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Liu X, Qiu X, Nie L, Zhou B, Bu P, Li Y, Xue X, Tang B, Feng Q, Cai K. Nonswellable Hydrogel Patch with Tissue-Mimetic Mechanical Characteristics Remodeling In Vivo Microenvironment for Effective Adhesion Prevention. ACS NANO 2024; 18:17651-17671. [PMID: 38932673 DOI: 10.1021/acsnano.4c02321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Postoperative adhesion is a common complication after abdominal surgery, but current clinical products have unsatisfactory therapeutic effects. Here, we present a hydrogel patch formed in a single step through dialysis. The exchange of DMSO into water facilitates hydrophobic aggregate in situ formation and the formation of hydrogen bonds within the hydrogel. Thanks to the optimized component ratio and precise structural design. The hydrogel patch has soft-tissue-like mechanical characteristics, including high strength, high toughness, low modulus similar to the abdominal wall, good fatigue resistance, and fast self-recovery properties. The nonswellable hydrogel patch retains over 80% of its original mechanical properties after 7 days of immersion in physiological saline, with a maximum swelling ratio of 5.6%. Moreover, the hydrophobic biomultifunctionality of benzyl isothiocyanate can self-assemble onto the hydrogel patch during the sol-gel transition process, enabling it to remodel the inflammatory microenvironment through synergistic antibacterial, antioxidant, and anti-inflammatory effects. The hydrogel patch prevents postsurgical adhesion in a rat sidewall defect-cecum abrasion model and outperforms the leading commercial Interceed. It holds promising potential for clinical translation, considering that FDA-approved raw materials (PVA and gelatin) form the backbone of this effective hydrogel patch.
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Affiliation(s)
- Xuezhe Liu
- Key Laboratory of Biorheological Science and Technology Ministry of Education, Collage of Bioengineering, Chongqing University, Chongqing 400044, China
| | - Xingan Qiu
- Chongqing Municipality Clinical Research Center for Geriatric Diseases, Chongqing 404000, China
- Chongqing University Three Gorges Hospital, Chongqing University, Chongqing 404000, China
| | - Linxia Nie
- School of Medicine, Chongqing University, Chongqing 40044, China
| | - Bikun Zhou
- Key Laboratory of Biorheological Science and Technology Ministry of Education, Collage of Bioengineering, Chongqing University, Chongqing 400044, China
| | - Pengzhen Bu
- Key Laboratory of Biorheological Science and Technology Ministry of Education, Collage of Bioengineering, Chongqing University, Chongqing 400044, China
| | - Yang Li
- Department of Pathology, The First Affiliated Hospital of the Army Medical University, Chongqing 400000, China
| | - Xinwen Xue
- Department of Pathology, The First Affiliated Hospital of the Army Medical University, Chongqing 400000, China
| | - Bo Tang
- Department of Pathology, The First Affiliated Hospital of the Army Medical University, Chongqing 400000, China
| | - Qian Feng
- Key Laboratory of Biorheological Science and Technology Ministry of Education, Collage of Bioengineering, Chongqing University, Chongqing 400044, China
| | - Kaiyong Cai
- Key Laboratory of Biorheological Science and Technology Ministry of Education, Collage of Bioengineering, Chongqing University, Chongqing 400044, China
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Bao YM, Ma WW, Li S, Jiang L, Yang MJ, Chen JY. The safety and efficacy of myomectomy in the treatment of recurrent uterine fibroids after HIFU. Int J Gynaecol Obstet 2024. [PMID: 38935313 DOI: 10.1002/ijgo.15757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 06/05/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE To evaluate the safety and efficacy of myomectomy for recurrent uterine fibroids (UFs) after high-intensity focused ultrasound (HIFU) ablation. METHODS This was a retrospective study. Patients who underwent abdominal myomectomy (AM) and laparoscopic myomectomy (LM) from January 2018 to December 2021 at the Three Gorges Hospital of Chongqing University were included. Among them, 73 had undergone prior HIFU ablation (Group 1), while 120 had not undergone HIFU (Group 2). Outcome measures included operating time, estimated blood loss (EBL), blood transfusion, postoperative activity times (PAT), duration of hospital stay (DOHS), and complications. RESULTS The operating time was 90.0 min (70.5, 115.0) for Group 1 and 110.0 min (81.5, 130.0) for Group 2 (P < 0.05). During all AM pathways, there were no significant differences observed between the two groups in EBL, blood transfusion, PAT, DOHS, and complications; however, operating time was shorter in Group 1. The operating time, EBL, blood transfusion, PAT, DOHS, and complications were similar in both groups during LM pathway. During the follow-up 40 (range: 24-53) months, the rate of relief, recurrence, and reintervention in Groups 1 and 2 was 78.1% versus 74.1%, 14.6% versus 16.4%, and 3.7% versus 2.6%, respectively (P > 0.05). CONCLUSION Myomectomy is a safe and effective surgical method for treating recurrent UFs after HIFU. Myomectomy for treating recurrent UFs resulted in a shorter operative and hospital stay, reduced blood loss, faster postoperative recovery, and fewer complications, better symptom relief rates, and lower risk of recurrence or reintervention. These findings indicate that previous HIFU ablation does not worsen the outcomes of the subsequent myomectomy.
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Affiliation(s)
- Yi-Ming Bao
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Three Gorges Hospital of Chongqing University, Chongqing, China
| | - Wang-Wa Ma
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Shuang Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Li Jiang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Mei-Jie Yang
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Jin-Yun Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
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Flutur IM, Păduraru DN, Bolocan A, Palcău AC, Ion D, Andronic O. Postsurgical Adhesions: Is There Any Prophylactic Strategy Really Working? J Clin Med 2023; 12:3931. [PMID: 37373626 DOI: 10.3390/jcm12123931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/01/2023] [Accepted: 06/04/2023] [Indexed: 06/29/2023] Open
Abstract
Postoperative adhesions are a frequent complication encountered after surgical procedures, mainly after intraperitoneal interventions. To this day, the pathophysiological mechanism behind the process of adhesions formation is not completely known. There are many strategies proposed as prophylaxis methods, involving surgical techniques, drugs or materials that prevent adhesions and even state of the art technologies such as nanoparticles or gene therapy. The aim of our review is to present these innovative approaches and techniques for postoperative adhesions prevention. After a thorough scientific database query, we selected 84 articles published in the past 15 years that were relevant to our topic. Despite all the recent groundbreaking discoveries, we are at an early stage of understanding the complexity of the adhesion formation mechanism. Further investigations should be made in order to create an ideal product for safe clinical use for prevention.
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Affiliation(s)
- Irina-Maria Flutur
- Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Dan Nicolae Păduraru
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- IIIrd Clinic of General and Emergency Surgery, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Alexandra Bolocan
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- IIIrd Clinic of General and Emergency Surgery, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Alexandru Cosmin Palcău
- IIIrd Clinic of General and Emergency Surgery, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Daniel Ion
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- IIIrd Clinic of General and Emergency Surgery, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Octavian Andronic
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- IIIrd Clinic of General and Emergency Surgery, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
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Ghobrial S, Ott J, Parry JP. An Overview of Postoperative Intraabdominal Adhesions and Their Role on Female Infertility: A Narrative Review. J Clin Med 2023; 12:jcm12062263. [PMID: 36983263 PMCID: PMC10051311 DOI: 10.3390/jcm12062263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Postoperative intraabdominal adhesions can occur after more than 90% of gynecologic surgeries. They not only cause chronic pelvic pain and small bowel obstruction, but are also one of the main reasons for infertility. Adhesions are not only a burden for the affected patients, but are also a burden for the healthcare system, since the treatment of adhesion-associated complications costs a considerable amount of money. The gold standard for the diagnosis of adhesions is by laparoscopy, although other methods, such as transvaginal hydro-laparoscopy, are being discussed as better alternatives. Ideally, adhesions are avoided inherently, by operating carefully and by using microsurgical principles. If this is not possible, gel barriers have been shown to be successful in reducing postoperative adhesions.
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Affiliation(s)
- Stefan Ghobrial
- Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Johannes Ott
- Clinical Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence: ; Tel.: +43-1-40400-28130
| | - John Preston Parry
- Parryscope and Positive Steps Fertility, Madison, Madison, WI 39110, USA
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, MS 39216, USA
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Devassy R, Torres-de la Roche LA, San Juan J, Krentel H, Becker S, De Wilde RL, Soliman A. To Laparoscopically Preserve Fertility in Intraabdominal Giant Myoma with Application of Contained In-Bag Morcellation: Mission Impossible? J Clin Med 2022; 11:jcm11154531. [PMID: 35956146 PMCID: PMC9369746 DOI: 10.3390/jcm11154531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 07/27/2022] [Indexed: 02/01/2023] Open
Abstract
A technical video was produced to demonstrate in step-by-step fashion a multiple contained myomectomy of a 20 × 30 cm giant myoma and seven additional fibroids found in the same patient, which required two different types of specimen retrieval bags for the electronic power morcellation. This complete surgical procedure included leiomyomata enucleation, contained in-bag electronic power morcellation, uterine reconstruction and the application of an adhesion prophylactic medical product.
