruction were monitored, the quality of the scar tissue was assessed histologically, and a newly developed scoring system was employed to evaluate the presence of adhesions. The material is easy to manipulate with. There was no mortality or major morbidity in our groups. No statistical difference was found inbetween the groups in the matter of level of peritoneal adhesions or the quality of the anastomoses. We created a new adhesion scoring system. The material appears to be safe however needs to be studied further to prove its' positive effects.
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Affiliation(s)
- Jachym Rosendorf
- Department of Surgery, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic. .,Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic.
| | - Jana Horakova
- Department of Nonwovens, Faculty of Textile Engineering, Technical University in Liberec, Liberec, Czech Republic
| | - Marketa Klicova
- Department of Nonwovens, Faculty of Textile Engineering, Technical University in Liberec, Liberec, Czech Republic
| | - Richard Palek
- Department of Surgery, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic.,Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Lenka Cervenkova
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Tomas Kural
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany.,Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Petr Hosek
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Tomas Kriz
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Vaclav Tegl
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic.,Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine in Plzen, Pilsen, Czech Republic
| | - Vladimira Moulisova
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Zbynek Tonar
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic.,Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Vladislav Treska
- Department of Surgery, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - David Lukas
- Department of Nonwovens, Faculty of Textile Engineering, Technical University in Liberec, Liberec, Czech Republic
| | - Vaclav Liska
- Department of Surgery, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic.,Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
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Mahmoudieh M, Keleidari B, Nasr Esfahani F, Zolfaghari B, Melali H, Davarpanah Jazi AH, Mehdinezhad N, Mokhtari M. The effect of Punica granatum L. flower extract on post-surgical peritoneal adhesions in a rat model. Eur J Obstet Gynecol Reprod Biol 2019; 246:113-116. [PMID: 32004879 DOI: 10.1016/j.ejogrb.2019.12.034] [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: 04/30/2019] [Revised: 12/09/2019] [Accepted: 12/23/2019] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Peritoneal adhesions may develop after every abdominopelvic surgery. Many agents and technical modifications have been investigated to minimize adhesions. Punica granatum (pomegranate) flower has some anti-inflammatory and antioxidative effects that would reduce the formation of peritoneal adhesions. In the present study, the effects of different doses of oral Punica granatum flower extract on postoperative peritoneal adhesions were evaluated in a rat model. STUDY DESIGN Thirty-two female Wistar rats were divided into four groups: one control group (CG) and three experimental groups, treated with 100 (EG100), 200 (EG200), and 400 (EG400) mg/kg/day Punica granatum extract orally for eight days. Induction of peritoneal adhesions was done in all groups using the same method. Two weeks after the first surgery, all rats re-operated and adhesions were evaluated via both macroscopic and microscopic changes. RESULTS We observed that rats in the control group had statistically higher adhesion area and more severe adhesions when compared to all experimental groups. Besides, those in the EG-400 group had a significantly lower rate of foreign body reaction in serosal layer when compared to the other three study groups. Other microscopic findings were comparable between the four groups. CONCLUSION Administration of the oral Punica granatum flower extract was associated with a decreased quantity and quality of the adhesions in the animal model of rat in this study. This therapy might be an effective and safe strategy to reduce intraperitoneal adhesion after abdominal surgeries in animal models.
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Affiliation(s)
- Mohsen Mahmoudieh
- Minimally Invasive Surgery Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Minimally Invasive Surgery, Al Zahra Hospital, Isfahan, Iran.
| | - Behrouz Keleidari
- Minimally Invasive Surgery Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Minimally Invasive Surgery, Al Zahra Hospital, Isfahan, Iran.
| | - Farid Nasr Esfahani
- Minimally Invasive Surgery Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Student Research Committee, School of Medicine, University of Medical Sciences, Isfahan, Iran.
| | - Behzad Zolfaghari
- Department of Pharmacognosy, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Iran.
| | - Hamid Melali
- Minimally Invasive Surgery Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Minimally Invasive Surgery, Al Zahra Hospital, Isfahan, Iran.
| | - Amir Hosein Davarpanah Jazi
- Minimally Invasive Surgery Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Minimally Invasive Surgery, Al Zahra Hospital, Isfahan, Iran.
| | - Negin Mehdinezhad
- Department of Pharmacognosy, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Iran.
| | - Mojgan Mokhtari
- Department of Pathology, Isfahan University of Medical Sciences, Isfahan, Iran.
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Vlasov AP, Markin OV, Shchapov VV, Salakhov EK, Sheyranov NS, Revva OV, Ganina MV, Glukhova IV. [Homeostasis correcting therapy in optimizing the early postoperative period of patients with peritonitis]. Khirurgiia (Mosk) 2019:69-75. [PMID: 31714533 DOI: 10.17116/hirurgia201911169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim - of the study was to study the effectiveness of Remaxol in the correction of homeostasis disorders in patients with acute peritonitis after laparotomic surgery intervention.
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Affiliation(s)
- A P Vlasov
- Ogaryov national Research Mordovia State University, Saransk, Russia
| | - O V Markin
- Ogaryov national Research Mordovia State University, Saransk, Russia
| | - V V Shchapov
- Ogaryov national Research Mordovia State University, Saransk, Russia
| | - E K Salakhov
- Ogaryov national Research Mordovia State University, Saransk, Russia
| | - N S Sheyranov
- Ogaryov national Research Mordovia State University, Saransk, Russia
| | - O V Revva
- Ogaryov national Research Mordovia State University, Saransk, Russia
| | - M V Ganina
- Ogaryov national Research Mordovia State University, Saransk, Russia
| | - I V Glukhova
- Ogaryov national Research Mordovia State University, Saransk, Russia
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Uemura A, Ogawa S, Tanaka R. Intrathoracic retention of insoluble hyaluronic acid and its absorption process in rats. Int J Artif Organs 2019; 43:283-287. [PMID: 31692411 DOI: 10.1177/0391398819885126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Post-thoracotomy adhesions are frequent postoperative complications. It has been reported that insoluble hyaluronic acid may prevent adhesions. MATERIALS AND METHODS This study had two objectives: first, to determine the in vivo degradation and absorption process, as well as the intrathoracic retention, of solid insoluble hyaluronic acid membrane; and second, to elucidate the association between postoperative intrathoracic retention and the morphological changes of insoluble hyaluronic acid in 12 Wistar rats. Insoluble hyaluronic acid membranes were cut into 2.0 cm × 1.0 cm rectangles in a dry state. After weighing, the test membranes were soaked and washed with saline to be implanted after pericardiotomy via thoracotomy. At Days 4, 7, 10, 14, and 28 after implantation, the rats were euthanized, the chest was opened, and the condition and implantation site of the inserted test membrane were examined. RESULTS Although approximately 10 days were required for the test membrane to decrease to half in the thoracic cavity, the intrathoracic remnant decreased to a mean of ~2% just 4 days later. CONCLUSION This study clarified the time-dependent degradation process and remnants of insoluble hyaluronic acid in the thoracic cavity. A close relationship between the intrathoracic remnant of insoluble hyaluronic acid and its morphological change associated with degradation was demonstrated.
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Affiliation(s)
- Akiko Uemura
- Faculty of Veterinary Medicine, Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Shingo Ogawa
- R&D Department of Medical Field Product and Cosmetics Material, Fundamental Research Division, Dainichiseika Color & Chemicals Mfg. Co, Ltd., Tokyo, Japan
| | - Ryou Tanaka
- Faculty of Veterinary Medicine, Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan
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Zhong J, Qin Z, Yu H, Liu X, Li C, Shi J, Mao J, Xu B. NPPB prevents postoperative peritoneal adhesion formation by blocking volume-activated Cl - current. Naunyn Schmiedebergs Arch Pharmacol 2019; 393:501-510. [PMID: 31659404 DOI: 10.1007/s00210-019-01740-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/20/2019] [Indexed: 12/11/2022]
Abstract
5-Nitro-2-(3-phenylpropylamino)-benzoic acid (NPPB) is a non-specific chloride channel blocker. Peritoneal adhesion is an inevitable complication of abdominal surgery and remains an important clinical problem, leading to chronic pain, intestinal obstruction, and female infertility. The aim of this study is to observe the effects of NPPB on peritoneal adhesions and uncover the underlying mechanism. The formation of postoperative peritoneal adhesions was induced by mechanical injury to the peritoneum of rats. MTT assay and wound-healing assay were used to evaluate proliferation and migration of primary cultured adhesion fibroblasts (AFB) respectively. Whole-cell chloride currents were measured using a fully automated patch-clamp workstation. Cell volume changes were monitored by light microscopy and video imaging. Our results demonstrated that NPPB could significantly prevent the formation of peritoneal adhesion in rats and inhibit the proliferation of AFB in a concentration-dependent manner. NPPB also reduced the migration of AFB cells with an IC50 of 53.09 μM. A 47% hypotonic solution successfully activated the ICl,vol in AFB cells. The current could be blocked by extracellular treatment with NPPB. Moreover, 100 μM NPPB almost completely eliminated the capacity of regulatory volume decrease (RVD) in these cells. These data indicate that NPPB could prevent the formation of postoperative peritoneal adhesions. The possible mechanism may be through the inhibition of the proliferation and migration of AFB cells by modulating ICl,vol and cell volume. These results suggest a potential clinical use of NPPB for preventing the formation of peritoneal adhesions.
