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Wang H, Li M, Hu J, Wang C, Xu S, Han CC. Multiple Targeted Drugs Carrying Biodegradable Membrane Barrier: Anti-Adhesion, Hemostasis, and Anti-Infection. Biomacromolecules 2013; 14:954-61. [DOI: 10.1021/bm301997e] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Heran Wang
- State Key Laboratory
of Polymer Physics and Chemistry, Joint Laboratory
of Polymer Science and Materials, Beijing
National Laboratory for Molecular Sciences, Institute
of Chemistry, Chinese Academy of Sciences, Beijing 100190, P. R. China
- Graduate School of Chinese Academy of Sciences, Beijing 100049, P. R.
China
| | - Min Li
- The First Affiliated Hospital of Soochow University, Suzhou 215000, P. R.
China
| | - Jianming Hu
- The First Affiliated Hospital of Soochow University, Suzhou 215000, P. R.
China
| | - Chenhong Wang
- State Key Laboratory
of Polymer Physics and Chemistry, Joint Laboratory
of Polymer Science and Materials, Beijing
National Laboratory for Molecular Sciences, Institute
of Chemistry, Chinese Academy of Sciences, Beijing 100190, P. R. China
- Graduate School of Chinese Academy of Sciences, Beijing 100049, P. R.
China
| | - Shanshan Xu
- State Key Laboratory
of Polymer Physics and Chemistry, Joint Laboratory
of Polymer Science and Materials, Beijing
National Laboratory for Molecular Sciences, Institute
of Chemistry, Chinese Academy of Sciences, Beijing 100190, P. R. China
| | - Charles C Han
- State Key Laboratory
of Polymer Physics and Chemistry, Joint Laboratory
of Polymer Science and Materials, Beijing
National Laboratory for Molecular Sciences, Institute
of Chemistry, Chinese Academy of Sciences, Beijing 100190, P. R. China
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152
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Park JH, Jeong SH, Lee YJ, Choi SK, Hong SC, Jung EJ, Jeong CY, Ju YT, Ha WS. Current status of the use of antiadhesive agents for gastric cancer surgery: a questionnaire survey in South Korea. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 84:160-7. [PMID: 23487148 PMCID: PMC3594643 DOI: 10.4174/jkss.2013.84.3.160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 12/31/2012] [Accepted: 01/13/2013] [Indexed: 01/08/2023]
Abstract
PURPOSE The aim of this study was to investigate the current status of the use of antiadhesive agents (AAdAs) via a questionnaire and to discuss the availability of AAdAs. METHODS The survey was sent to a list of members that was approved by the Korean Gastric Association. The survey included questions on AAdA use by surgeons, the type of AAdAs used, and the reasons for not using AAdAs. Surgeons were also asked to describe complications related to AAdAs, and the reliability of its use. RESULTS The response rate was 21%. The rates of frequent use stratified by procedure were 26.9% (14/52) for open gastrectomy, 5.9% (3/51) for laparoscopic gastrectomy, and 31.5% (17/54) for surgery for postoperative bowel obstruction (P < 0.01). After including data from the occasional use group, the corresponding values were 51.9% (27/52), 19.6% (10/51), and 70.4% (38/54), respectively (P < 0.01). Sefrafilm and Guardix were most commonly used for open procedures. Guardix and Interceed were most commonly used for laparoscopic surgery. The primary reasons for nonuse of AAdAs were ineffectiveness and high cost. Ten percent (4/40) of surgeons observed complications associated with AAdAs. A minority (17.3%, 9/52) had positive attitudes toward AAdAs. The majority of respondents expressed neutral (73.1%, 38/52) or negative (9.6%, 5/52) attitudes toward AAdAs. CONCLUSION The low use rates of AAdAs in gastric cancer surgery may be attributable to perceptions that AAdAs are ineffective, unreliable, and costly. We anticipate the emergence of promising antiadhesive strategies that reach far beyond the limitations of current products.