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Affiliation(s)
- Rajesh Devassy
- University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, Carl von Ossietzky University, 26121 Oldenburg, Germany; (R.D.); (L.A.T.-d.l.R.); (J.S.J.); (H.K.); (A.S.)
| | - Luz Angela Torres-de la Roche
- University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, Carl von Ossietzky University, 26121 Oldenburg, Germany; (R.D.); (L.A.T.-d.l.R.); (J.S.J.); (H.K.); (A.S.)
| | - Johannes San Juan
- University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, Carl von Ossietzky University, 26121 Oldenburg, Germany; (R.D.); (L.A.T.-d.l.R.); (J.S.J.); (H.K.); (A.S.)
| | - Harald Krentel
- University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, Carl von Ossietzky University, 26121 Oldenburg, Germany; (R.D.); (L.A.T.-d.l.R.); (J.S.J.); (H.K.); (A.S.)
| | - Sven Becker
- Gynecologic Oncology and Gynecologic Specialties, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany;
| | - Rudy Leon De Wilde
- University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, Carl von Ossietzky University, 26121 Oldenburg, Germany; (R.D.); (L.A.T.-d.l.R.); (J.S.J.); (H.K.); (A.S.)
- Correspondence:
| | - Amr Soliman
- University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, Carl von Ossietzky University, 26121 Oldenburg, Germany; (R.D.); (L.A.T.-d.l.R.); (J.S.J.); (H.K.); (A.S.)
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High-Intensity Focused Ultrasound (HIFU) for Uterine Myoma Ablation Caused Incarcerated Internal Hernia. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03214-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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ShaykhoIslami A, Ghasemian M, Zardast M, Farzad M. Effect of intra-abdominal administration of ascites fluid on postoperative peritoneal adhesion in rat model: A randomized controlled trail. Ann Med Surg (Lond) 2021; 71:102928. [PMID: 34659745 PMCID: PMC8503846 DOI: 10.1016/j.amsu.2021.102928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Intra-abdominal adhesions are typically found after the most surgical procedures. Normally, most adhesions are asymptomatic; however, few individuals experience postoperative adhesion-related problems such as small bowel obstruction, pelvic pain, infertility, or other complications. We aimed to evaluate the preventive effect of the ascites fluid for postoperative peritoneal adhesions in rat models. Material and methods This experimental trial was conducted in Sixty Syrian male rat randomly assigned to six groups of 10 animals each as follows: control (group 1&4); normal saline (group 2&5): 2 mL of normal saline was poured into the peritoneal cavity; and case (group 3&6): 2 mL ascites fluid was poured into the peritoneal cavity. All animals in the six groups underwent laparotomy and measurable serosal injury were created with a standard technique. 10 and 30 days after initial surgery, the rats underwent another laparotomy in groups 1, 2, 3 and 4, 5, 6, respectively to assess macroscopic and microscopic adhesions, which were scored by an examiner who was blind to the animals̕ group assignment. Data analyzed by SPSS version 18, using the kruskal Wallis and Bonferroni-corrected Mann-Whitney U tests. P-values of less than 0.05 were considered significant. Results The mean scores of both microscopic and macroscopic adhesion were significantly different between all the groups (P < 0.05). Total macroscopic and microscopic adhesion scores were significantly lower in the ascites fluid treatment than in the control (P = 0.0001) or the normal saline (P < 0.001) group. There was no significant difference between adhesion intensity 10 and 30 days after laparotomy (P > 0.05). Conclusions Ascites fluid can decrease the possibility of post-operative intraperitoneal adhesion formation. Ascites fluid decreases post-operative adhesion formation. The intensity of adhesion did not differ over time. Ideal adhesion-reducing substances are still under investigation.
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Affiliation(s)
- Ali ShaykhoIslami
- Surgical Resident, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Mohammadreza Ghasemian
- Cardiovascular Diseases Research Center, Department of Surgery, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran.,Imamreza Clinical Research Development Unit, Birjand University of Medical Sciences, Birjand, Iran
| | - Mahmoud Zardast
- Department of Pathology, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Marjan Farzad
- Cardiovascular Diseases Research Center, School of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran.,Clinical Research Development Unit of Razi Hospital, Birjand University of Medical Sciences, Birjand, Iran
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Wang X, Liu Z, Sandoval-Salaiza DA, Afewerki S, Jimenez-Rodriguez MG, Sanchez-Melgar L, Güemes-Aguilar G, Gonzalez-Sanchez DG, Noble O, Lerma C, Parra-Saldivar R, Lemos DR, Llamas-Esperon GA, Shi J, Li L, Lobo AO, Fuentes-Baldemar AA, Bonventre JV, Dong N, Ruiz-Esparza GU. Nanostructured Non-Newtonian Drug Delivery Barrier Prevents Postoperative Intrapericardial Adhesions. ACS APPLIED MATERIALS & INTERFACES 2021; 13:29231-29246. [PMID: 34137251 DOI: 10.1021/acsami.0c20084] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
With the increasing volume of cardiovascular surgeries and the rising adoption rate of new methodologies that serve as a bridge to cardiac transplantation and that require multiple surgical interventions, the formation of postoperative intrapericardial adhesions has become a challenging problem that limits future surgical procedures, causes serious complications, and increases medical costs. To prevent this pathology, we developed a nanotechnology-based self-healing drug delivery hydrogel barrier composed of silicate nanodisks and polyethylene glycol with the ability to coat the epicardial surface of the heart without friction and locally deliver dexamethasone, an anti-inflammatory drug. After the fabrication of the hydrogel, mechanical characterization and responses to shear, strain, and recovery were analyzed, confirming its shear-thinning and self-healing properties. This behavior allowed its facile injection (5.75 ± 0.15 to 22.01 ± 0.95 N) and subsequent mechanical recovery. The encapsulation of dexamethasone within the hydrogel system was confirmed by 1H NMR, and controlled release for 5 days was observed. In vitro, limited cellular adhesion to the hydrogel surface was achieved, and its anti-inflammatory properties were confirmed, as downregulation of ICAM-1 and VCAM-1 was observed in TNF-α activated endothelial cells. In vivo, 1 week after administration of the hydrogel to a rabbit model of intrapericardial injury, superior efficacy was observed when compared to a commercial adhesion barrier, as histological and immunohistochemical examination revealed reduced adhesion formation and minimal immune infiltration of CD3+ lymphocytes and CD68+ macrophages, as well as NF-κβ downregulation. We presented a novel nanostructured drug delivery hydrogel system with unique mechanical and biological properties that act synergistically to prevent cellular infiltration while providing local immunomodulation to protect the intrapericardial space after a surgical intervention.
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Affiliation(s)
- Xichi Wang
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Zongtao Liu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Diego A Sandoval-Salaiza
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- School of Engineering and Science, Tecnologico de Monterrey, Monterrey, Nuevo Leon 64849, Mexico
| | - Samson Afewerki
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Department of Chemical Engineering and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
| | - Mildred G Jimenez-Rodriguez
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- School of Engineering and Science, Tecnologico de Monterrey, Monterrey, Nuevo Leon 64849, Mexico
| | - Lorena Sanchez-Melgar
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- School of Engineering and Science, Tecnologico de Monterrey, Monterrey, Nuevo Leon 64849, Mexico
| | - Gabriela Güemes-Aguilar
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- School of Medicine and Health Science, Tecnologico de Monterrey, Monterrey, Nuevo Leon 64849, Mexico
| | - David G Gonzalez-Sanchez
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- School of Medicine and Health Science, Tecnologico de Monterrey, Monterrey, Nuevo Leon 64849, Mexico
| | - Oscar Noble
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- School of Medicine and Health Science, Tecnologico de Monterrey, Monterrey, Nuevo Leon 64849, Mexico
| | - Cecilia Lerma
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- School of Engineering and Science, Tecnologico de Monterrey, Monterrey, Nuevo Leon 64849, Mexico
| | - Roberto Parra-Saldivar
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- School of Engineering and Science, Tecnologico de Monterrey, Monterrey, Nuevo Leon 64849, Mexico
| | - Dario R Lemos
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
| | - Guillermo A Llamas-Esperon
- Department of Interventional Cardiology, Hospital Cardiológica, Aguascalientes, Aguascalientes 20230, Mexico
| | - Jiawei Shi
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Li Li
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
| | - Anderson O Lobo
- LIMAV-Interdisciplinary Laboratory for Advanced Materials, BioMatLab group, Material Science and Engineering Graduate Program, UFPI- Federal University of Piauí, Teresina, Piauí 64049-550, Brazil
| | - Andres A Fuentes-Baldemar
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
| | - Joseph V Bonventre
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Guillermo U Ruiz-Esparza
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
- Division of Health Sciences and Technology, Harvard University - Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, United States
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, United States
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Liu X, Dong X, Mu Y, Huang G, He J, Hu L. High-intensity focused ultrasound (HIFU) for the treatment of uterine fibroids: does HIFU significantly increase the risk of pelvic adhesions? Int J Hyperthermia 2021; 37:1027-1032. [PMID: 32873107 DOI: 10.1080/02656736.2020.1811903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To investigate the prevalence of pelvic adhesions in patients with uterine fibroids after high-intensity focused ultrasound (HIFU) treatment, then analyze the influencing factors of pelvic adhesions. MATERIALS AND METHODS From October 2010 to March 2020, a total of 2619 patients with uterine fibroids underwent either hysterectomy, myomectomy, or cesarean section in Suining Central Hospital of Sichuan province. Of the 2619 patients, 810 were excluded because of a documented history of either pelvic infections, endometriosis, prior abdominopelvic surgery, or gynecological malignancies; 1809 patients were enrolled and the data were retrospectively assessed for the prevalence and patterns of pelvic adhesions. Among them, 96 patients with uterine fibroids had had prior HIFU treatment (HIFU group), 1713 patients had not had HIFU or surgical treatments (control group). RESULTS Among the 96 patients in the HIFU group, adhesions were detected in 42 patients, the incidence of pelvic adhesion being 43.75%; the 1713 patients in the control group, adhesions were detected in 619 patients, the prevalence of pelvic adhesion being 36.14%. No statistically significant difference in the incidence of adhesion between the two groups was observed (p = .132), no significant difference in location of pelvic adhesions between the two groups and no significant difference in the severity of adhesions between the two groups was observed (p > .05). CONCLUSIONS Based on our results with limited numbers, we concluded that HIFU treatment did not significantly increase the risk of pelvic adhesions.