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Affiliation(s)
- Jie Zhong
- School of Biosciences and Biopharmaceutics, Guangdong Pharmaceutical University, Guangzhou, 510006, Guangdong, People's Republic of China
| | - Zhuan Qin
- School of Biosciences and Biopharmaceutics, Guangdong Pharmaceutical University, Guangzhou, 510006, Guangdong, People's Republic of China
| | - Huiping Yu
- School of Biosciences and Biopharmaceutics, Guangdong Pharmaceutical University, Guangzhou, 510006, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, Guangdong Pharmaceutical University, Guangzhou, 510006, Guangdong, People's Republic of China
| | - Xueqiang Liu
- School of Biosciences and Biopharmaceutics, Guangdong Pharmaceutical University, Guangzhou, 510006, Guangdong, People's Republic of China
| | - Chunmei Li
- School of Biosciences and Biopharmaceutics, Guangdong Pharmaceutical University, Guangzhou, 510006, Guangdong, People's Republic of China
| | - Jingwen Shi
- School of Biosciences and Biopharmaceutics, Guangdong Pharmaceutical University, Guangzhou, 510006, Guangdong, People's Republic of China
| | - Jianwen Mao
- School of Biosciences and Biopharmaceutics, Guangdong Pharmaceutical University, Guangzhou, 510006, Guangdong, People's Republic of China.
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, Guangdong Pharmaceutical University, Guangzhou, 510006, Guangdong, People's Republic of China.
| | - Bin Xu
- School of Biosciences and Biopharmaceutics, Guangdong Pharmaceutical University, Guangzhou, 510006, Guangdong, People's Republic of China.
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances, Guangdong Pharmaceutical University, Guangzhou, 510006, Guangdong, People's Republic of China.
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Ushigome H, Nishimura J, Takahashi Y, Yasui M, Ohue M, Yamada D, Yamamoto K, Wada H, Takahashi H, Omori T, Miyata H, Takiguchi S. Colorectal surgery in patients with prior pancreaticoduodenectomy. JOURNAL OF THE ANUS RECTUM AND COLON 2019; 3:121-127. [PMID: 31583327 PMCID: PMC6774738 DOI: 10.23922/jarc.2019-005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/16/2019] [Indexed: 01/05/2023]
Abstract
Objectives: Colorectal cancer (CRC) surgery after pancreaticoduodenectomy (PD) is difficult to perform, because PD involves dissection and complex reconstruction of the digestive tract. We evaluated the clinical outcomes of CRC surgery in patients with prior PD. Methods: Between January 2008 and March 2018, a total of 1727 patients received CRC surgery at our institution. Of these, 10 had previously undergone PD (PD group). As a control group, 280 patients were collected who had undergone resection without any history of previous abdominal surgery. The PD and control groups were further subdivided into four groups by right or left side. Outcomes of colorectal surgery were investigated in the PD and control groups. Results: The number of harvested lymph nodes was significantly lower in the PD group. In the right colectomy group, distance from the surgical margin was significantly shorter in the PD group. The rate of postoperative complications was higher in the PD group. Peritoneal dissemination originating from pancreatic cancer was found during CRC surgery for one patient, and one patient developed refractory ascites. Three patients died of pancreatic cancer, rectal cancer, and other disease. Seven patients were alive without recurrence. Conclusions: CRC surgery for patients with prior PD can involve difficulty in dissecting lymph nodes and higher postoperative morbidity rates but can provide sufficiently curative resection for CRC.
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Affiliation(s)
- Hajime Ushigome
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Junichi Nishimura
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Yusuke Takahashi
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Masayoshi Yasui
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Masayuki Ohue
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Daisaku Yamada
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Kazuyoshi Yamamoto
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroshi Wada
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hidenori Takahashi
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Takeshi Omori
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroshi Miyata
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Nagoya City University, Aichi, Japan
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Saban A, Shoham-Vardi I, Yohay D, Weintraub AY. Peritoneal adhesions are an independent risk factor for peri- and post-partum infectious morbidity. Eur J Obstet Gynecol Reprod Biol 2019; 241:60-65. [DOI: 10.1016/j.ejogrb.2019.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
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65
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Öztürk M, McDermott JC, Laeseke PF, Nakada SY, Hedican SP, Best SL, Kleedehn MG. Management of Indiana pouch stones through a percutaneous approach: A single center experience. Turk J Urol 2019; 45:366-371. [PMID: 31509509 DOI: 10.5152/tud.2019.19049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/19/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We present our experience of the treatment of reservoir stones using a percutaneous approach in patients with Indiana pouch urinary diversions. MATERIAL AND METHODS Patients who were treated percutaneously for Indiana pouch reservoir stones between January 2008 and December 2018 were identified from the hospital database, and their data were retrospectively analyzed. Patient charts were reviewed for stone burden, surgery details, and postoperative complications. The Indiana pouch was punctured under a direct ultrasound guidance, and a 30F sheath was placed into the pouch. A urologist removed the stones by inserting a rigid nephroscope through the sheath. A Foley catheter was left in the pouch through the percutaneous tract and opened to drainage. RESULTS Seven patients (mean age: 47.3±14.7 years) were included. All patients were stone free after the procedure. The median stone number was 3 (range: 1-8). The mean maximum stone diameter was 24.4±4.9 mm (range: 19-33 mm). Six patients were successfully treated in one session, whereas 1 patient required two treatment sessions. The median postoperative hospital admission was 1 day (range: 1-5 days). The Foley catheters were removed after a median of 18 days (range: 10-19 days). No major complications were reported. CONCLUSION The percutaneous approach for Indiana pouch reservoir stones treatment ensures direct and safe management without major periprocedural complications.
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Affiliation(s)
- Mesut Öztürk
- Section of Interventional Radiology, Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.,Department of Radiology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - John C McDermott
- Section of Interventional Radiology, Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Paul F Laeseke
- Section of Interventional Radiology, Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Stephen Y Nakada
- Department of Urology, University of Wisconsin Madison School of Medicine and Public Health, Madison, WI, USA
| | - Sean P Hedican
- Department of Urology, University of Wisconsin Madison School of Medicine and Public Health, Madison, WI, USA
| | - Sara L Best
- Department of Urology, University of Wisconsin Madison School of Medicine and Public Health, Madison, WI, USA
| | - Mark G Kleedehn
- Section of Interventional Radiology, Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
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66
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Model-based analysis of treatment effects of paclitaxel microspheres in a microscopic peritoneal carcinomatosis model in mice. Pharm Res 2019; 36:127. [DOI: 10.1007/s11095-019-2660-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 06/16/2019] [Indexed: 01/23/2023]
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67
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Jiang HH, Dong XL, Tang X, Li AJ, Chang Y, Li HG, Chen Y, Zhang ZY, Tang EJ, Lin MB. Nomogram for Predicting Risk of Intestinal Complications After Colorectal Cancer Surgery. Med Sci Monit 2019; 25:2104-2111. [PMID: 30897070 PMCID: PMC6439933 DOI: 10.12659/msm.915692] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background Intestinal complications are a major cause of morbidity after colorectal cancer surgery. This study aimed to develop an effective nomogram for predicting risk of intestinal complications following colorectal cancer surgery. Material/Methods We retrospectively analyzed 1876 patients who underwent colorectal cancer surgery at Yangpu and Zhuji hospitals from January 2013 to October 2018. Intestinal complications were defined as intestinal obstruction, leakage or bleeding, or peritonitis within 30 days after surgery. A logistic regression model was used to identify the risk factors associated with postoperative intestinal complications, and a nomogram for intestinal complications was established. The predictive accuracy of the nomogram was assessed using area under the receiver operating characteristic curve (AUC) and calibration plot. Results A total of 164 patients (8.7%) developed intestinal complications after colorectal cancer surgery; 35 (21.3%) of whom died in the postoperative period. Multivariate logistic analysis showed that male gender, history of abdominal surgery, preoperative intestinal obstruction/perforation, metastatic cancer, and lower level of hemoglobin and prognostic nutrition index were independent risk factors (P<0.05 for all). A nomogram was then constructed, and it displayed good accuracy in predicting postoperative intestinal complications with an AUC of 0.76. The calibration plot also showed an excellent agreement between the predicted and observed probabilities. Conclusions We constructed a nomogram based on clinical variables, which could provide individual prediction of postoperative intestinal complications with good accuracy.
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Affiliation(s)
- Hui-Hong Jiang
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China (mainland).,Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Xian-Long Dong
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China (mainland).,Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Xuan Tang
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China (mainland).,Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai, China (mainland)
| | - A-Jian Li
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China (mainland).,Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Yi Chang
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Hua-Guang Li
- Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai, China (mainland).,Center for Clinical Research and Translational Medicine, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Ying Chen
- Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai, China (mainland).,Center for Clinical Research and Translational Medicine, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Zhi-Yong Zhang
- Department of General Surgery, Zhuji People's Hospital of Zhejiang Province, Zhuji, Zhejiang, China (mainland)
| | - Er-Jiang Tang
- Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai, China (mainland).,Center for Clinical Research and Translational Medicine, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Mou-Bin Lin
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China (mainland).,Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai, China (mainland)
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68
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Placement of SurgiWrap® adhesion barrier film around the protective loop stoma after laparoscopic colorectal cancer surgery may reduce the peristomal adhesion severity and facilitate the closure. Int J Colorectal Dis 2019; 34:513-518. [PMID: 30617410 DOI: 10.1007/s00384-018-03229-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE A temporary loop stoma is often created after laparoscopic colorectal cancer surgery. Peristomal adhesions may make stoma closure into a complicated operation. We demonstrated how to place the SurgiWrap® adhesion barrier film and evaluated the peristomal adhesion severity and feasibility of stoma closure. METHODS This is a retrospective case-control study. Patients were divided into a study group (placement of adhesion barrier film) and a control group (no placement). Patient characteristics, operative data, and severity of adhesions were recorded. We used logistic regression to probe the association between the variables and the adhesion severity. RESULTS A total of 180 patients were identified with 60 in the study group and 120 in the control group. In the study group, the adhesion severity (p < 0.001), operative time (p = 0.025), and time to flatus (p = 0.042) are significantly reduced. In logistic regression analysis, placement of the film (p < 0.001), neoadjuvant concurrent chemoradiotherapy (p = 0.041), and time interval between stoma creation and closure ≧ 12 weeks (p = 0.038) are three significant factors influencing the peristomal adhesion. CONCLUSION The placement of SurgiWrap® adhesion barrier film around the loop stoma after laparoscopic colorectal cancer surgery may reduce the peristomal adhesion severity and facilitate the stoma closure in terms of operative time and time to flatus.