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Affiliation(s)
- Ji-Ho Park
- Department Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
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153
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Yigitler C, Karakas DO, Kucukodaci Z, Cosar A, Gülec B, Akin ML. Adhesion-preventing properties of 4% icodextrin and canola oil: a comparative experimental study. Clinics (Sao Paulo) 2012; 67. [PMID: 23184208 PMCID: PMC3488990 DOI: 10.6061/clinics/2012(11)14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Postsurgical abdominal adhesions are common, serious postoperative complications. The present study compared the usefulness of 4% icodextrin and canola oil in preventing postoperative peritoneal adhesions. METHODS Twenty-four Wistar albino rats were divided into three groups. Following a laparotomy, a serosal abrasion was made by brushing the cecum, and 3 mL of 0.9% NaCl, 4% icodextrin, or 3 mL of canola oil were intraperitoneally administered for the control, icodextrin, and canola oil groups, respectively. The abdomen was then closed. All of the rats were sacrificed at day 10. Macroscopic, histopathological, and biochemical evaluations were performed. The results were statistically analyzed using Kruskal-Wallis and ANOVA tests. RESULTS Macroscopic analyses revealed that both canola oil and 4% icodextrin reduced adhesion formation, but the difference was not statistically significant (p = 0.17). The histopathological examinations revealed no significant differences in terms of giant cell, lymphocyte/plasmocyte, neutrophil, ICAM1, or PECAM1 scores. However, both canola oil and 4% icodextrin significantly reduced fibrosis (p = 0.025). In the canola oil group, the histiocytic reactions were significantly increased (p = 0.001), and the hydroxyproline levels were significantly lower than those in the other groups (p = 0.034). CONCLUSIONS In the present study, canola oil was determined to be superior to 4% icodextrin in lowering hydroxyproline levels and increasing histiocytic reactions. Considering these results, we believe that canola oil is a promising agent for preventing adhesion formation.
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Affiliation(s)
- Cengizhan Yigitler
- Department of General Surgery, Gülhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey.
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154
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Peyton CC, Keys T, Tomblyn S, Burmeister D, Beumer JH, Holleran JL, Sirintrapun J, Washburn S, Hodges SJ. Halofuginone infused keratin hydrogel attenuates adhesions in a rodent cecal abrasion model. J Surg Res 2012; 178:545-52. [PMID: 22901798 DOI: 10.1016/j.jss.2012.07.053] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 07/03/2012] [Accepted: 07/20/2012] [Indexed: 12/25/2022]
Abstract
BACKGROUND Postoperative adhesion formation continues to be a significant surgical complication, and methods for preventing abdominopelvic adhesions remain limited. Halofuginone (HF) is a type-1 collagen synthesis inhibitor and may enhance the effects of a physical barrier in preventing adhesion formation. We evaluated the effectiveness of a HF infused keratin hydrogel on preventing adhesions in a rat cecal abrasion model. MATERIAL AND METHODS Laparotomy and standardized cecal abrasion was performed on 58 retired-breeder Sprague Dawley female rats to induce intra-abdominal adhesions. Rats were randomized to: no treatment; Interceed absorbable adhesion barrier; keratin hydrogel alone; or keratin hydrogel infused with 22 μg/mL of HF. Necropsies were performed at postop d-14 to assess the extent and tenacity of adhesions and grade histologic inflammation and fibrosis using a standard scoring system. Serum, liver, kidneys, and lungs were harvested to evaluate tissue HF concentrations. Protein and drug elution curves were generated to assess the release of HF from the hydrogel. RESULTS Treatment with Keratin-HF hydrogel resulted in significantly fewer abdominal adhesions than any other treatment, and significantly less dense adhesions compared with Interceed or keratin hydrogel alone. Subset histologic analysis did not reveal qualitative differences. HF was undetectable in serum and kidneys, and detected at negligible concentrations in liver and lungs. Keratin-HF hydrogel drug release in phosphate-buffered solution (PBS) was sustained over 7 d and correlated with keratin protein degradation. CONCLUSIONS Keratin-HF hydrogel is a novel therapeutic agent that may provide a better method for preventing the development of postoperative adhesions using a combined physical barrier and pharmacologic approached.
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Affiliation(s)
- Charles C Peyton
- Department of Urology, Wake Forest University School of Medicine, Winston Salem, North Carolina 27157, USA.