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Affiliation(s)
- Xiaofang Liu
- Department of Gynecology and Obstetrics, Second Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Xiaojing Dong
- Department of Gynecology and Obstetrics, Second Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Yan Mu
- Department of Gynecology and Obstetrics, Suining Central Hospital, Sichuan, PR China
| | - Guohua Huang
- Department of Gynecology and Obstetrics, Suining Central Hospital, Sichuan, PR China
| | - Jia He
- Department of Gynecology and Obstetrics, Suining Central Hospital, Sichuan, PR China.,Department of Gynecology and Obstetrics, Suining Municipal Hospital of Traditional Chinese Medicine, Sichuan, PR China
| | - Lina Hu
- Department of Gynecology and Obstetrics, Second Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
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Zhang S, Xu Z, Wen X, Wei C. A nano chitosan membrane barrier prepared via Nanospider technology with non-toxic solvent for peritoneal adhesions' prevention. J Biomater Appl 2021; 36:321-331. [PMID: 33840253 DOI: 10.1177/08853282211008109] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Peritoneal adhesion is one of the most common postsurgical complications and can cause bowel obstruction, pelvic pain, and infertility. Setting up a physical barrier directly between the injured site and surrounding tissues is an effective solution for preventing this adverse situation. This study investigated a chitosan electrospun membrane (CSEM) as a potent anti-adhesion barrier, which was prepared by a needleless technology called Nanospider. Scanning electron microscopy revealed that CSEM is a laminated nanofiber with good mechanical properties. The fiber is uniform with the diameter distributing in the range of 100-120 nm. The tensile strength can reach 27.45 ± 6.30 MPa with a maximum elongation at break of 18.50 ± 1.44%, which makes it stick easily to damaged parts but not to be easily damaged by tissue friction. The growth of S. aureus on CSEM was 59.18% lower than the control at 10 h, which indicates its better antibacterial property. In addition, CSEM has good coagulant and biocompatibility characteristics. It can perform hemostatic function within 10 min and the L929 mouse fibroblast viability on it was 92.18% ± 1.08% on the seventh day. In vivo experiments indicated that CSEM significantly prevented peritoneal adhesions within four weeks after surgery with wound surface coverage. These results indicate that CSEM is a promising anti-adhesion barrier material.
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Affiliation(s)
- Shuo Zhang
- School of Perfume and Aroma Technology, Shanghai Institute of Technology, Shanghai, China
| | - Zhuoyue Xu
- School of Perfume and Aroma Technology, Shanghai Institute of Technology, Shanghai, China
| | - Xuejun Wen
- School of Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Changzheng Wei
- Shanghai Qisheng Biological Preparation Co. Ltd., Shanghai, China
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11
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Nakashima M, Takeuchi M, Kawakami K. Effectiveness of barrier agents for preventing postoperative bowel obstruction after laparoscopic surgery: a retrospective cohort study. Surg Today 2021; 51:1335-1342. [PMID: 33646411 DOI: 10.1007/s00595-021-02258-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/18/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The effectiveness of using anti-adhesion agents in laparoscopic surgery is controversial. We compared the outcomes of patients exposed to anti-adhesion agents (barrier group) with those of patients not exposed (no barrier group) in laparoscopic surgery. METHODS Using a nationwide claim-based database in Japan, we analyzed data from patients who underwent laparoscopic surgery between 2005 and 2019 and compared the patient characteristics and the proportion of those with bowel obstruction between the barrier and no barrier groups. We also performed several sensitivity and subgroup analyses. RESULTS Of the 57,499 patients who met the inclusion criteria, 14,360 and 43,139 were assigned to the barrier and no barrier groups, respectively. The proportion of patients with a bowel obstruction in the two groups did not differ among all patients hospitalized for obstruction (1.1 vs. 1.1%, p = 0.63) and those requiring surgery (0.2 vs. 0.2%, p = 0.39). In the sensitivity analysis with propensity score matching, the incidences of bowel obstruction between the barrier and non-barrier groups were equivocal (1.3 vs. 1.6%), but statistically marginal (chi-square test, p = 0.035; log-rank test, p = 0.09). CONCLUSION The use of barrier agents for adhesive prevention did not show clear effectiveness for the prevention of bowel obstruction after laparoscopic surgery for unselected cases. Further studies focusing on more specific procedures are needed.
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Affiliation(s)
- Masayuki Nakashima
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoecho, Sakyoku, Kyoto, 606-8501, Japan
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoecho, Sakyoku, Kyoto, 606-8501, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoecho, Sakyoku, Kyoto, 606-8501, Japan.
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12
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Kang S, Park S, Baek I, Song Y, Kim S, Choi D, Kim J, Lee Y. Development of poly(D,L-lactic-co-glycolic acid) films coated with biomembrane-mimicking polymers for anti-adhesion activity. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 120:111780. [PMID: 33545908 DOI: 10.1016/j.msec.2020.111780] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/12/2020] [Accepted: 11/26/2020] [Indexed: 12/19/2022]
Abstract
A physical barrier is one of the most effective strategies to alleviate excessive postoperative adhesion (POA) between tissues at an injury site. To overcome the limitations of current polymeric film-type physical barriers, we suggest a film of poly(lactic-co-glycolic acid) (PLGA) that is non-covalently coated with poly(2-methacryloyloxyethyl phosphorylcholine (MPC)-co-n-butyl methacrylate (BMA)) (PMB). While maintaining the degradability and mechanical properties of PLGA, the PMB coating introduces strong anti-adhesive properties to the film by forming a zwitterionic MPC-based surface through the hydrophobic interactions between BMA moieties and PLGA. Compared to SurgiWrap®, the commercially available poly(lactic acid)-based anti-adhesive film against POA, the PMB-coated PLGA film is much more inhibitory against protein adsorption and fibroblast adhesion, processes that are crucial to the POA process. PMB coating also inhibits the expression of fibronectin containing extra domain A (FN-EDA), α-smooth muscle actin (α-SMA), and collagen type IV alpha 2 (COL4A2), which are marker genes and proteins involved in fibroblast activation and excessive fibrosis during POA. Such inhibitory activities are clearly observed in a 3-dimensional culture of fibroblasts within a collagen matrix, which mimics the in vivo environment of an injury site, as well as in a 2-dimensional culture. The kinetics and the stability of the PMB coating suggest potential future clinical use to coat PLGA films to create a film-type anti-adhesion barrier that overcomes the limitations of current products.
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Affiliation(s)
- Sunah Kang
- Department of Chemistry, College of Natural Sciences, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Sohyun Park
- Department of Chemistry, College of Natural Sciences, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Insu Baek
- SOLSION Biomedical, Inc., 25, Gasan digital 1-ro, Geumcheon-gu, Seoul 08594, Republic of Korea
| | - Youngjun Song
- Department of Chemistry, College of Natural Sciences, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Sungwhan Kim
- Department of Chemistry, College of Natural Sciences, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Dongkil Choi
- Department of Chemistry, College of Natural Sciences, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Jungah Kim
- Department of Chemistry, College of Natural Sciences, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Yan Lee
- Department of Chemistry, College of Natural Sciences, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.