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69
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Cheng F, Wu Y, Li H, Yan T, Wei X, Wu G, He J, Huang Y. Biodegradable N, O-carboxymethyl chitosan/oxidized regenerated cellulose composite gauze as a barrier for preventing postoperative adhesion. Carbohydr Polym 2019; 207:180-190. [DOI: 10.1016/j.carbpol.2018.10.077] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/23/2018] [Accepted: 10/23/2018] [Indexed: 10/28/2022]
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70
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Chengxi W, Rishuo G, QuLiang G, Laiyou W, Lianbing H, Linghao Q. The prevention effects of cryptotanshinone nanoemulsion on postoperative peritoneal adhesions. Drug Dev Ind Pharm 2019; 45:695-702. [DOI: 10.1080/03639045.2018.1529788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Wang Chengxi
- School of Pharmacy, Guangdong Pharmaceutical University, Guangzhou, China
| | - Guo Rishuo
- School of Pharmacy, Guangdong Pharmaceutical University, Guangzhou, China
| | - Gu QuLiang
- School of Basic Science, Guangdong Pharmaceutical University, Guangzhou, China
| | - Wang Laiyou
- School of Pharmacy, Guangdong Pharmaceutical University, Guangzhou, China
| | - Hou Lianbing
- Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qin Linghao
- School of Pharmacy, Guangdong Pharmaceutical University, Guangzhou, China
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71
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Long-term hospital mortality due to small bowel obstruction after major colorectal surgery in a national cohort database. Int J Colorectal Dis 2019; 34:329-336. [PMID: 30478639 DOI: 10.1007/s00384-018-3200-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE Adhesions following major colorectal surgery can be responsible for bowel obstruction, mostly occurring in the small intestine. Published data for long-term survival following major colorectal surgery complicated with intestinal obstruction are limited. The aim of this study was to identify the mortality rates and mortality risk factors in patients with primary colorectal surgery (PMCS) complicated with surgical small bowel obstruction (SBO). METHODS This was a retrospective analysis of a prospective national registry of patients who underwent PMCS in 2008. RESULTS Of 15,640 patients who underwent PMCS, 2900 required further surgery for SBO with a median follow-up of 42 months (until the end of 2014). Re-hospitalization mortality rate was 10.1%, and 65% of deaths were obstruction-related. No differences were found in SBO incidence between patients who had undergone laparoscopic or open procedures. Hospital mortality was significantly higher in patients who underwent open PMCS compared with those who underwent a laparoscopic procedure (11% vs. 2%, p = 0.0006). Overall 1- and 5-year survival rates in patients who underwent surgical SBO treatment were significantly lower when the initial surgery was an open procedure compared with a laparoscopy (96.8% vs. 99.4% and 86.6% vs. 95.1%, respectively, p = 0.0016). Multivariate analysis revealed that age, sex, a history of diabetes, cancer, and heart disease were mortality risk factors. CONCLUSIONS The surgical incidence and mortality rate of PMCS complicated with SBO were elevated. Laparoscopy clearly reduced long-term postoperative mortality in patients with and without abdominal adhesions.
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72
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Cho H, Jammalamadaka U, Tappa K, Egbulefu C, Prior J, Tang R, Achilefu S. 3D Printing of Poloxamer 407 Nanogel Discs and Their Applications in Adjuvant Ovarian Cancer Therapy. Mol Pharm 2019; 16:552-560. [PMID: 30608705 DOI: 10.1021/acs.molpharmaceut.8b00836] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Nanogels are attractive biocompatible materials that enable local delivery of multiple drugs. In this study, we demonstrated that 3D printing technology could be used to precisely construct nanogel discs carrying paclitaxel and rapamycin. 3D-printed nanogel disc rounds (12 mm diameter × 1 mm thickness) carrying paclitaxel and rapamycin evaded premature gelation during storage and the initial burst release of the drugs in the dissolution medium. In vivo 3D-printed nanogel discs permitted successful intraperitoneal delivery of paclitaxel and rapamycin in ES-2-luc ovarian-cancer-bearing xenograft mice. They were also shown to be therapeutically effective and capable of preventing postsurgical peritoneal adhesions in the treated xenograft mice.
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Affiliation(s)
- Hyunah Cho
- School of Pharmacy and Heath Sciences , Fairleigh Dickinson University , Florham Park , New Jersey 07932 , United States
| | - Udayabhanu Jammalamadaka
- Mallinckrodt Institute of Radiology , Washington University School of Medicine , St. Louis , Missouri 63110 , United States
| | - Karthik Tappa
- Mallinckrodt Institute of Radiology , Washington University School of Medicine , St. Louis , Missouri 63110 , United States
| | - Christopher Egbulefu
- Mallinckrodt Institute of Radiology , Washington University School of Medicine , St. Louis , Missouri 63110 , United States
| | - Julie Prior
- Mallinckrodt Institute of Radiology , Washington University School of Medicine , St. Louis , Missouri 63110 , United States
| | - Rui Tang
- Mallinckrodt Institute of Radiology , Washington University School of Medicine , St. Louis , Missouri 63110 , United States
| | - Samuel Achilefu
- Mallinckrodt Institute of Radiology , Washington University School of Medicine , St. Louis , Missouri 63110 , United States
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Murakami T, Hijikuro I, Yamashita K, Tsunoda S, Hirai K, Suzuki T, Sakai Y, Tabata Y. Antiadhesion effect of the C17 glycerin ester of isoprenoid-type lipid forming a nonlamellar liquid crystal. Acta Biomater 2019; 84:257-267. [PMID: 30529080 DOI: 10.1016/j.actbio.2018.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/20/2018] [Accepted: 12/04/2018] [Indexed: 12/17/2022]
Abstract
Postoperative adhesion is a relevant clinical problem that causes a variety of clinical complications after abdominal surgery. The objective of this study is to develop a liquid-type antiadhesion agent and evaluate its efficacy in preventing tissue adhesion in a rat peritoneal adhesion model. The liquid-type agent was prepared by submicron-sized emulsification of C17 glycerin ester (C17GE), squalene, pluronic F127, ethanol, and water with a high-pressure homogenizer. The primary component was C17GE, which is an amphiphilic lipid of one isoprenoid-type hydrophobic chain and can form two phases of self-assembly nonlamellar liquid crystals. The C17GE agent consisted of nanoparticles with an internal inverted hexagonal phase when evaluated by small-angle X-ray scattering (SAXS) and cryo-transmission electron microscopy (cryo-TEM). Upon contact with the biological tissue, this agent formed a thin membrane with a bioadhesive property. After this agent was applied to a sidewall injury of rats, it showed a percentage average of adhesion significantly less than that obtained with the Seprafilm® antiadhesion membrane in a rat model. Additionally, the retention of the agent prolonged at the applied site in the peritoneal cavity of rats. In conclusion, the C17GE agent is promising as an antiadhesion material. STATEMENT OF SIGNIFICANCE: Postoperative adhesion remains a common adverse effect. Although various materials have been investigated, there are few products commercially available to prevent adhesion. For the sheet-type agent, it is inconvenient to be applied through small laparotomy, especially in laparoscopic surgery. Additionally, the liquid-type agent currently used requires a complicated procedure to spray at the targeted site. Our liquid-type antiadhesion agent can form liquid crystals and act as a thin membrane-like physical barrier between the peritoneum and tissues to prevent adhesion. Indeed, the antiadhesion agent used in our present study significantly prevents adhesion compared with the antiadhesion membrane most used clinically. Moreover, our agent is highly stable by itself and easy to use in laparoscopic surgery, thus leading to a promising new candidate as an antiadhesion material.
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Affiliation(s)
- Takahide Murakami
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Laboratory of Biomaterials, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan
| | - Ichiro Hijikuro
- Farnex Incorporated, Tokyo Institute of Technology Yokohama Venture Plaza, 4259 - 3, Nagatsuta-cho, Midori-ku, Yokohama, Kanagawa, Japan
| | - Kota Yamashita
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Laboratory of Biomaterials, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan
| | - Shigeru Tsunoda
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenjiro Hirai
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takahisa Suzuki
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Laboratory of Biomaterials, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuhiko Tabata
- Laboratory of Biomaterials, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan.
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Moon JH, Park JH, Jeong JH, Sung NS, Jeong YG, Song KC, Ahn JP, Lee NS, Han SY. Metformin-loaded Citric Acid Cross-linked Agarose Films in the Prevention of Postoperative Abdominal Adhesion. ACTA ACUST UNITED AC 2019. [DOI: 10.11637/aba.2019.32.4.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ji Hyun Moon
- Department of Anatomy, College of Medicine, Konyang University, Korea
| | - Jong Ho Park
- Department of Biomedical Material, College of Medical Engineering, Konyang University, Korea
| | - Ji Heun Jeong
- Department of Anatomy, College of Medicine, Konyang University, Korea
| | - Nak Song Sung
- Department of General Surgery, Konyang University Hospital, Korea
| | - Young Gil Jeong
- Department of Anatomy, College of Medicine, Konyang University, Korea
| | - Ki Chang Song
- Department of Biomedical Material, College of Medical Engineering, Konyang University, Korea
| | - Jong Pil Ahn
- Korea Institute of Ceramic Engineering and Technology, Korea
| | - Nam-Seob Lee
- Department of Anatomy, College of Medicine, Konyang University, Korea
| | - Seung Yun Han
- Department of Anatomy, College of Medicine, Konyang University, Korea
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Biondo-Simões MDLP, Sichciopi AA, Ioshii SO, Robes RR, Biondo-Simões R. Comparative study of fibrosis induced by Marlex®, Parietex Composite®, Vicryl® and Ultrapro® meshes1. Acta Cir Bras 2018; 33:792-798. [PMID: 30328911 DOI: 10.1590/s0102-865020180090000007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/13/2018] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the fibrosis induced by four different meshes: Marlex®, Parietex Composite®, Vicryl® and Ultrapro®. METHODS Histological cutouts of abdominal wall were analyzed with polarized light 28 days after the meshes implants and colorized by picrosirius to identify the intensity of collagen types I and III, and their maturation index. RESULTS When the four groups were compared, the total collagen area analyzed was bigger in groups A and D, with no difference between them. The collagen type I density was bigger in group A, with an average of 9.62 ± 1.0, and smaller in group C, with an average of 3.86 ± 0.59. The collagen type III density was similar in groups A, B and C, and bigger in group D. The collagen maturation index was different in each of the four groups, bigger in group A with 0.87, group B with 0.66, group D with 0.57 and group C with 0.33 (p = 0.0000). CONCLUSION The most prominent fibrosis promotion in the given meshes was found on Marlex® (polypropylene mesh) and the Parietex Composite® (non-biodegradable polyester); the collagen maturation index was higher in the Marlex® mesh, followed by Ultrapro®, Parietex Composite® and Vicryl® meshes.