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155
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Comparison of 4 % icodextrin and omega 3 Fatty acids in prevention of peritoneal adhesions. Indian J Surg 2012; 76:181-6. [PMID: 25177113 DOI: 10.1007/s12262-012-0661-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Accepted: 06/21/2012] [Indexed: 10/28/2022] Open
Abstract
Postoperative peritoneal adhesions are major concerns in abdominal surgery. In this experimental study, the effects of 4 % icodextrin and omega-3 fatty acids (ω-3 FA) on prevention of postoperative peritoneal adhesions were evaluated. Twenty-four Wistar albino rats were divided into three groups. After laparotomy, serosal abrasion was carried out by cecal brushing. Intraperitoneally 3 cm(3) 0.9 % NaCl, 3 cm(3) 4 % icodextrin, and 200 mg/kg ω-3 FAs for each group were applied, and then the abdomen was closed. All subjects sacrificed 10 days postoperatively. Macroscopic and histopathological cellular reactions as a function of giant cell, lymphocyte/plasmocyte, neutrophil, histiocyte, intracellular adhesion molecule-1 (ICAM-1), and platelet endothelial cell adhesion molecule-1 (PECAM-1) were assessed and hydroxyproline levels were measured in all three groups and compared using Kruskal-Wallis and ANOVA tests when appropriate. Macroscopically, both ω-3 FAs and 4 % icodextrin reduced adhesion formation but the difference was not statistically significant (P = 0.253). Histopathological examination revealed that there was no statistical significance in terms of giant cell, lymphocyte/plasmocyte, neutrophil, ICAM-1, and PECAM-1 scores; however, both ω-3 FAs and 4 % icodextrin were found to be prone to reduce fibrosis (P = 0.047), whereas in the ω-3 FA group, histiocytic reaction was significantly increased (P = 0.001), and hydroxyproline levels were significantly lower than other groups (P = 0.044). In this study, ω-3 FAs were found to be superior to 4 % icodextrin with the lower hydroxyproline level and greater histiocytic reaction. Considering these results, ω-3 FAs can be a promising agent in the prevention of adhesion formation.
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156
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Lou W, Zhang H, Ma J, Zhang D, Liu C, Wang S, Deng Z, Xu H, Liu J. In vivo evaluation of in situ polysaccharide based hydrogel for prevention of postoperative adhesion. Carbohydr Polym 2012; 90:1024-31. [PMID: 22840035 DOI: 10.1016/j.carbpol.2012.06.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 06/07/2012] [Accepted: 06/13/2012] [Indexed: 11/30/2022]
Abstract
In this paper, the carboxymethyl chitosan/oxidized dextran hydrogel was developed and its potency application in the prevention of postoperative adhesion was investigated. The developed hydrogel showed porous and interconnected interior structure with pore size about 250 μm, which was sensitive to lysozymic solution (1.5 μg/ml) with almost complete degradation after 4 weeks of in vitro incubation. In vivo study suggested that the developed hydrogel showed the great capacity on the prevention of postoperative adhesions in rat model. According to the result of histopathological examination, it clearly showed that the mesothelial cell layer of abdominal wall and cecum were completely recovered after 7 days of surgery in 3% carboxymethyl chitosan/oxidized dextran hydrogel group, while obvious adhesion between abdominal wall and cecum was observed as treatment with saline solution or 3% carboxymethyl chitosan solution after 1 day of surgery. All these results suggested that the developed biodegradable hydrogel might have potential application in the prevention of postoperative adhesion.
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Affiliation(s)
- Weiwei Lou
- Department of Prosthodontics, School & Hospital of Stomatology, Wenzhou Medical College, Wenzhou 325027, China
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157
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Electrospun anti-adhesion barrier made of chitosan alginate for reducing peritoneal adhesions. Carbohydr Polym 2012. [DOI: 10.1016/j.carbpol.2012.02.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Diamond MP, Burns EL, Accomando B, Mian S, Holmdahl L. Seprafilm® adhesion barrier: (1) a review of preclinical, animal, and human investigational studies. ACTA ACUST UNITED AC 2012; 9:237-245. [PMID: 22837732 PMCID: PMC3401296 DOI: 10.1007/s10397-012-0741-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 02/13/2012] [Indexed: 01/30/2023]
Abstract
The aim of this study was to provide a single site resource for investigators, clinicians, and others seeking preclinical, animal, and human investigational studies concerning the postsurgical, anti-adhesion barrier Seprafilm™ (Genzyme Corporation, Cambridge, MA). All published preclinical, animal, human extra-abdominal research as of July 2011 have been summarized and included in this document. Searches of Medline and EMBASE Drugs and Pharmaceuticals databases were conducted for original preclinical, animal, and human extra-abdominal studies involving Seprafilm. Preclinical, animal, and extra-abdominal human investigational studies are the study selection for this manuscript. Intraabdominal use is discussed in the accompanying manuscript. Data extraction includes systematic manuscript review. Summary of preclinical, animal, and extra-abdominal human investigational use of Seprafilm by surgical discipline were gathered for data synthesis. The clinical use of Seprafilm, which was approved by the FDA for intra-abdominal procedures, is supported by preclinical and animal studies relating to general surgical and obstetrical/gynecological applications. Findings from preclinical, animal, and human investigational studies at other sites throughout the body raises the potential for additional human clinical trials to assess efficacy and safety following surgical procedures at non-abdominal locations.