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13
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Stapleton LM, Lucian HJ, Grosskopf AK, Smith AAA, Totherow KP, Woo YJ, Appel EA. Dynamic Hydrogels for Prevention of Post‐Operative Peritoneal Adhesions. ADVANCED THERAPEUTICS 2021. [DOI: 10.1002/adtp.202000242] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | - Haley J. Lucian
- Department of Cardiothoracic Surgery Stanford University School of Medicine Stanford CA 94305 USA
| | - Abigail K. Grosskopf
- Department of Materials Science and Engineering Stanford University Stanford CA 94305 USA
| | - Anton A. A. Smith
- Department of Materials Science and Engineering Stanford University Stanford CA 94305 USA
| | | | - Y. Joseph Woo
- Department of Bioengineering Stanford University Stanford CA 94305 USA
- Department of Cardiothoracic Surgery Stanford University School of Medicine Stanford CA 94305 USA
| | - Eric A. Appel
- Department of Bioengineering Stanford University Stanford CA 94305 USA
- Department of Materials Science and Engineering Stanford University Stanford CA 94305 USA
- ChEM‐H Institute Stanford University Stanford CA 94305 USA
- Department of Pediatrics (Endocrinology) Stanford University School of Medicine Stanford CA 94305 USA
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14
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Herrmann A, Torres-de la Roche LA, Krentel H, Cezar C, de Wilde MS, Devassy R, De Wilde RL. Adhesions after Laparoscopic Myomectomy: Incidence, Risk Factors, Complications, and Prevention. Gynecol Minim Invasive Ther 2020; 9:190-197. [PMID: 33312861 PMCID: PMC7713662 DOI: 10.4103/gmit.gmit_87_20] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/10/2020] [Accepted: 07/10/2020] [Indexed: 12/23/2022] Open
Abstract
Uterine fibroids or uterine myomas are one of the most common benign diseases of the uterus. Symptoms associated with myomas can make surgical removal of myomas necessary. Besides the traditional abdominal route, laparoscopic myomectomy (LM) has gained more acceptances over the last few decades, and it is anticipated that laparoscopy is associated with lower adhesion development. Therefore, we conducted this review to analyze the evidence on adhesions after LM. The PubMed database was searched using the search terms “myomectomy” alone and in combination with “adhesions,” “infertility OR fertility outcome,” and “laparoscopy” among articles published in English and German. Although the well-known advantages of laparoscopy, for example, less pain, less blood loss, or shorter hospital stay, myomectomy belongs to high-risk operations concerning adhesion formation, with at least every fifth patient developing postsurgical adhesions. In laparoscopic surgery, surgeons´ experience as well tissue trauma, due to desiccation and hypoxia, are the underlying mechanisms leading to adhesion formation. Incisions of the posterior uterus may be associated with a higher rate of adhesions compared to anterior or fundal incisions. Adhesions can be associated with severe complications such as small bowel obstruction, chronic pelvic pain, complications in further operations, or impaired fertility. Tissue trauma and the experience of the surgeon in laparoscopic surgery are most of the influencing factors for adhesion formation after myomectomy. Therefore, every surgeon should adopt strategies to reduce adhesion development in daily routine, especially when it conducted to preserve or restore fertility.
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Affiliation(s)
- Anja Herrmann
- University Hospital for Gynecology Pius Hospital, University of Oldenburg, Germany
| | | | - Harald Krentel
- University Hospital for Gynecology Pius Hospital, University of Oldenburg, Germany
| | - Cristina Cezar
- University Hospital for Gynecology Pius Hospital, University of Oldenburg, Germany
| | - Maya Sophie de Wilde
- University Hospital for Gynecology Pius Hospital, University of Oldenburg, Germany
| | - Rajesh Devassy
- University Hospital for Gynecology Pius Hospital, University of Oldenburg, Germany
| | - Rudy Leon De Wilde
- University Hospital for Gynecology Pius Hospital, University of Oldenburg, Germany
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15
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Learning curve analysis of applying Seprafilm hyaluronic acid/carboxymethylcellulose membrane during laparoscopic hysterectomy. Sci Rep 2020; 10:16592. [PMID: 33024214 PMCID: PMC7538582 DOI: 10.1038/s41598-020-73692-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 09/20/2020] [Indexed: 01/22/2023] Open
Abstract
This study was designed to evaluate the learning curve of applying Seprafilm (modified hyaluronic acid and carboxymethylcellulose; Genzyme, Cambridge, MA, USA) during laparoscopic hysterectomy or subtotal hysterectomy with or without adnexectomy. In this retrospective cohort study, 35 patients who underwent laparoscopic hysterectomy or subtotal hysterectomy with or without adnexectomy were enrolled. The Seprafilm was cut into 4 pieces, rolled up with a trimmed plastic sleeve and delivered through an incision wound made for the 5-mm ancillary trocar. The membrane was unrolled and placed on the rough surface after hysterectomy or subtotal hysterectomy with or without adnexectomy. The time from the insertion of the first piece of membrane into the abdominal cavity to the complete removal of the trimmed plastic sleeve was recorded. The median time for Seprafilm placement was 3 min. The learning curve was analyzed using the power-law method and suggested that 10 cases were required to achieve proficiency in the procedure. The presence of adnexectomy was significantly associated with the time required for Seprafilm placement (P < 0.001). Although Seprafilm placement is more complicated compared to the liquid and gel forms of anti-adhesion barriers, surgical proficiency seemed to be attained after 10 cases for an experienced surgeon.
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16
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Kishan A, Buie T, Whitfield-Cargile C, Jose A, Bryan L, Cohen N, Cosgriff-Hernandez E. In vivo performance of a bilayer wrap to prevent abdominal adhesions. Acta Biomater 2020; 115:116-126. [PMID: 32846239 DOI: 10.1016/j.actbio.2020.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 12/27/2022]
Abstract
There is a high prevalence of intra-abdominal adhesions following bowel resection, which can result in chronic pain, bowel obstruction, and morbidity. Although commercial adhesion barriers have been widely utilized for colonic resections, these barriers do not prevent anastomotic leakage resulting from reduced healing of the anastomosis, which can result in long-term health problems. To address this limitation, we have developed an adhesive bilayer wrap with selective bioactivity to simultaneously prevent intra-abdominal adhesion formation and promote anastomotic healing. Reactive electrospinning was used to generate a crosslinked gelatin mesh to serve as a cell-instructive substrate to improve anastomotic healing. A coating of poly(ethylene glycol) (PEG) foam was applied to the bioactive mesh to generate an antifouling layer and prevent intra-abdominal adhesions. After in vitro confirmation of selective bioactivity, the composite wrap was compared after 2 weeks to a commercial product (InterceedⓇ) in an in vivo rat colonic abrasion model for prevention of intra-abdominal adhesions. The composite bilayer wrap was able to prevent intra-abdominal adhesions when clinical placement was maintained. The composite bilayer wrap was further modified to include tissue adhesive properties for improved efficacy. Preliminary studies indicated that the adhesive composite bilayer wrap maintained a maximum shear strength comparable to InterceedⓇ and greater than fibrin glue. Overall, this work resulted in an initial proof-of-concept device that was shown to effectively prevent intra-abdominal adhesion formation in vivo. The composite bilayer wrap studied here could lead to an improved technology for improved healing of intestinal anastomoses.
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Affiliation(s)
- Alysha Kishan
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, 77843 United States.
| | - Taneidra Buie
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712 United States.
| | - Canaan Whitfield-Cargile
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, 77843 United States.
| | - Anupriya Jose
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712 United States.
| | - Laura Bryan
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, 77843 United States.
| | - Noah Cohen
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, 77843 United States.
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17
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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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18
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Torres-de la Roche LA, Devassy R, de Wilde MS, Cezar C, Krentel H, Korell M, De Wilde RL. A new approach to avoid ovarian failure as well function-impairing adhesion formation in endometrioma infertility surgery. Arch Gynecol Obstet 2020; 301:1113-1115. [PMID: 32206876 DOI: 10.1007/s00404-020-05483-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Deep ovarian endometriosis surgery is likely to be associated with diffuse bleeding, intraoperative ovarian tissue destruction and perioperative adhesion formation. A new surgical approach is hereby proposed to avoid the negative short-term impact of classic laparoscopic cystectomy on ovarian reserve. RESULTS The need for intraoperative periovarian coagulation after endometrioma excision was avoided by combining the gold standard minimal-access endometrioma stripping technique with a purely plant-based medical product with high-hemostatic and antiadhesion barrier properties. CONCLUSION Endometrioma stripping followed by the application of a polysaccharide agent could avoid ovarian failure and at same time could reduce adhesion formation, thereby preserving tubo-ovarian function in endometrioma surgery. We encourage other surgically working groups to investigate middle- and long-term effects of this combined technique.
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Affiliation(s)
- Luz Angela Torres-de la Roche
- University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, Georgstrasse 12, 26121, Oldenburg, Germany
| | - Rajesh Devassy
- Department of Obstetrics and Gynecology, Dubai London Clinic and Speciality Hospital, 3371500, Dubai, United Arab Emirates
| | - Maya Sophie de Wilde
- University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, Georgstrasse 12, 26121, Oldenburg, Germany
| | - Cristina Cezar
- University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, Georgstrasse 12, 26121, Oldenburg, Germany
| | - Harald Krentel
- University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, Georgstrasse 12, 26121, Oldenburg, Germany
| | - Matthias Korell
- Department of Obstetrics and Gynecology, Johanna-Etienne-Hospital, 41462, Neuss, Germany
| | - Rudy Leon De Wilde
- University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, Georgstrasse 12, 26121, Oldenburg, Germany.