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Affiliation(s)
- Maria de Lourdes Pessole Biondo-Simões
- PhD, Full Professor, Department of Surgery, Universidade Federal do Paraná (UFPR), Brazil. Intellectual and design of the study, analysis of data, manuscript writing, final approval the version to be published
| | | | - Sérgio Ossamu Ioshii
- PhD, Associate Professor, Division of Pathology, UFPR, and Postgraduate Program in Technology in Health, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba-PR, Brazil. Intellectual and scientific content of the study, critical revision
| | - Rogério Ribeiro Robes
- Master, Full Professor, Department of Anesthesiology, Faculty of Veterinary Medicine, UFPR, Curitiba-PR, Brazil. Analgesia and post-operative care, manuscript writing
| | - Rachel Biondo-Simões
- Surgeon Oncologist, Hospital Angelina Caron, Campina Grande do Sul-PR, Brazil. Technical procedures
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Abstract
OBJECTIVE To evaluate the association of cesarean deliveries on the incidence of small bowel obstruction. METHODS We formed a population-based cohort of all women with a first live birth between 1998 and 2007 using the U.K. Clinical Practice Research Datalink. Women were followed until 2015, the occurrence of a small bowel obstruction, or loss to follow-up. Cesarean delivery was identified from the Hospital Episode Statistics and small bowel obstruction events were identified using the Classification of Interventions and Procedures and International Classification of Diseases, 10th Revision codes. Cox proportional hazard models, with cesarean delivery defined as a time-dependent exposure, estimated the adjusted hazard ratios and 95% CIs of small bowel obstruction associated with cesarean delivery. RESULTS The cohort included 81,480 women with a median follow-up of 8.0 years (range 6 months to 16.6 years), during which 575 new small bowel obstructions occurred (incidence 9.1/10,000 person-years). Risk of small bowel obstruction was higher among women with a cesarean delivery compared with women without (16.3 vs 6.4 patients/10,000 person-years, odds ratio [OR] 2.54, 95% CI 2.15-3.00). Increasing number of cesarean deliveries was associated with an increasing risk of small bowel obstruction (OR 1.61, 95% CI 1.46-1.78, per additional cesarean delivery). Repeated small bowel obstructions were more common among women with a cesarean delivery and the association remained when restricting to small bowel obstruction requiring surgical management. CONCLUSION Although rare, small bowel obstructions are increased among women who have undergone a cesarean delivery. With increasing rates of cesarean deliveries worldwide, small bowel obstructions and related morbidities may become a more prevalent women's health concern.
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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: 0.7] [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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Dehghani Firoozabadi MM, Alibakhshi A, Alaeen H, Zand S, Nazemian R, Rahmani M. Evaluation of the diagnostic potential of trans abdominal ultrasonography in detecting intra-abdominal adhesions: A double-blinded cohort study. Ann Med Surg (Lond) 2018; 36:79-82. [PMID: 30425829 PMCID: PMC6224334 DOI: 10.1016/j.amsu.2018.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 08/31/2018] [Accepted: 09/15/2018] [Indexed: 12/12/2022] Open
Abstract
Background Intra-abdominal adhesion is one of the most important complications of abdominopelvic surgery. It increases morbidity and mortality for patients. Although laparoscopy is the gold standard of adhesion diagnosis, it can cause visceral damage during the operation. Therefore, surgeons prefer to use non-invasive methods for planning the operation. We designed this study to evaluate transabdominal ultrasonography ( TAU) accuracy for diagnosing Intra-abdominal Adhesions Material & methods This double-blinded cohort study was conducted on 47 patients with previous laparotomy who undergo another surgery. Spontaneous visceral slide (SVS) and induced visceral slide (IVS) were measured during TAU. Results The mean age and BMI of 47 patients were 43.21±10.3 and 27.545±5.76. The majority of the patients were female (76%). Mean SVS and IVS in patients with intra-abdominal adhesion were 8.73±1.60 and 44.84±11.60. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of TAU in intra-abdominal diagnosis were 83.33%, 51.72%, 51.72%, 83.33%, 63.83%. Conclusions Although TAU is an appropriate method for detecting the intra-abdominal adhesion, it isn't good enough for diagnosing free adhesion area. We recommended further researches with greater sample size and other non-invasive techniques. Evaluation of accuracy, sensitivity, specificity, PPV, NPV for adhesion diagnosis. There are not a lot of studies on ultrasonography accuracy before. It’s an only double-blinded cohort study. Our study refers to high sensitivity and NPV for diagnosing the adhesion.
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Affiliation(s)
| | - Abbas Alibakhshi
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Hoorieh Alaeen
- Students' Research Scientific Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sanaz Zand
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Ryan Nazemian
- Institute for Transformative Molecular Medicine, Case Western Reserve University, Cleveland, USA
| | - Maryam Rahmani
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Department of Radiology, University of Medical Sciences, Tehran, Iran
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Kim SH, Kim KH, Ha TY, Jung DH, Park GC, Lee SG. Salvage living donor liver transplantation for recurrent hepatocellular carcinoma after prior laparoscopic hepatectomy. Hepatobiliary Pancreat Dis Int 2018; 17:473-476. [PMID: 30257795 DOI: 10.1016/j.hbpd.2018.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 09/10/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Seok-Hwan Kim
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Department of Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Ki-Hun Kim
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Tae-Yong Ha
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hwan Jung
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gil-Chun Park
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Gyu Lee
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Thermoresponsive polysaccharide-based composite hydrogel with antibacterial and healing-promoting activities for preventing recurrent adhesion after adhesiolysis. Acta Biomater 2018; 74:439-453. [PMID: 29803006 DOI: 10.1016/j.actbio.2018.05.037] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 01/11/2023]
Abstract
Postoperative adhesions are very common complications after general abdominal surgery. Although adhesiolysis has been proven effective in eliminating the preexisting adhesions, the new trauma caused by surgical lysis can induce recurrent adhesion. The prevention of recurrent adhesion after adhesiolysis is more difficult because the injury is more severe and adhesion mechanism is more complicated compared with the primary adhesion. In this study, a thermoresponsive hydrogel contained galactose modified xyloglucan (mXG) and hydroxybutyl chitosan (HBC) was developed as a barrier device for recurrent adhesion prevention after adhesiolysis due to its injectability and spontaneous gelling behaviors at the body temperature without any chemical reactions or extra driving factors. First, mXG and HBC were synthesized via enzymatic modification and etherification reaction, respectively. Rheological measurements indicated that the mXG/HBC composite system showed excellent thermosensitivity properties, and their gelation temperature and time can be modulated via adjusting the mXG/HBC ratio. Moreover, the mXG/HBC hydrogel exhibited excellent cytocompatibility and hemocompatibility in vitro. Furthermore, the mXG/HBC hydrogel could promote wound healing in the rat skin wound model. Finally, the efficacy of the mXG/HBC composite hydrogel in the prevention of recurrent adhesion was evaluated in a more rigorous rat repeated-injury adhesion model. The results demonstrated that the composite hydrogel could not only effectively prevent recurrent adhesion after adhesiolysis, but also promote wound healing and reduce scare formation. These results suggested that the mXG/HBC composite hydrogel may be a promising candidate as an injectable anti-adhesion system for clinical applications. STATEMENT OF SIGNIFICANCE Although adhesiolysis has been proven effective in eliminating the preexisting adhesions, the new trauma caused by surgical lysis can induce recurrent adhesion. So far, most of the existing barrier systems and pharmacological approaches were developed for primary adhesion prevention while few attention has paid on prevention of recurrent adhesion after adhesiolysis. In the present study, we developed a thermoresponsive polysaccharide-based composite hydrogel by simple mixing galactose modified xyloglucan (mXG) and hydroxybutyl chitosan (HBC). The resulting mXG/HBC composite hydrogel not only was easy to handle and highly effective in preventing the recurrent adhesion after adhesiolysis, but also could promote wound healing and reduce scare formation. Our study provide an effective anti-adhesion system for preventing recurrent adhesion after adhesiolysis.