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Affiliation(s)
- Michael P. Diamond
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University, 60 West Hancock, Detroit, MI 48201 USA
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159
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Abstract
Safe management of small bowel obstruction (SBO) depends on rapid diagnosis. The objective of this study was to determine factors predictive for operation and resulting in operative delay. A retrospective review was done of 1613 patients over 4 years (2003 to 2007) with International Classification of Diseases, 9th Revision codes for SBO. After excluding patients with incomplete clinical data, incorrectly coded, and age younger than 5 years, 872 patients were reviewed. Analysis was done for factors predictive for operation and factors associated with operative delay. Statistics was done using t test, Wilcoxon-rank-sum, and χ2. Four hundred ninety-four patients (56.6%) underwent surgery for SBO. Three hundred seventy-eight patients (43.4%) were managed nonoperatively. Of factors examined, younger patients ( P = 0.001), no previous operation ( P < 0.001), and absence of adhesive disease ( P < 0.001) were more likely to go to operation. Acquiring a computed tomographic scan ( P = 0.029) or radiograph ( P < 0.001) were the only factors that increased time to the operating room (OR). Increased time to the OR was associated with a higher incidence of bowel resection. With those with time to OR less than 24 hours, 39 of 325 patients(12%) had bowel resection versus time to OR greater than 24 hours, 23 of 80 patients (29%) required bowel resection. Identifying patients who may safely undergo nonoperative management remains difficult. Delay in operation for SBO places patients at higher risk for bowel resection.
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Affiliation(s)
- Anna Mary Leung
- Department of Surgery, John Wayne Cancer Institute, Santa Monica, California
| | - Huan Vu
- Department of Surgery, Medical College of Virginia, Campus of Virginia Commonwealth University, Richmond, Virginia
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160
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A sprayable hyaluronate/carboxymethylcellulose adhesion barrier exhibits regional adhesion reduction efficacy and does not impair intestinal healing. J Gastrointest Surg 2012; 16:325-33. [PMID: 21983948 DOI: 10.1007/s11605-011-1709-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 09/20/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND While bioresorbable solid barriers such as Seprafilm® prevent adhesions, their efficacy is limited to sites of application. The aim of this study was to assess the effectiveness of the sprayable adhesion barrier Sepraspray® in preventing adhesions to sites of direct application and to remote sites. METHODS Intraabdominal adhesions were induced in 30 rats by creating three ischemic buttons on each side of a midline incision. To assess efficacy, Sepraspray (5 mg/button) or Seprafilm (1 cm(2)/button) was applied over three buttons on one side of the peritoneum. Operated control animals received no treatment. On day 7, adhesions were scored as percent of buttons with adhesions. To assess safety, 81 rats underwent a colonic transection repaired with an end-to-end anastomosis. Both barriers were applied circumferentially to anastomoses. Controls received no product. The integrity of healing anastomosed colonic wounds was assessed by burst pressure and tensile strength at days 3, 5, and 7 postoperatively. RESULTS The direct application of both Sepraspray and Seprafilm significantly (p < 0.001) reduced adhesion formation compared to controls. While Seprafilm had no remote effect on adhesion formation, Sepraspray significantly (p < 0.001) reduced adhesion formation to contralateral ischemic buttons. Neither barrier affected anastomotic integrity at any time point. CONCLUSIONS Sepraspray has widespread efficacy throughout the peritoneum in reducing adhesions without compromising intestinal healing. Furthermore, this sprayable alternative offers the potential for easier intraabdominal application.