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19
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Lang J, Ma D, Xiang Y, Hua K, Liu K, Pan L, Wang P, Yao S, Zhao F, Cheng W, Cui M, Guo H, Guo R, Hong L, Li P, Liu M, Meng Y, Wang H, Wang J, Wang W, Wu M, Yang X, Zhang J. Chinese expert consensus on the prevention of abdominal pelvic adhesions after gynecological tumor surgeries. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:79. [PMID: 32175372 DOI: 10.21037/atm.2020.02.53] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Adhesion is a postoperative complication that has plagued gynecologists for many years, as 60-90% of gynecological patients develop adhesions after abdominopelvic surgeries. Abdominopelvic adhesions could lead to chronic pelvic pain, infertility, intestinal obstruction, and complicated reoperations. Adhesions might also increase the risk of postoperative chemoradiotherapy failure and endanger patients' lives, especially after surgeries for gynecological malignant tumors. The aim of this consensus was to review the pathogenesis and clinical consequences of adhesions and to summarize various surgical procedures and preventive measures that can reduce the occurrence of adhesions after gynecological tumor surgeries based on a discussion among well-known domestic gynecology specialists.
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Affiliation(s)
- Jinghe Lang
- Department of Genecology and Obstetrics, Beijing Union Medical College Hospital, Beijing 100140, China
| | - Ding Ma
- Department of Genecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yang Xiang
- Department of Genecology and Obstetrics, Beijing Union Medical College Hospital, Beijing 100140, China
| | - Keqin Hua
- Department of Genecology and Obstetrics, Fudan University Affiliated Obstetrics and Gynecology Hospital, Shanghai 200032, China
| | - Kaijiang Liu
- Department of Genecology and Obstetrics, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China
| | - Lingya Pan
- Department of Genecology and Obstetrics, Beijing Union Medical College Hospital, Beijing 100140, China
| | - Ping Wang
- Department of Genecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Shuzhong Yao
- Department of Genecology and Obstetrics, The First Affiliated Hospital of Zhongshan University, Guangzhou 510080, China
| | - Fujie Zhao
- Department of Genecology and Obstetrics, Shengjing Hospital Affiliated with China Medical University, Shenyang 110004, China
| | - Wenjun Cheng
- Department of Genecology and Obstetrics, Jiangsu Provincial People's Hospital, Nanjing 210036, China
| | - Manhua Cui
- Department of Genecology and Obstetrics, Second Hospital of Jilin University, Changchun 130042, China
| | - Hongyan Guo
- Department of Genecology and Obstetrics, Third Hospital of Peking University, Beijing 100191, China
| | - Ruixia Guo
- Department of Genecology and Obstetrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Li Hong
- Department of Genecology and Obstetrics, Wuhan University People's Hospital, Wuhan 430060, China
| | - Peiling Li
- Department of Genecology and Obstetrics, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Mubiao Liu
- Department of Genecology and Obstetrics, Guangdong Provincial People's Hospital, Guangzhou 510080, China
| | - Yuanguang Meng
- Department of Genecology and Obstetrics, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Hui Wang
- Department of Genecology and Obstetrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jianliu Wang
- Department of Genecology and Obstetrics, Peking University People's Hospital, Beijing 100044, China
| | - Wuliang Wang
- Department of Genecology and Obstetrics, The Second Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Ming Wu
- Department of Genecology and Obstetrics, Beijing Union Medical College Hospital, Beijing 100140, China
| | - Xingsheng Yang
- Department of Genecology and Obstetrics, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Jun Zhang
- Department of Genecology and Obstetrics, Beijing Anzhen Hospital, Capital Medical University, Beijing 100011, China
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20
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Abstract
During second-look surgery or hospitalization, intra-abdominal surgeries may cause severe postoperative complications, such as pelvic adhesion, postoperative ileus, and severe pain. However, only few studies have analyzed the outcomes of antiadhesive barriers in second-look surgery. This retrospective study aims to identify the outcomes of different antiadhesive barriers by analyzing surgical images. The study included patients who received an adhesion barrier during second-look surgery between January 2011 and November 2017. Four brands of adhesive barriers were used: Interceed, Seprafilm, Adept, and SurgiWrap. Adhesion scores were calculated for four quadrants of the uterus and surrounding structures before and after the use of antiadhesive barriers. The differences between the data of 2 observers and surgery times were also determined. A total of 18 patients were enrolled in the study. The adhesion scores were not significantly different before and after the placement of antiadhesive barriers. The difference in the adhesion scores between the two observers was also not significant, except in the Seprafilm group (P = .029). Furthermore, no significant change in the adhesion scores was observed between the first and second surgeries. Therefore, using adhesion barriers may not decrease the adhesion scores in the current setting.
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Affiliation(s)
- Ci Huang
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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21
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Lee KS, Huang JP. Short-Term Postoperative Outcomes between 4% Icodextrin Solution and Hyaluronic Acid- Carboxymethyl Cellulose Membrane during Emergency Cesarean Section. J Clin Med 2019; 8:E1249. [PMID: 31426585 PMCID: PMC6723814 DOI: 10.3390/jcm8081249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/07/2019] [Accepted: 08/16/2019] [Indexed: 11/21/2022] Open
Abstract
Emergency cesarean sections are associated with more postoperative complications than with elective cesarean sections. Seprafilm and Adept are commonly used adhesion reduction devices and have been applied in abdominal or pelvic surgery for a long time. This study focuses on comparing the short-term postoperative outcomes of emergency cesarean sections between two groups. We performed a retrospective study that included all patients who received emergency caesarean sections from the same surgeon at MacKay Memorial Hospital between August 2014 and November 2017, We analyzed the overall cases and conducted a subgroup analysis of cases with contaminated or dirty/infected wounds in regard to the rates of surgical-site infection (SSI), bandemia, delayed flatus passage, and length of hospital stay. The two groups were similar with respect to the rates of SSI, bandemia, and length of hospital stay. However, Seprafilm was associated with higher risk of delayed flatus passage over 48 h (OR: 2.67, 95% CI = 2.16-7.64, p = 0.001). It also needs less time for recovery of the digestive system and less medical management postoperatively. In cases of contaminated or dirty/infected wounds, Adept user also had significantly lower rates (10.3% vs. 32%, p = 0.048, OR: 4.12, CI = 1.09-15.61) of postcesarean metritis.
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Affiliation(s)
- Kuan-Sheng Lee
- Department of Obstetrics & Gynecology, MacKay Memorial Hospital, Taipei 104, Taiwan
| | - Jian-Pei Huang
- Department of Obstetrics & Gynecology, MacKay Memorial Hospital, Taipei 104, Taiwan.
- MacKay Junior College of Medicine, Nursing and Management, New Taipei City 251, Taiwan.
- Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan.
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Stapleton LM, Steele AN, Wang H, Lopez Hernandez H, Yu AC, Paulsen MJ, Smith AAA, Roth GA, Thakore AD, Lucian HJ, Totherow KP, Baker SW, Tada Y, Farry JM, Eskandari A, Hironaka CE, Jaatinen KJ, Williams KM, Bergamasco H, Marschel C, Chadwick B, Grady F, Ma M, Appel EA, Woo YJ. Use of a supramolecular polymeric hydrogel as an effective post-operative pericardial adhesion barrier. Nat Biomed Eng 2019; 3:611-620. [DOI: 10.1038/s41551-019-0442-z] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/08/2019] [Indexed: 01/24/2023]
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A prospective multi-center registry concerning the clinical performance of laparoscopic colorectal surgery using an absorbable adhesion barrier (INTERCEED ®) made of oxidized regenerated cellulose. Surg Today 2019; 49:877-884. [PMID: 31037393 PMCID: PMC6754356 DOI: 10.1007/s00595-019-01816-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/15/2019] [Indexed: 01/12/2023]
Abstract
Purpose The aim of this prospective multi-center registry was to evaluate the safety and clinical performance of INTERCEED® in laparoscopic colorectal surgery. Methods This study was a prospective, multi-center, single-arm registry wherein patients who received INTERCEED® in laparoscopic colorectal surgery were registered consecutively (UMIN-CTR 00001872). The primary outcome was the incidence rate of postoperative adhesive small intestinal obstruction within 6 months. The secondary outcomes were reoperation related to postoperative bleeding and anastomotic leak, surgical site infection (SSI) and anastomotic leak. Results Between March 2012 and March 2015, a total of 202 patients were enrolled from six institutions. INTERCEED® was not applied in two patients, so 200 patients were analyzed using the full analysis set population. The incidence rate of postoperative adhesive intestinal obstruction was 1.0% (2/200). The total SSI rate was 3.5% (7/200), the deep incisional SSI rate was 0.0% (0/200), and the organ SSI rate was 0.0% (0/200). The incidence of anastomotic leak was 1.0% (2/200). Reoperation was performed in two cases: one for anastomotic leak and the other as cardiac surgery due to heart disease. Conclusions Using INTERCEED® in laparoscopic colorectal surgery is safe and may be useful for preventing postoperative adhesive small intestinal obstruction.