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Influence of previous abdominal surgery on clinical outcomes of patients undergoing total laparoscopic hysterectomy. Obstet Gynecol Sci 2018; 61:379-385. [PMID: 29780781 PMCID: PMC5956122 DOI: 10.5468/ogs.2018.61.3.379] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/16/2017] [Accepted: 09/19/2017] [Indexed: 11/08/2022] Open
Abstract
Objective To evaluate the potential effects of previous abdominal surgery on post-operative outcome and incidence of complications after total laparoscopic hysterectomy (TLH). Methods Between June 2008 and December 2016, 331 patients who underwent TLH were retrospectively reviewed. Participating patients were divided into 2 groups according to previous abdominal surgery. We compared the 2 groups based on estimated blood loss, operation time, hospital stay, surgery-related complications, and conversion to laparotomy rates. Results Group 1 included patients without a history of abdominal surgery (n=186), group 2 included patients with a history of abdominal surgery (n=145). The complication rate was 3.2% in group 1 and 2.8% in group 2. Other post-operative outcome and complications such as estimated blood loss, hospital stay and conversion to laparotomy rates did not differ significantly between groups. Adhesiolysis was significantly more common in group 2 (P<0.001) and operation time was significantly longer in the group 2 (P=0.004). The rate of conversion to laparotomy was higher in group 2, but this difference was not significant (P=0.115). Group 2 patients were divided into subgroups according to the number of surgery. In subgroups analysis of group 2, there were 70 patients who had one previous abdominal surgery and 75 patients who had 2 or more previous surgeries. Moreover, there were significant differences in adhesiolysis (P=0.004) and conversion to laparotomy (P=0.034). There were no significant differences in other complications observed upon subgroup analysis. Conclusion TLH can be conducted successfully regardless of previous abdominal surgery. Patients with previous abdominal surgery are suitable and feasible candidates for TLH.
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Major P, Droś J, Kacprzyk A, Pędziwiatr M, Małczak P, Wysocki M, Janik M, Walędziak M, Paśnik K, Hady HR, Dadan J, Proczko-Stepaniak M, Kaska Ł, Lech P, Michalik M, Duchnik M, Kaseja K, Pastuszka M, Stepuch P, Budzyński A. Does previous abdominal surgery affect the course and outcomes of laparoscopic bariatric surgery? Surg Obes Relat Dis 2018; 14:997-1004. [PMID: 29801774 DOI: 10.1016/j.soard.2018.03.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 03/07/2018] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Global experiences in general surgery suggest that previous abdominal surgery may negatively influence different aspects of perioperative care. As the incidence of bariatric procedures has recently increased, it is essential to assess such correlations in bariatric surgery. OBJECTIVES To assess whether previous abdominal surgery influences the course and outcomes of laparoscopic bariatric surgery. SETTING Seven referral bariatric centers in Poland. METHODS We conducted a retrospective analysis of 2413 patients; 1706 patients who underwent laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) matched the inclusion criteria. Patients with no history of abdominal surgery were included as group 1, while those who had undergone at least 1 abdominal surgery were included as group 2. RESULTS Group 2 had a significantly prolonged median operation time for RYGB (P = .012), and the longest operation time was observed in patients who had previously undergone surgeries in both the upper and lower abdomen (P = .002). Such a correlation was not found in SG cases (P = .396). Groups 1 and 2 had similar rates of intraoperative adverse events and postoperative complications (P = .562 and P = .466, respectively). Group 2 had a longer median duration of hospitalization than group 1 (P = .034), while the readmission rate was similar between groups (P = .079). There was no significant difference between groups regarding the influence of the long-term effects of bariatric treatment on weight loss (percentage of follow-up was 55%). CONCLUSIONS Previous abdominal surgery prolongs the operative time of RYGB and the duration of postoperative hospitalization, but does not affect the long-term outcomes of bariatric treatment.
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Affiliation(s)
- Piotr Major
- Second Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland; Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland.
| | - Jakub Droś
- Students' Scientific Group at the Second Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Artur Kacprzyk
- Students' Scientific Group at the Second Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Michał Pędziwiatr
- Second Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland; Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Piotr Małczak
- Second Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland; Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Michał Wysocki
- Second Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland; Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Michał Janik
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Krzysztof Paśnik
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Hady Razak Hady
- First Clinical Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Jacek Dadan
- First Clinical Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Monika Proczko-Stepaniak
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Łukasz Kaska
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Paweł Lech
- Chair and Clinic of General, Minimally Invasive and Elderly Surgery, University of Warmia & Mazury, Olsztyn, Poland
| | - Maciej Michalik
- Chair and Clinic of General, Minimally Invasive and Elderly Surgery, University of Warmia & Mazury, Olsztyn, Poland
| | - Michał Duchnik
- Department of General and Vascular Surgery, Individual Public Voivodeship Joint Hospital, Szczecin, Poland
| | - Krzysztof Kaseja
- Department of General and Vascular Surgery, Individual Public Voivodeship Joint Hospital, Szczecin, Poland
| | - Maciej Pastuszka
- Department of General and Minimally Invasive Surgery, Łęczna, Poland
| | - Paweł Stepuch
- Department of General and Minimally Invasive Surgery, Łęczna, Poland
| | - Andrzej Budzyński
- Second Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland; Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
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Single-plane retroperitoneoscopic adrenalectomy: a new operative procedure for benign adrenal disease. Sci Rep 2018; 8:4027. [PMID: 29507374 PMCID: PMC5838216 DOI: 10.1038/s41598-018-22433-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/21/2018] [Indexed: 11/09/2022] Open
Abstract
To evaluate the therapeutic effect of single-plane retroperitoneoscopic adrenalectomy. From February 2014 to March 2017, 251 patients underwent single-plane retroperitoneoscopic adrenalectomy, and their operative outcomes were compared with those of 98 patients who underwent anatomical three-plane retroperitoneoscopic adrenalectomy. Among 35 patients with a body mass index (BMI) of ≥30 kg/m2, their operative outcomes were compared between two operative procedures. The demographic data and perioperative outcomes of the patients were statistically analysed. The single-plane and three-plane groups were comparable in terms of estimated blood loss, time to oral intake, hospital stay, and incidence of complications among patients with similar baseline demographics. The single-plane group had a significantly shorter operation time (46.9 ± 5.8 vs 54.8 ± 7.0 mins, P < 0.0001) and lower analgesia requirement (56/251 vs 33/98, p = 0.03). For obese patients with a BMI of ≥30 kg/m2, single-plane adrenalectomy was also associated with a significantly shorter operation time(48.1 ± 6.2 vs 64.1 ± 5.1 mins, p < 0.0001). Single-plane retroperitoneoscopic adrenalectomy is feasible, safe, and effective in the treatment of adrenal masses <5 cm in size and provides a shorter operation time and better pain control than anatomical retroperitoneal adrenalectomy, especially in obese patients.
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84
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Evaluation of the effects of Iranian propolis on the severity of post operational-induced peritoneal adhesion in rats. Biomed Pharmacother 2018; 99:346-353. [DOI: 10.1016/j.biopha.2018.01.068] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/06/2018] [Accepted: 01/11/2018] [Indexed: 12/29/2022] Open
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Ayachi A, Bouchahda R, Derouich S, Mkaouer L, Kehila M, Abouda H, Channoufi B, Bouyahia M, Braham M, Zhioua F, Bouchahda H, Mourali M. Accuracy of preoperative real-time dynamic transvaginal ultrasound sliding sign in prediction of pelvic adhesions in women with previous abdominopelvic surgery: prospective, multicenter, double-blind study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:253-258. [PMID: 28294441 DOI: 10.1002/uog.17465] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 02/19/2017] [Accepted: 03/03/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To investigate the role of the transvaginal sonographic (TVS) sliding sign in predicting pelvic adhesions in women with previous abdominopelvic surgery. METHODS This was a multicenter, prospective, interventional, double-blind study of patients with a history of abdominopelvic surgery who were undergoing laparoscopy or laparotomy during the 6-month period from March to August 2016 in one of three academic obstetrics and gynecology departments. Prior to surgery, patients were examined by TVS to assess the vesicouterine pouch, uterus, ovaries and pouch of Douglas, using the TVS pelvic sliding sign. Ultrasound findings and medical and surgical data were recorded. We assessed the accuracy of the preoperative TVS sliding sign in the prediction of pelvic adhesions overall and in each compartment separately. RESULTS During the study period, complete TVS sliding sign and laparoscopic or laparotomic data were available for 107 women. Their mean age was 44.0 (95% CI, 41.6-46.4; range, 20-79) years. Their mean parity was 2.0 (95% CI, 1.7-2.3; range, 0-9) and the mean number of previous abdominal surgical procedures per patient was 1.3 (95% CI, 1.2-1.5; range, 1-4). Adhesions were noted in 27/107 (25.2%) patients. The TVS sliding sign had a sensitivity of 96.3% and specificity of 92.6% in predicting pelvic adhesions. There was a significant relationship between adhesions in each compartment and the TVS sliding sign (P < 0.05). CONCLUSIONS The TVS sliding sign is an effective means to detect preoperatively pelvic adhesions in patients with previous abdominopelvic surgery. Use of such a non-invasive and well-tolerated technique could help in the planning of laparoscopy or laparotomy and counseling of these patients. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Ayachi
- Department of Obstetrics and Gynaecology, University Hospital of Bougatfa, Bizerte, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - R Bouchahda
- Department of Obstetrics and Gynaecology, Taher Sfar Hospital, Mahdia, Tunisia
| | - S Derouich
- Department of Obstetrics and Gynaecology, University Hospital of Bougatfa, Bizerte, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - L Mkaouer
- Department of Obstetrics and Gynaecology, University Hospital of Bougatfa, Bizerte, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - M Kehila
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Department of Obstetrics and Gynaecology, Neonatology and Maternity Center of Tunis, Tunis, Tunisia
| | - H Abouda
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Department of Obstetrics and Gynaecology, Neonatology and Maternity Center of Tunis, Tunis, Tunisia
| | - B Channoufi
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Department of Obstetrics and Gynaecology, Neonatology and Maternity Center of Tunis, Tunis, Tunisia
| | - M Bouyahia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Department of Obstetrics and Gynaecology, Aziza Othmana Hospital, Tunis, Tunisia
| | - M Braham
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Department of Obstetrics and Gynaecology, Aziza Othmana Hospital, Tunis, Tunisia
| | - F Zhioua
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Department of Obstetrics and Gynaecology, Aziza Othmana Hospital, Tunis, Tunisia
| | - H Bouchahda
- Department of Obstetrics and Gynaecology, Taher Sfar Hospital, Mahdia, Tunisia
| | - M Mourali
- Department of Obstetrics and Gynaecology, University Hospital of Bougatfa, Bizerte, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
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Uemura A, Fukayama T, Tanaka T, Hasegawa-Baba Y, Shibutani M, Tanaka R. Development of an Anti-Adhesive Membrane for Use in Video-Assisted Thoracic Surgery. Int J Med Sci 2018; 15:689-695. [PMID: 29910673 PMCID: PMC6001413 DOI: 10.7150/ijms.24050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/12/2018] [Indexed: 01/21/2023] Open
Abstract
Background: The need to prevent postoperative adhesions after surgery has been considered a significant challenge in thoracic surgery, especially with the advent of video-assisted thoracic surgery (VATS). While preventive materials for postoperative adhesions have been studied for many years, they are all still in the development phases. Methods: In this animal study, an insoluble hyaluronic acid membrane was used in VATS for wedge resection to test its operability and to examine the body's response to the membrane. Ten beagles were divided into two groups, an experimental group and a negative control group. In the experimental group, an insoluble hyaluronic acid membrane containing glycerol was used as the test membrane (10 x 10 x 0.1 cm3). The test membrane was implanted in the left thoracic cavity of the animal under VATS following wedge resection. The animals were observed for two weeks and then euthanized for examination. Results: Macroscopically, the median adhesion score was lower in the experimental group (0) than in the control group (2.5). On histopathological examination, the test membrane elicited only a minor inflammatory response and foreign body reaction. Conclusion: The test membrane showed satisfactory operability and appears to be a practical material to prevent postoperative adhesions after thoracic surgery in VATS.