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161
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Atta HM. Prevention of peritoneal adhesions: a promising role for gene therapy. World J Gastroenterol 2011; 17:5049-58. [PMID: 22171139 PMCID: PMC3235588 DOI: 10.3748/wjg.v17.i46.5049] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 07/14/2011] [Accepted: 07/21/2011] [Indexed: 02/06/2023] Open
Abstract
Adhesions are the most frequent complication of abdominopelvic surgery, yet the extent of the problem, and its serious consequences, has not been adequately recognized. Adhesions evolved as a life-saving mechanism to limit the spread of intraperitoneal inflammatory conditions. Three different pathophysiological mechanisms can independently trigger adhesion formation. Mesothelial cell injury and loss during operations, tissue hypoxia and inflammation each promotes adhesion formation separately, and potentiate the effect of each other. Studies have repeatedly demonstrated that interruption of a single pathway does not completely prevent adhesion formation. This review summarizes the pathogenesis of adhesion formation and the results of single gene therapy interventions. It explores the promising role of combinatorial gene therapy and vector modifications for the prevention of adhesion formation in order to stimulate new ideas and encourage rapid advancements in this field.
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162
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Hirschelmann A, Tchartchian G, Wallwiener M, Hackethal A, De Wilde RL. A review of the problematic adhesion prophylaxis in gynaecological surgery. Arch Gynecol Obstet 2011; 285:1089-97. [PMID: 22037682 PMCID: PMC3303068 DOI: 10.1007/s00404-011-2097-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 09/21/2011] [Indexed: 01/15/2023]
Abstract
Background Adhesions lead to considerable patient morbidity and are a mounting burden on surgeons and the health care system alike. Although adhesion formation is the most frequent complication in abdominal and pelvic surgery, many surgeons are still not aware of the extent of the problem. To provide the best care for their patients, surgeons should consistently inform themselves of anti-adhesion strategies and include these methods in their daily routine. Methods Searches were conducted in PubMed and The Cochrane Library to identify relevant literature. Findings Various complications are associated with adhesion formation, including small bowel obstruction, infertility and chronic pelvic pain. Increasingly, an understanding of adhesion formation as a complex process influenced by many different factors has led to various conceivable anti-adhesion strategies. At present, a number of different anti-adhesion agents are available. Although some agents have proved effective in reducing adhesion formation in randomised controlled trials, none of them can completely prevent adhesion formation. Conclusion To fulfil our duty to provide best possible care for our patients, it is now time to regard adhesions as the most common complication in surgery. Further research is needed to fully understand adhesion formation and to develop new strategies for adhesion prevention. Large clinical efficacy trials of anti-adhesion agents will make it easier for surgeons to decide which agent to use in daily routine.
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Affiliation(s)
- Anja Hirschelmann
- Pius-Hospital, Klinik für Frauenheilkunde und Geburtshilfe, Georgstraße 12, 26121 Oldenburg, Germany
| | - Garri Tchartchian
- Klinik für Minimal Invasive Chirurgie, Kurstraße 11, 14129 Berlin-Zehlendorf, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynaecology, Heidelberg University Hospital, Voßstraße 9, 69115 Heidelberg, Germany
| | - Andreas Hackethal
- Giessen School of Endoscopic Surgery, Klinikstraße 32, 35392 Giessen, Germany
| | - Rudy Leon De Wilde
- Pius-Hospital, Klinik für Frauenheilkunde und Geburtshilfe, Georgstraße 12, 26121 Oldenburg, Germany
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Laxa BU, Bouchard A, De Petris G, Heigh R, Heppell J. Eosinophilic enteritis confined to an ileostomy site. Case Rep Gastroenterol 2011; 5:422-7. [PMID: 21960943 PMCID: PMC3180657 DOI: 10.1159/000329990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Eosinophilic enteritis is a rather rare condition that can manifest anywhere from esophagus to rectum. Its description in the literature is sparse, but associations have been made with collagen vascular disease, malignancy, food allergy, parasitic or viral infections, inflammatory bowel disease, and drug sensitivity. We present the case of a 41-year-old male diagnosed with ulcerative colitis who underwent proctocolectomy with ileal pouch anal anastomosis and loop ileostomy formation utilizing Seprafilm®, who later developed eosinophilic enteritis of the loop ileostomy site. This is the first report of eosinophilic enteritis and its possible link to the use of bioabsorbable adhesion barriers.
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Affiliation(s)
- Bernadette U Laxa
- Department of Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, Ariz., USA
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164
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