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Laparoscopy or laparotomy as the way of entrance in myoma enucleation. Arch Gynecol Obstet 2017; 296:709-720. [PMID: 28819682 DOI: 10.1007/s00404-017-4490-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 08/07/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE Uterine myomas are the main cause of benign uterine diseases in premenopausal women. Objective of the present paper is to investigate the current best treatment modalities of myomas, depending on age of the patient and her desire to preserve fertility, as well as on clinical presentation of this pathology, such as size, number, and location of fibroids and, furthermore, on surgical experience of the gynecologist. METHODS The design of our work is a systematic literature review of existing studies, reviews, and meta-analysis conducted in PubMed and Cochrane Library to identify relevant literature. Commonly, the myomectomy is to be recommended in women desiring to preserve fertility when myomas are associated with symptoms such as excessive bleeding, pelvic discomfort, or palpable abdominally fibroids. The decision of surgical approach for myomectomy should be individualized, depending on size and location, as well as on surgeon's experience. The different modalities of myomectomy, laparoscopic, hysteroscopic, robotic-assisted, or laparotomic are in detail presented in the paper, according to Society of Obstetricians and Gynecologists of Canada (SOGC) clinical practice guidelines and taking into consideration possible concerns of myomectomy such as uterine rupture, development of adhesions, and myomas' recurrence.
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Trew GH, Pistofidis GA, Brucker SY, Krämer B, Ziegler NM, Korell M, Ritter H, McConnachie A, Ford I, Crowe AM, Estridge TD, Diamond MP, De Wilde RL. A first-in-human, randomized, controlled, subject- and reviewer-blinded multicenter study of Actamax™ Adhesion Barrier. Arch Gynecol Obstet 2016; 295:383-395. [PMID: 27844212 PMCID: PMC5281664 DOI: 10.1007/s00404-016-4211-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/22/2016] [Indexed: 01/11/2023]
Abstract
Purpose Post-surgical adhesions remain a significant concern following abdominopelvic surgery. This study was to assess safety, manageability and explore preliminary efficacy of applying a degradable hydrogel adhesion barrier to areas of surgical trauma following gynecologic laparoscopic abdominopelvic surgery. Methods This first-in-human, prospective, randomized, multicenter, subject- and reviewer-blinded clinical study was conducted in 78 premenopausal women (18–46 years) wishing to maintain fertility and undergoing gynecologic laparoscopic abdominopelvic surgery with planned clinically indicated second-look laparoscopy (SLL) at 4–12 weeks. The first two patients of each surgeon received hydrogel, up to 30 mL sprayed over all sites of surgical trauma, and were assessed for safety and application only (n = 12). Subsequent subjects (n = 66) were randomized 1:1 to receive either hydrogel (Treatment, n = 35) or not (Control, n = 31); 63 completed the SLL. Results No adverse event was assessed as serious, or possibly device related. None was severe or fatal. Adverse events were reported for 17 treated subjects (17/47, 36.2%) and 13 Controls (13/31, 41.9%). For 95.7% of treated subjects, surgeons found the device “easy” or “very easy” to use; in 54.5%, some residual material was evident at SLL. For 63 randomized subjects who completed the SLL, adjusted between-group difference in the change from baseline adhesion score demonstrated a 41.4% reduction for Treatment compared with Controls (p = 0.017), with a 49.5% reduction (p = 0.008) among myomectomy subjects (n = 34). Conclusion Spray application of a degradable hydrogel adhesion barrier during gynecologic laparoscopic abdominopelvic surgery was performed easily and safely, without evidence of clinically significant adverse outcomes. Data suggest the hydrogel was effective in reducing postoperative adhesion development, particularly following myomectomy. Electronic supplementary material The online version of this article (doi:10.1007/s00404-016-4211-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Geoffrey H Trew
- Consultant in Reproductive Medicine and Surgery, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK.
| | - George A Pistofidis
- Department of Gynecological Endoscopic Surgery, Lefkos Stavros Hospital, Athens, 115 28, Greece
| | - Sara Y Brucker
- Department of Gynecology and Obstetrics, University of Tübingen, Tübingen, 72076, Germany
| | - Bernhard Krämer
- Department of Gynecology and Obstetrics, University of Tübingen, Tübingen, 72076, Germany
| | - Nicole M Ziegler
- Department of Obstetrics, Gynecology, and Gynecology Oncology, Pius Hospital, Oldenburg, 26121, Germany
| | - Matthias Korell
- Department of Obstetrics and Gynecology, Johanna Etienne Krankenhaus, Neuss, 41462, Germany
| | - Henning Ritter
- Department of Obstetrics, Gynecology, and Gynecology Oncology, Pius Hospital, Oldenburg, 26121, Germany
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, G12 8QQ, UK
| | | | | | - Michael P Diamond
- Department of Obstetrics and Gynecology, Augusta University, Augusta, GA, 30912, USA
| | - Rudy L De Wilde
- Department of Obstetrics, Gynecology, and Gynecology Oncology, Pius Hospital, Oldenburg, 26121, Germany
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Zhang Y, Liu Q, Yang N, Zhang X. Hyaluronic acid and oxidized regenerated cellulose prevent adhesion reformation after adhesiolysis in rat models. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:3501-3507. [PMID: 27822014 PMCID: PMC5087760 DOI: 10.2147/dddt.s103824] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Postsurgical adhesion formation is the most common complication in abdominal and pelvic surgery. Adhesiolysis is the most commonly applied treatment for adhesion formation but is often followed by adhesion reformation. Therefore, an efficient strategy should be adopted to solve these problems. This study aimed to explore whether hyaluronic acid and oxidized regenerated cellulose (ORC) could prevent adhesion formation and reformation. Thirty female Sprague Dawley rats were randomly divided into three groups (n=10 each) and subjected to different treatments during the first and second surgery. The control group was treated with isotonic sodium chloride, the ORC group was treated with ORC (1.5×1 cm), and the medical sodium hyaluronate (MSH) group was treated with 1% MSH (0.5 mL). At 2 weeks after the first surgery, adhesion scores in the MSH group (1.90±0.99) and the ORC group (1.40±0.97) were significantly lower than those in the control group (3.00±0.82) (P=0.005). Similarly, 2 weeks after the second surgery, adhesion scores in the MSH group (2.00±0.82) and the ORC group (1.50±1.27) were significantly lower than those in the control group (3.50±0.53) (P=0.001). In addition, body weights in the MSH group and the ORC group did not change significantly, whereas the control group showed a consistent decrease in body weight during the experiment. Histological examination revealed that inflammatory infiltration was involved in both adhesion formation and reformation. In conclusion, hyaluronic acid and ORC were both efficient in reducing adhesion formation and reformation in the rat model.
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Affiliation(s)
- Yan Zhang
- Department of Gynecology, Kunshan Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu, People's Republic of China
| | - Qin Liu
- Department of Gynecology, Kunshan Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu, People's Republic of China
| | - Ning Yang
- Department of Gynecology, Kunshan Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu, People's Republic of China
| | - Xuegang Zhang
- Department of Gynecology, Kunshan Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu, People's Republic of China
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Ziegler N, Korell M, Herrmann A, de Wilde MS, Torres-de la Roche LA, Larbig A, De Wilde RL. Uterine perforation following a fractional curettage successfully treated with the modified polysaccharide 4DryField® PH: a case report. J Med Case Rep 2016; 10:243. [PMID: 27599567 PMCID: PMC5011909 DOI: 10.1186/s13256-016-1029-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 08/09/2016] [Indexed: 01/01/2023] Open
Abstract
Background Uterine perforation is the most common complication of curettage and may result in bleeding. Therefore, urgent control of bleeding from the uterine wall perforation is necessary to avoid an emergency hysterectomy or blood transfusion, to prevent peritoneal adhesion formation, possible chronic pelvic pain, and infertility. In the present case, an active bleeding secondary to a perforation of the uterus during curettage, for diagnosis of endometrial carcinoma, was instantaneously and successfully treated with only the application of a novel modified polysaccharide powder. This is, to the best of our knowledge, the first time that the agent 4DryField® has been used for this purpose. Case presentation A 71-year-old German woman with serometra and endometrial hyperplasia suffered a perforation of the anterior wall of the uterus during the hysteroscopic resection of submucosal polyps and a fractional curettage. Subsequently, an immediate laparoscopy showed an active bleeding from the wound, which was promptly stopped with only the application of the hemostatic and anti-adhesion polysaccharide powder, 4DryField®. There were no postoperative complications. Nine weeks later, a laparoscopic hysterectomy with bilateral salpingoophorectomy for endometrial carcinoma (histology: stage IA, pT1a, cN0, L0 V0 M0/G2) was performed. The former injured area looked slightly prominent, was completely healed, and showed a shiny serosa. All her pelvic organs were free of adhesions, and there was one 0.5-mm calcified granuloma in the Douglas pouch. Conclusions The efficient hemostasis combined with the adhesion prevention effect of 4DryField®, allowed a fast control of the uterine wall bleeding, saved operation time, avoided the risks of other procedures for bleeding control and contributed to the normal healing of the uterine wall without any adhesion formation.