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Affiliation(s)
- Akiko Uemura
- Tokyo University of Agriculture and Technology Animal Medical Center, 3-5-8 Saiwaicho, Fuchu-shi, Tokyo 183-8509, Japan
| | - Toshiharu Fukayama
- National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan
| | - Takashi Tanaka
- Tokyo University of Agriculture and Technology Animal Medical Center, 3-5-8 Saiwaicho, Fuchu-shi, Tokyo 183-8509, Japan
| | - Yasuko Hasegawa-Baba
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu-shi, Tokyo 183-8509, Japan
| | - Makoto Shibutani
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu-shi, Tokyo 183-8509, Japan
| | - Ryou Tanaka
- Tokyo University of Agriculture and Technology Animal Medical Center, 3-5-8 Saiwaicho, Fuchu-shi, Tokyo 183-8509, Japan
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Liu Z, Cheng S, Gu C, Pei H, Hong X. Effect of Hydrogen-Rich Saline on Postoperative Intra-Abdominal Adhesion Bands Formation in Mice. Med Sci Monit 2017; 23:5363-5373. [PMID: 29127274 PMCID: PMC5695092 DOI: 10.12659/msm.904669] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Postsurgical peritoneal adhesions (PPAs) are pathologic fibrous bands within the peritoneal cavity. The aim of this study was to investigate the protective effect of hydrogen-rich saline (HRS) on PPAs formation in mice. Material/Methods Adhesions were induced in mice using the cecum rubbing model. The mice were allocated into 4 groups: control sham group without cecum rubbing; PPA group with saline applied intraperitoneally (i.p.) daily after cecum rubbing; PPA+HRS (5) group with 5 ml/kg of HRS applied i.p. daily after cecum rubbing; and PPA+HRS (10) group with 10 ml/kg of HRS applied i.p. daily after cecum rubbing. On the 1st, 3rd, and 7th days after the operation, mice were killed and pathological adhesion bands were quantified to detect the effect of HRS on PPAs formation. Results HRS did not affect PPAs formation on the 1st day, but did make a significant reduction on the 3rd and 7th days. A significant increase of t-PA and decrease of TGF-β1 and PAI-1 in the peritoneal fluids were observed in the HRS-treated groups. The levels of MDA and MPO in the HRS-treated groups were significantly lower than those in the PPA group. TNF-α and IL-6 levels in HRS-treated groups significantly decreased compared with those in the PPA group on postoperative day 3 and 7. Moreover, HRS decreased the mRNA levels of pro-inflammatory cytokines and TGF-β1 expression in the postsurgical adhesion bands. Conclusions These results showed that HRS had therapeutic potential for preventing PPAs formation, possibly through balancing the expression of TGF-β1, t-PA, and PAI-1, and inhibiting oxidative stress and inflammation.
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Affiliation(s)
- Zhong Liu
- Department of Emergency Medicine, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Sanfang Cheng
- Department of Emergency Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Changwei Gu
- Department of Emergency Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Honghong Pei
- Department of Emergency Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Xin Hong
- Department of Emergency Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
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Yang Y, Liu X, Li Y, Wang Y, Bao C, Chen Y, Lin Q, Zhu L. A postoperative anti-adhesion barrier based on photoinduced imine-crosslinking hydrogel with tissue-adhesive ability. Acta Biomater 2017; 62:199-209. [PMID: 28867650 DOI: 10.1016/j.actbio.2017.08.047] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/07/2017] [Accepted: 08/24/2017] [Indexed: 11/19/2022]
Abstract
Postoperative adhesion is a serious complication that can further lead to morbidity and/or mortality. Polymer anti-adhesion barrier material provides an effective precaution to reduce the probability of postoperative adhesion. Clinical application requires these materials to be easily handled, biocompatible, biodegradable, and most importantly tissue adherent to provide target sites with reliable isolation. However, currently there is nearly no polymer barrier material that can fully satisfy these requirements. In this study, based on the photoinduced imine-crosslinking (PIC) reaction, we had developed a photo-crosslinking hydrogel (CNG hydrogel) that composed of o-nitrobenzyl alcohol (NB) modified carboxymethyl cellulose (CMC-NB) and glycol chitosan (GC) as an anti-adhesion barrier material. Under light irradiation, CMC-NB generated aldehyde groups which subsequently reacted with amino groups distributed on GC or tissue surface to form a hydrogel barrier that covalently attached to tissue surface. Rheological analysis demonstrated that CNG hydrogel (30mg/mL polymer content) could be formed in 30s upon light irradiation. Tissue adhesive tests showed that the tissue adhesive strength of CNG hydrogel (30mg/mL) was about 8.32kPa-24.65kPa which increased with increasing CMC-NB content in CNG hydrogel. Toxicity evaluation by L929 cells demonstrated that CNG hydrogel was cytocompatible. Furthermore, sidewall defect-cecum abrasion model of rat was employed to evaluate the postoperative anti-adhesion efficacy of CNG hydrogel. And a significantly reduction of tissue adhesion (20% samples with low score adhesion) was found in CNG hydrogel treated group, compared with control group (100% samples with high score adhesion). In addition, CNG hydrogel could be degraded in nearly 14days and showed no side effect on wound healing. These findings indicated that CNG hydrogel can effectively expanded the clinical treatments of postoperative tissue adhesion. STATEMENT OF SIGNIFICANCE In this study, a tissue adhesive photo-crosslinking hydrogel (CNG) was developed based on photo-induced imine crosslinking reaction (PIC) for postoperative anti-adhesion. CNG hydrogel showed the features of easy and convenient operation, fast and controllable gelation, suitable gel strength, good biocompatibility, and most importantly strong tissue adhesiveness. Therefore, it shows very high performance to prevent postoperative tissue adhesion. Overall, our study provides a more suitable hydrogel barrier material that can overcome the shortcomings of current barriers for clinical postoperative anti-adhesion.
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Affiliation(s)
- Yunlong Yang
- Key Laboratory for Advanced Materials, Institute of Fine Chemicals, East China University of Science and Technology, 130# Meilong Road, Shanghai 200237, China; Institute of Microsurgery on Extremities, Institute of Orthopaedic Surgery, Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People' Hospital, 600# Yishan Road, Shanghai 200233, China
| | - Xiaolin Liu
- Institute of Microsurgery on Extremities, Institute of Orthopaedic Surgery, Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People' Hospital, 600# Yishan Road, Shanghai 200233, China
| | - Yan Li
- Key Laboratory for Advanced Materials, Institute of Fine Chemicals, East China University of Science and Technology, 130# Meilong Road, Shanghai 200237, China
| | - Yang Wang
- Institute of Microsurgery on Extremities, Institute of Orthopaedic Surgery, Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People' Hospital, 600# Yishan Road, Shanghai 200233, China.
| | - Chunyan Bao
- Key Laboratory for Advanced Materials, Institute of Fine Chemicals, East China University of Science and Technology, 130# Meilong Road, Shanghai 200237, China
| | - Yunfeng Chen
- Institute of Microsurgery on Extremities, Institute of Orthopaedic Surgery, Department of Orthopaedic Surgery, Shanghai Jiaotong University Affiliated Sixth People' Hospital, 600# Yishan Road, Shanghai 200233, China
| | - Qiuning Lin
- Key Laboratory for Advanced Materials, Institute of Fine Chemicals, East China University of Science and Technology, 130# Meilong Road, Shanghai 200237, China.
| | - Linyong Zhu
- Key Laboratory for Advanced Materials, Institute of Fine Chemicals, East China University of Science and Technology, 130# Meilong Road, Shanghai 200237, China
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Vaginal Cuff Dehiscence Presenting with Free Air 60 Days after Robotic-Assisted Hysterectomy. Case Rep Surg 2017; 2017:5052634. [PMID: 29098108 PMCID: PMC5643087 DOI: 10.1155/2017/5052634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 07/11/2017] [Accepted: 07/24/2017] [Indexed: 12/02/2022] Open
Abstract
Introduction The vast majority of patients presenting with pneumoperitoneum have visceral organ perforation and require urgent diagnostic laparoscopy. Nonsurgical causes are relatively rare and may be attributed to multiple etiologies. Case Presentation Here we describe the case of a 38-year-old Caucasian female who presented to the emergency department with three days of cramping, epigastric abdominal pain. Her physical exam was notable for tenderness to palpation in the epigastric area and abdominal and chest X-rays showed free air under the diaphragm. Free air around the porta hepatis was verified on CT scan. Approximately 90% of pneumoperitoneum cases are due to perforation of visceral organs and therefore require operative management. An urgent exploratory laparoscopy revealed no clear source of free air, but postoperatively the patient developed a large volume of watery discharge from her vagina. Subsequent workup revealed a 1 cm vaginal cuff dehiscence which was later repaired with no postoperative complications. Conclusion Although the majority of patients with pneumoperitoneum require urgent exploratory laparoscopy, a careful diagnostic workup may reveal sources of free air that are not related to hollow viscous perforation. Vaginal cuff dehiscence represents a rare yet nonurgent source of pneumoperitoneum. This differential should be considered in light of the possible intra- and postoperative complications of surgery.