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Affiliation(s)
- Nicole Ziegler
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius Hospital-Medical Campus University, Oldenburg, Germany
| | - Matthias Korell
- Department of Obstetrics and Gynecology, Johanna-Etienne-Hospital, Neuss, Germany
| | - Anja Herrmann
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius Hospital-Medical Campus University, Oldenburg, Germany
| | - Maya Sophie de Wilde
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius Hospital-Medical Campus University, Oldenburg, Germany
| | - Luz Angela Torres-de la Roche
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius Hospital-Medical Campus University, Oldenburg, Germany
| | - Angelika Larbig
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius Hospital-Medical Campus University, Oldenburg, Germany
| | - Rudy Leon De Wilde
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius Hospital-Medical Campus University, Oldenburg, Germany.
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De Wilde RL, Alvarez J, Brölmann H, Campo R, Cheong Y, Lundorff P, Pawelczyk L, Roman H, di Spiezio Sardo A, Wallwiener M. Adhesions and endometriosis: challenges in subfertility management : (An expert opinion of the ANGEL-The ANti-Adhesions in Gynaecology Expert PaneL-group). Arch Gynecol Obstet 2016; 294:299-301. [PMID: 26894304 PMCID: PMC4937065 DOI: 10.1007/s00404-016-4049-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 02/11/2016] [Indexed: 12/16/2022]
Abstract
There is molecular evidence that endometriosis has a negative impact on the ovaries, although the exact pathophysiology concerning endometriosis-associated subfertility is not known. The negative impact on the tubo-ovarian unit can be directly by distorting the anatomy, indirectly by invoking inflammation or by oxidative damage with poorer-quality oocytes. Endometriosis even seems to have a negative effect on pregnancy outcome after in vitro fertilization.
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Affiliation(s)
- R L De Wilde
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany.
| | - J Alvarez
- Hospital Universitario Infanta Sofía, Paseo de Europa, 34, 28702, San Sebastián de Los Reyes, Spain
| | - H Brölmann
- Department of Obstetrics and Gynecology, VU University, 1081, Amsterdam, The Netherlands
| | - R Campo
- Leuven Institute for Fertility and Embryology (LIFE), Tiensevest 168, 3000, Louvain, Belgium
| | - Y Cheong
- Human Development and Health Unit, University of Southampton and Complete Fertility Centre, Southampton, UK
| | - P Lundorff
- Department of Obstetrics and Gynecology, Privathospitalet Mølholm, 7100, Vejle, Denmark
| | - L Pawelczyk
- Division of Infertility and Reproductive Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - H Roman
- Hopitaux De Rouen, Clinique Gynecologique et Obstetricale, 1 Rue Germont, 76031, Rouen Cedex, France
| | | | - M Wallwiener
- Department of Obstetrics and Gynecology, University Clinic Heidelberg, 69120, Heidelberg, Germany
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Cezar C, Tchartchian G, Korell M, Ziegler N, Senshu K, De Wilde MS, Herrmann A, Larbig A, De Wilde RL. Long term follow-up concerning safety and efficacy of novel adhesion prophylactic agent for laparoscopic myomectomy in the prospective randomized ADBEE study. Best Pract Res Clin Obstet Gynaecol 2016; 35:97-112. [PMID: 27449312 DOI: 10.1016/j.bpobgyn.2016.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 06/28/2016] [Indexed: 01/20/2023]
Abstract
We conducted a prospective randomized single blind - subject study in the University Clinic of Gynecology of Pius-Hospital Oldenburg. The primary objective of the ADBEE study was to assess the safety and manageability of ADBLOCK when used as an adjunct to laparoscopic surgery for the primary of myomas in women wishing to improve pregnancy outcomes. The study population included 32 women aged between 18-45 years, in good general health condition, who have not completed their family planning and who are undergoing primary ('virgin') laparoscopic myomectomy with an aim to improve pregnancy outcomes. The patients were randomized in 2 groups, ADBLOCK arm with 21 patients and surgery only arm with 11 patients. The study was single blind - subject and the investigators were blinded to treatment group assignment until completion of uterine suturing and prior to removal of the endoscope. A vigorous follow-up of subjects was organized, focusing on its two critical characteristics: completeness and duration. Completeness represented the percentage of subjects who returned to every planed follow - up appointments. The patients were evaluated in a specific period of time, which defined the duration of follow-up. Safety of the ADBLOCK was estimated after analyzing and documentation of any adverse events occurred, clinical and physical examination of patients as well as evaluation of laboratory measures. There were 25 adverse events reported in ADBLOCK treatment group and 12 events in NO-ADBLOCK group over the 24-months treatment. All adverse events in both treatment arms were not anticipated, with all events in the ADBLOCK group being resolved. At 28 days, there was no significant difference in proportion of events between the two treatments (p = 0.440). Overall, the number of events reported was low and the severity of events was generally mild with an unlikely or no relationship to treatment. There were no unanticipated device related adverse events seen in both treatment groups over the immediate post-operative period or during the 24 months follow up period. By 12 weeks all patients reported their wound as healing well or healed and at 6 months all wounds were reported as healed. There were no differences between both treatment groups regarding the use of painkillers over 24 months follow up period. This clinical first - in - human study, sustained by a rigorous follow-up of the subjects has demonstrated that ADBLOCK is a safe product, presenting no additional safety risk or burden to the patients over surgery alone. The device was relatively easy to use, with a low device failure rate that had no impact on the surgical procedures.
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Affiliation(s)
- Cristina Cezar
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University Oldenburg, 26121 Oldenburg, Germany.
| | - Garri Tchartchian
- Clinic for Minimal-Invasive Surgery, 14129 Berlin-Zehlendorf, Germany
| | - Matthias Korell
- Johanna-Etienne-Clinic, Department for Obstetrics and Gynecology, 41462 Neuss, Germany
| | - Nicole Ziegler
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University Oldenburg, 26121 Oldenburg, Germany
| | | | - Maya Sophie De Wilde
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University Oldenburg, 26121 Oldenburg, Germany
| | - Anja Herrmann
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University Oldenburg, 26121 Oldenburg, Germany
| | - Angelika Larbig
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University Oldenburg, 26121 Oldenburg, Germany
| | - Rudy Leon De Wilde
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University Oldenburg, 26121 Oldenburg, Germany
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Use of Modified Polysaccharide 4DryField (®) PH for Adhesion Prevention and Hemostasis in Gynecological Surgery: A Two-Center Observational Study by Second-Look Laparoscopy. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3029264. [PMID: 26904672 PMCID: PMC4745300 DOI: 10.1155/2016/3029264] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 11/18/2015] [Accepted: 11/30/2015] [Indexed: 01/20/2023]
Abstract
Purpose. This study evaluates both scopes of 4DryField PH, certified for adhesion prevention and hemostasis, in patients undergoing surgery for various and severe gynecological disorders. Methods. This is a two-institutional study. Adhesion prevention efficacy was evaluated using video documentation of first-look laparoscopies (FLL) and second-look laparoscopies (SLL); other patient data were analyzed retrospectively. Twenty patients with various disorders were evaluated, 4 assigned to a uterus pathology, 10 to endometriosis, and 6 to an adhesion disease group. Nine patients received 4DryField primarily for hemostasis and 11 solely for adhesion prevention. Nineteen patients had SLL after 5 to 12 weeks and one after 13 months. Results. At FLL with 4DryField, immediate hemostasis could be achieved in diffuse bleeding. At SLL, effective adhesion prevention was observed in 18 of all 20 women, with only 2 revealing major adhesions. In particular, only 1 of the 6 women with adhesion disease as predominant disorder showed major adhesions at SLL. Conclusions. Modified polysaccharide 4DryField is not only effective in diffuse bleeding. In this cohort with extensive surgery for various gynecological pathologies, 4DryField showed effective adhesion prevention as confirmed at SLL, too. Its use as premixed gel is a convenient variant for treatment of large peritoneal wounds.
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Poehnert D, Grethe L, Maegel L, Jonigk D, Lippmann T, Kaltenborn A, Schrem H, Klempnauer J, Winny M. Evaluation of the Effectiveness of Peritoneal Adhesion Prevention Devices in a Rat Model. Int J Med Sci 2016; 13:524-32. [PMID: 27429589 PMCID: PMC4946123 DOI: 10.7150/ijms.15167] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/04/2016] [Indexed: 12/08/2022] Open
Abstract
BACKGROUND Abdominal operations are followed by adhesions, a prevalent cause of abdominal pain, and the most frequent cause for bowel obstruction and secondary female infertility. This rat study addresses adhesion prevention capability of Adept(®), Interceed(®), Seprafilm(®), and a novel device, 4DryField(®) PH which is provided as powder and generates its effect as gel. METHODS Sixty-eight male Lewis rats had cecal abrasion and creation of an equally sized abdominal wall defect, and were grouped randomly: A control group without treatment (n=10); two groups treated with 4DryField(®) PH using premixed gel (n=15) or in-situ gel technique (n=16); one group each was treated with Seprafilm(®) (n=8), Interceed(®) (n=9), or Adept(®) (n=10). Sacrifice was on day 7 to evaluate incidence, quality, and quantity of adhesions, as expressed via adhesion reduction rate (AR). Histologic specimens were evaluated. Statistical analyses used ANOVA and unpaired t-tests. RESULTS 4DryField(®) PH significantly reduced incidence and severity of adhesions both as premixed gel (AR: 85.2%) and as in-situ made gel (AR: 100%), a comparison between these two application techniques showed no differences in efficacy. Seprafilm(®) did not reduce incidence but severity of adhesions significantly (AR: 53.5%). With Interceed(®) (AR: 3.7%) and Adept(®) (AR: 16.1%) no significant adhesion-reduction was achieved. Except for inflammatory response with Interceed(®), histopathology showed good tissue compatibility of all other devices. CONCLUSION 4DryField(®) PH and Seprafilm(®) showed significant adhesion prevention capabilities. 4DryField(®) PH achieved the highest adhesion prevention effectiveness without restrictions concerning mode of application and compatibility and, thus, is a promising strategy to prevent abdominal adhesions.