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Moris D, Chakedis J, Rahnemai-Azar AA, Wilson A, Hennessy MM, Athanasiou A, Beal EW, Argyrou C, Felekouras E, Pawlik TM. Postoperative Abdominal Adhesions: Clinical Significance and Advances in Prevention and Management. J Gastrointest Surg 2017; 21:1713-1722. [PMID: 28685387 DOI: 10.1007/s11605-017-3488-9] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 06/23/2017] [Indexed: 01/31/2023]
Abstract
Postoperative adhesions remain one of the more challenging issues in surgical practice. Although peritoneal adhesions occur after every abdominal operation, the density, time interval to develop symptoms, and clinical presentation are highly variable with no predictable patterns. Numerous studies have investigated the pathophysiology of postoperative adhesions both in vitro and in vivo. Factors such as type and location of adhesions, as well as timing and recurrence of adhesive obstruction remain unpredictable and poorly understood. Although the majority of postoperative adhesions are clinically silent, the consequences of adhesion formation can represent a lifelong problem including chronic abdominal pain, recurrent intestinal obstruction requiring multiple hospitalizations, and infertility. Moreover, adhesive disease can become a chronic medical condition with significant morbidity and no effective therapy. Despite recent advances in surgical techniques, there is no reliable strategy to manage postoperative adhesions. We herein review the pathophysiology and clinical significance of postoperative adhesions while highlighting current techniques of prevention and treatment.
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Affiliation(s)
- Demetrios Moris
- Department of Surgery, Ohio State University, Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Jeffery Chakedis
- Department of Surgery, Ohio State University, Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Amir A Rahnemai-Azar
- Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - Ana Wilson
- Department of Surgery, Ohio State University, Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | | | - Antonios Athanasiou
- Department of Surgery, Mercy University Hospital, Grenville Pl, Cork, Ireland
| | - Eliza W Beal
- Department of Surgery, Ohio State University, Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Chrysoula Argyrou
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Felekouras
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Timothy M Pawlik
- Department of Surgery, Ohio State University, Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
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91
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Comparison of honey and dextrose solution on post-operative peritoneal adhesion in rat model. Biomed Pharmacother 2017; 92:849-855. [DOI: 10.1016/j.biopha.2017.05.114] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/21/2017] [Accepted: 05/24/2017] [Indexed: 12/22/2022] Open
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92
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Zhang E, Li J, Zhou Y, Che P, Ren B, Qin Z, Ma L, Cui J, Sun H, Yao F. Biodegradable and injectable thermoreversible xyloglucan based hydrogel for prevention of postoperative adhesion. Acta Biomater 2017; 55:420-433. [PMID: 28391053 DOI: 10.1016/j.actbio.2017.04.003] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/21/2017] [Accepted: 04/03/2017] [Indexed: 11/19/2022]
Abstract
Peritoneal adhesion is very common after abdominal and pelvic surgery, which leads to a variety of severe complications. Although numerous pharmacological treatments and barrier-based devices have been investigated to minimize or prevent postoperative adhesion, the clinical efficacy is not very encouraging. In this work, a biodegradable and thermoreversible galactose modified xyloglucan (mXG) hydrogel was developed and the efficacy of mXG hydrogel in preventing postoperative peritoneal adhesion was investigated. The 4% (w/v) mXG solution was a free flowing sol at low temperature, but could rapidly convert into a physical hydrogel at body temperature without any extra additives or chemical reactions. In vitro cell tests showed that mXG hydrogel was non-toxic and could effectively resist the adhesion of fibroblasts. Moreover, in vitro and in vivo degradation experiments exhibited that mXG hydrogel was degradable and biocompatible. Finally, the rat model of sidewall defect-cecum abrasion was employed to evaluate the anti-adhesion efficacy of the mXG hydrogel. The results demonstrated that mXG hydrogel could effectively prevent postoperative peritoneal adhesion without side effects. The combination of suitable gel temperature, appropriate biodegradation period, and excellent postoperative anti-adhesion efficacy make mXG hydrogel a promising candidate for the prevention of postsurgical peritoneal adhesion. STATEMENT OF SIGNIFICANCE Despite numerous drugs or barrier-based devices have been developed to prevent postoperative adhesion, few solutions have proven to be uniformly effective in subsequent clinical trials. In the present study, we developed a biodegradable and thermoreversible galactose modified xyloglucan (mXG) hydrogel by green enzymatic reaction without using any organic reagents. The developed physical mXG hydrogel not only showed excellent injectability, appropriate gelation time and temperature, but also exhibited excellent biocompatibility and biodegradability both in vitro and in vivo. In addition, mXG hydrogel was easy to handle and could effectively prevent postoperative adhesion without side effects in a rat model of sidewall defect-bowel abrasion. Our study provide a safe and effective postoperative anti-adhesion material which may have potential applications in clinical practice.
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Affiliation(s)
- Ershuai Zhang
- School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China; Department of Basic Medical Sciences, North China University of Science and Technology, Tangshan 063000, China
| | - Junjie Li
- Department of Advanced Interdisciplinary Studies, Institute of Basic Medical Sciences and Tissue Engineering Research Center, Academy of Military Medical Sciences, Beijing 100850, China
| | - Yuhang Zhou
- School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China
| | - Pengcheng Che
- Department of Basic Medical Sciences, North China University of Science and Technology, Tangshan 063000, China
| | - Bohua Ren
- School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China
| | - Zhihui Qin
- School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China
| | - Litao Ma
- Department of Basic Medical Sciences, North China University of Science and Technology, Tangshan 063000, China
| | - Jing Cui
- Department of Basic Medical Sciences, North China University of Science and Technology, Tangshan 063000, China
| | - Hong Sun
- Department of Basic Medical Sciences, North China University of Science and Technology, Tangshan 063000, China; School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China.
| | - Fanglian Yao
- School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China; Key Laboratory of Systems Bioengineering of Ministry of Education, Tianjin University, Tianjin 300350, China.
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Ellison JS, Lendvay TS. Robot-assisted ureteroureterostomy in pediatric patients: current perspectives. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2017; 4:45-55. [PMID: 30697563 PMCID: PMC6193430 DOI: 10.2147/rsrr.s99536] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Developments in pediatric robotic surgery have increased the feasibility of minimally invasive surgery for complex urinary tract reconstruction. Ureteroureterostomy is a commonly employed strategy for the management of a duplicated ureteral system with either upper pole obstruction or lower pole vesicoureteral reflux, and this approach minimizes the risk to a healthy ureter as might be seen in a common sheath ureteral reimplant and avoids complex dissection around the renal hilum as with a heminephrectomy. The robotic platform enables optimum instrument manipulation for an end-to-side ureteral anastomosis as well as excellent visualization deep into the pelvis for excision of the distal ureteral stump. In this study, the indications and preoperative evaluation for pediatric robotic ureteroureterostomy (RUU) were described and intraoperative considerations for a successful repair were highlighted. In order to assess the outcomes, a PubMed search was performed to find the articles focusing on RUU in the pediatric population. The institutional experience of the authors was also reviewed. As with an open procedure, both minimizing dissection on the recipient ureter and ensuring a tension-free, watertight anastomosis are key principles to minimize complications. Although port placement is similar to that in robotic pyeloplasty, small adjustments may need to be made to ensure access to the pelvis. An assistant port and/or traction sutures is often used to aid in the dissection and anastomosis. RUU was first described in 2008, and several reports have demonstrated positive short-term results. However, median follow-up times are limited with most series reporting outcomes <1 year postoperatively. A future study is required to establish the long-term efficacy of this procedure and define the optimum patient population for a robotic approach.
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Affiliation(s)
- Jonathan S Ellison
- Division of Pediatric Urology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA,
| | - Thomas S Lendvay
- Division of Pediatric Urology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA,
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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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95
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Milyukov VE, Nguen KK. [Pathogenic aspects of stomach ulcerogenesis in acute intestinal obstruction]. Khirurgiia (Mosk) 2017:36-41. [PMID: 28374711 DOI: 10.17116/hirurgia2017336-41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To identify the patterns and the correlation of morphological and functional changes in stomach wall with the dynamics of different types of acute intestinal obstruction. MATERIAL AND METHODS The study was performed on 33 adult mongrel dogs of both genders weighing 17-20 kg. All researches were conducted in accordance with the documents, such as the 'Guide for the Care and Use of laboratory animals of the National Institute of Health (National Institute of Health - NIH, Bethesda, USA)' and 'Rules of work with experimental animals'. The same methods were used to study the morphology of stomach wall in normal conditions and after intestinal obstruction simulation. We used H & E stain, Van Gieson's picrofuchsin staining combined with Mallory. The choice of histochemical methods was determined by the need to study metabolic processes in epithelial cells and gastric mucosa glands. Einarson method for detecting total nucleic acids was used. The last group of methods was statistical analysis. RESULTS We determined the regularities of structural organization of microcirculation in various parts of the stomach, the correlation of morphological and functional changes in stomach wall with the dynamics of different types of acute intestinal obstruction. CONCLUSION Our data indicate proximal-distal gradient of gastric perfusion: the most pronounced vascular network and maximum blood flow are observed in proximal stomach in both normal conditions and acute intestinal obstruction. More tenuous and reduced blood flow was revealed in the antrum, that is morphological basis of the most frequent localization of acute ulcers in this department.
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Affiliation(s)
- V E Milyukov
- Department of Human Anatomy, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Moscow
| | - K K Nguen
- Department of Human Anatomy, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Moscow
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Tsauo J, Kim KY, Song HY, Park JH, Jun EJ, Kim MT, Yoon SH. Fluoroscopic Balloon Dilation for Treating Postoperative Nonanastomotic Strictures in the Proximal Small Bowel: A 15-Year Single-Institution Experience. J Vasc Interv Radiol 2017; 28:1141-1146. [PMID: 28283402 DOI: 10.1016/j.jvir.2017.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/03/2017] [Accepted: 01/05/2017] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To evaluate safety and effectiveness of fluoroscopic balloon dilation (FBD) for treating postoperative nonanastomotic strictures in proximal small bowel. MATERIALS AND METHODS Data of 44 patients (26 men and 18 women; mean age, 53.7 y ± 13.0) treated with FBD for postoperative nonanastomotic strictures in the proximal small bowel between January 2000 and February 2016 were retrospectively reviewed. Site of stricture was located in the first portion of duodenum in 8 (18.2%) patients, second portion of duodenum in 8 (18.2%) patients, third portion of duodenum in 1 (2.3%) patient, fourth portion of duodenum in 1 (2.3%) patient, and proximal jejunum in 26 (59.1%) patients. Mean distance between the most anal-side lesion and the oral cavity was 63.9 cm ± 15.0. RESULTS Technical success was achieved in 39 (88.6%) patients. Mean stricture length was 3.0 cm ± 1.8. Technical failure because of inability to negotiate the guide wire through the stricture occurred in 5 (13.6%) patients. Complete resolution of obstructive symptoms and resumption of oral intake of soft or solid food within 3 days occurred in 34 patients after 1 (n = 32) or 2 (n = 2) FBD sessions, rendering a clinical success rate of 87.2%. There were no major complications directly related to FBD. Median follow-up period was 1,406 days (interquartile range, 594-2,236 d). Nine (26.5%) patients had recurrence within a median 47 days (interquartile range, 20-212 d). CONCLUSIONS FBD may be safe and effective for treating postoperative nonanastomotic strictures in the proximal small bowel.
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Affiliation(s)
- Jiaywei Tsauo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea
| | - Kun Yung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea
| | - Ho-Young Song
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea.
| | - Jung-Hoon Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea
| | - Eun Jung Jun
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea
| | - Min Tae Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea
| | - Sung-Hwan Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea
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Biondo-Simões MDELP, Schiel WA, Arantes M, Silveira TDA, Robes RR, Tomasich FDS. Comparison between polypropylene and polypropylene with poliglecaprone meshes on intraperitoneal adhesion formation. Rev Col Bras Cir 2017; 43:416-423. [PMID: 28273225 DOI: 10.1590/0100-69912016006002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 09/29/2016] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE to compare intraperitoneal adhesion formation in rats when using polypropylene and polypropylene with poliglecaprone meshes. METHODS we used twenty male, Wistar rats, divided in two groups. In group 1, the rats received the polypropylene mesh on their right side and the polypropylene with poliglecaprone mesh on their left side. In group 2 the position of the meshes was inverted. After 30 days, we analyzed the presence or not of adhesion formation, including only those over the meshes. The findings undergone an analysis through the Mann-Whitney test, at a level of significance of p≤0.05. RESULTS all meshes presented adhesions. We verified that, for the polypropylene meshes, the percentage of their surface covered by adhesions varied from 10.5 to 100%, with an average of 34.07±24.21%, while for the polypropylene with poliglecaprone mesh, the percentage covered by adhesions varied between 8.5% and 100%, with an average of 44.7±32.85% (p=0.12). CONCLUSION both meshes lead to adhesion formation, none being superior to the other.
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Evaluation of surgical anti-adhesion products to reduce postsurgical intra-abdominal adhesion formation in a rat model. PLoS One 2017; 12:e0172088. [PMID: 28207824 PMCID: PMC5312873 DOI: 10.1371/journal.pone.0172088] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 01/31/2017] [Indexed: 11/29/2022] Open
Abstract
Background Adhesions frequently occur after abdominal surgery. Many anti-adhesion products have been used in clinic. However, the evidences are short for surgeons to reasonably choose the suitable anti-adhesion produces in clinical practice. This study provided such evidence by comparing the efficiency of five products to prevent abdominal adhesion formation in a rat model. Methods Fifty-six Sprague-Dawley rats were randomly divided into seven groups: sham-operation group, adhesion group, and five product groups (n = 8). The abdomens of rats were opened. The injuries were created on abdominal wall and cecum in the adhesion and product groups. The wounds on abdominal wall and cecum of rats in the adhesion group were not treated before the abdomens were closed. The wounds on abdominal wall and cecum of rats in the product groups were covered with anti-adhesion product: polylactic acid (PLA) film, Seprafilm®, medical polyethylene glycol berberine liquid (PEG), medical sodium hyaluronate gel (HA), or medical chitosan (Chitosan). Fourteen days after surgery, the adhesions were evaluated by incidence, severity, adhesion area on abdominal wall and adhesion breaking strength. Results The application of PLA film and Seprafilm® significantly reduced the incidence, severity, adhesion area and breaking strength of cecum-abdomen adhesion (P<0.05). HA, PEG and Chitosan failed to significantly reduce the cecum-abdomen adhesion (P>0.05). The statistical significances in the incidence and severity of abdomen-adipose adhesion between adhesion group and the product groups were not achieved. However, Seprafilm® was more effective to reduce abdomen-adipose adhesion than PLA film. Furthermore, it was found that the products tested in this study did not effectively reduce cecum-adipose adhesion. The application of PEG could result in abdomen-small intestine adhesion. Conclusion Based on the results of this study, the preference order of anti-adhesion products used to reduce postsurgical intra-abdominal adhesion formation is Seprafilm > PLA >> HA > Chitosan > PEG.
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Tabibian N, Swehli E, Boyd A, Umbreen A, Tabibian JH. Abdominal adhesions: A practical review of an often overlooked entity. Ann Med Surg (Lond) 2017; 15:9-13. [PMID: 28203370 PMCID: PMC5295619 DOI: 10.1016/j.amsu.2017.01.021] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/27/2017] [Accepted: 01/29/2017] [Indexed: 12/13/2022] Open
Abstract
Formation of intra-abdominal adhesions is a common consequence of abdomino-pelvic surgery, radiation therapy, and inflammatory processes. In a small but clinically significant proportion of patients, adhesive disease may develop, wherein adhesions lead to a variety of chronic symptoms such as abdominal distension, pain, nausea, and abnormal bowel movement pattern which can be daily, intermittent, or episodic. Due to the chronic and troublesome nature of these symptoms, adhesive disease may be life-altering in many patients, particularly when not recognized and appropriately addressed, as is the case not infrequently. In addition, there is a paucity of literature regarding the evaluation and management of patients with suspected abdominal adhesive disease. Therefore, in this concise review, we provide a clinically practical synopsis of the etiopathogenesis, symptoms, differential diagnosis, evaluation, and treatment of abdominal adhesive disease.
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Affiliation(s)
- N Tabibian
- Kaweah Delta Medical Center, Department of Family Medicine Residency Program, Visalia, CA, USA
| | - E Swehli
- Kaweah Delta Medical Center, Department of Family Medicine Residency Program, Visalia, CA, USA
| | - A Boyd
- Kaweah Delta Medical Center, Department of Family Medicine Residency Program, Visalia, CA, USA
| | - A Umbreen
- Kaweah Delta Medical Center, Department of Family Medicine Residency Program, Visalia, CA, USA
| | - J H Tabibian
- UC Davis Medical Center, Division of Gastroenterology and Hepatology, Sacramento, CA, USA
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Wang P, Chu W, Zhuo X, Zhang Y, Gou J, Ren T, He H, Yin T, Tang X. Modified PLGA–PEG–PLGA thermosensitive hydrogels with suitable thermosensitivity and properties for use in a drug delivery system. J Mater Chem B 2017; 5:1551-1565. [DOI: 10.1039/c6tb02158a] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PLGA–PEG–PLGA (PPP) triblock copolymer is the most widely studied thermosensitive hydrogel owing to its non-toxic, biocompatible, biodegradable, and thermosensitive properties.
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Affiliation(s)
- Puxiu Wang
- Department of Pharmaceutics
- Shenyang Pharmaceutical University
- Shenyang
- China
| | - Wei Chu
- Department of Pharmaceutics
- Shenyang Pharmaceutical University
- Shenyang
- China
| | - Xuezhi Zhuo
- Department of Pharmaceutics
- Shenyang Pharmaceutical University
- Shenyang
- China
| | - Yu Zhang
- Department of Pharmaceutics
- Shenyang Pharmaceutical University
- Shenyang
- China
| | - Jingxin Gou
- Department of Pharmaceutics
- Shenyang Pharmaceutical University
- Shenyang
- China
| | - Tianyang Ren
- Department of Pharmaceutics
- Shenyang Pharmaceutical University
- Shenyang
- China
| | - Haibing He
- Department of Pharmaceutics
- Shenyang Pharmaceutical University
- Shenyang
- China
| | - Tian Yin
- School of Functional Food and Wine
- Shenyang Pharmaceutical University
- Shenyang
- China
| | - Xing Tang
- Department of Pharmaceutics
- Shenyang Pharmaceutical University
- Shenyang
- China
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