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Affiliation(s)
- D Poehnert
- 1. Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Germany
| | - L Grethe
- 1. Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Germany
| | - L Maegel
- 2. Institute of Pathology, Hannover Medical School, Germany
| | - D Jonigk
- 2. Institute of Pathology, Hannover Medical School, Germany
| | - T Lippmann
- 2. Institute of Pathology, Hannover Medical School, Germany
| | - A Kaltenborn
- 3. Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Center-Transplantation (IFB-Tx), Hannover Medical School, Germany;; 4. Department of Trauma and Orthopaedic Surgery, Federal Armed Forces Hospital Westerstede, Westerstede, Germany
| | - H Schrem
- 1. Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Germany;; 3. Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Center-Transplantation (IFB-Tx), Hannover Medical School, Germany
| | - J Klempnauer
- 1. Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Germany
| | - M Winny
- 1. Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Germany
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de Vries A, Kuhry E, Mårvik R. Operative procedures in warm humidified air: Can it reduce adhesion formation? A randomized experimental rat model. INTERNATIONAL JOURNAL OF SURGERY OPEN 2016. [DOI: 10.1016/j.ijso.2016.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Safety of laparoscopically assisted vaginal hysterectomy for women with anterior wall adherence after cesarean section. Obstet Gynecol Sci 2015; 58:501-6. [PMID: 26623415 PMCID: PMC4663229 DOI: 10.5468/ogs.2015.58.6.501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 05/22/2015] [Accepted: 06/24/2015] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate the safety and surgical outcomes of laparoscopically assisted vaginal hysterectomy (LAVH) for women with anterior wall adherence after cesarean section. Methods We conducted a retrospective study of 328 women with prior cesarean section history who underwent LAVH from March 2003 to July 2013. The subjects were classified into two groups: group A, with anterior wall adherence (n=49); group B, without anterior wall adherence (n=279). We compared the demographic, clinical characteristics, and surgical outcomes of two groups. Results The median age and parity of the patients were 46 years (range, 34 to 70 years) and 2 (1 to 6). Patients with anterior wall adherence had longer operating times (175 vs. 130 minutes, P<0.05). There were no significant differences in age, parity, number of cesarean section, body mass index, specimen weight, postoperative change in hemoglobin concentration, or length of hospital stay between the two groups. There was one case from each group who sustained bladder laceration during the vaginal portion of the procedure, both repaired vaginally. There was no conversion to abdominal hysterectomy in either group. Conclusion LAVH is effective and safe for women with anterior wall adherence after cesarean section.
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Binda MM. Humidification during laparoscopic surgery: overview of the clinical benefits of using humidified gas during laparoscopic surgery. Arch Gynecol Obstet 2015; 292:955-71. [PMID: 25911545 PMCID: PMC4744605 DOI: 10.1007/s00404-015-3717-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 04/02/2015] [Indexed: 12/21/2022]
Abstract
PURPOSE The peritoneum is the serous membrane that covers the abdominal cavity and most of the intra-abdominal organs. It is a very delicate layer highly susceptible to damage and it is not designed to cope with variable conditions such as the dry and cold carbon dioxide (CO2) during laparoscopic surgery. The aim of this review was to evaluate the effects caused by insufflating dry and cold gas into the abdominal cavity after laparoscopic surgery. METHODS A literature search using the Pubmed was carried out. Articles identified focused on the key issues of laparoscopy, peritoneum, morphology, pneumoperitoneum, humidity, body temperature, pain, recovery time, post-operative adhesions and lens fogging. RESULTS Insufflating dry and cold CO2 into the abdomen causes peritoneal damage, post-operative pain, hypothermia and post-operative adhesions. Using humidified and warm gas prevents pain after surgery. With regard to hypothermia due to desiccation, it can be fully prevented using humidified and warm gas. Results relating to the patient recovery are still controversial. CONCLUSIONS The use of humidified and warm insufflation gas offers a significant clinical benefit to the patient, creating a more physiologic peritoneal environment and reducing the post-operative pain and hypothermia. In animal models, although humidified and warm gas reduces post-operative adhesions, humidified gas at 32 °C reduced them even more. It is clear that humidified gas should be used during laparoscopic surgery; however, a question remains unanswered: to achieve even greater clinical benefit to the patient, at what temperature should the humidified gas be when insufflated into the abdomen? More clinical trials should be performed to resolve this query.
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Affiliation(s)
- Maria Mercedes Binda
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Gynécologie, Avenue Mounier 52, bte B1.52.02, 1200, Brussels, Belgium.
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Poehnert D, Abbas M, Kreipe HH, Klempnauer J, Winny M. Evaluation of 4DryField® PH as Adhesion Prevention Barrier Tested in an Optimized Adhesion Model in Rats. Eur Surg Res 2015; 55:341-351. [PMID: 26505616 DOI: 10.1159/000441025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 09/10/2015] [Indexed: 12/08/2022]
Abstract
BACKGROUND Adhesions due to pelvic/abdominal surgery are a common serious pathology possibly entailing severe complications. This study investigates the adhesion prevention capability of the novel starch-based agent 4DryField® PH, which together with saline solution forms a barrier gel. Herein, an optimized adhesion model (OPAM) inducing severe adhesions/agglutinations with high reproducibility was used. METHODS In 19 Lewis rats, a 1 × 2 cm abdominal wall defect was created, the peritoneum of the neighboring cecum was abraded, and both injured areas were approximated by suture. Rats were randomized to control (n = 10) or 4DryField PH treatment (n = 9) groups. Another 8 rats had sham surgery for safety assessment of 4DryField PH. At day 7, the quantity and quality of adhesions were assessed macro-/microscopically and evaluated statistically. RESULTS 4DryField PH treatment significantly reduced the incidence and severity of adhesions as verified by significantly improved adhesion scorings (0.4 vs. 4.5; 1.1 vs. 9). Histology revealed reconstitution of the cecum and abdominal wall including regeneration of the visceral/parietal peritoneum. In sham-operated rats, 4DryField PH did not induce adhesion formation. CONCLUSIONS 4DryField PH gel was highly effective in preventing adhesions. Histologically, the injured cecum and abdominal wall regenerated well in the presence of 4DryField PH. Considering the severity of OPAM trauma, the potential of 4DryField PH to prevent adhesions can be rated excellent.
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Affiliation(s)
- Daniel Poehnert
- Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
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Tracking of Drug Release and Material Fate for Naturally Derived Omega-3 Fatty Acid Biomaterials. Ann Biomed Eng 2015; 44:782-92. [PMID: 26502170 DOI: 10.1007/s10439-015-1489-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 10/14/2015] [Indexed: 10/22/2022]
Abstract
In vitro and in vivo studies were conducted on omega-3 fatty acid-derived biomaterials to determine their utility as an implantable material for adhesion prevention following soft tissue hernia repair and as a means to allow for the local delivery of antimicrobial or antibiofilm agents. Naturally derived biomaterials offer several advantages over synthetic materials in the field of medical device development. These advantages include enhanced biocompatibility, elimination of risks posed by the presence of toxic catalysts and chemical crosslinking agents, and derivation from renewable resources. Omega-3 fatty acids are readily available from fish and plant sources and can be used to create implantable biomaterials either as a stand-alone device or as a device coating that can be utilized in local drug delivery applications. In-depth characterization of material erosion degradation over time using non-destructive imaging and chemical characterization techniques provided mechanistic insight into material structure: function relationship. This in turn guided rational tailoring of the material based on varying fatty acid composition to control material residence time and hence drug release. These studies demonstrate the utility of omega-3 fatty acid derived biomaterials as an absorbable material for soft tissue hernia repair and drug delivery applications.
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Adhesions are the major cause of complications in operative gynecology. Best Pract Res Clin Obstet Gynaecol 2015; 35:71-83. [PMID: 26586540 DOI: 10.1016/j.bpobgyn.2015.10.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 10/02/2015] [Indexed: 12/29/2022]
Abstract
Adhesion formation has been found to be highly prevalent in patients with a history of operations or inflammatory peritoneal processes. These patients are at a high risk of serious intraoperative complications during a subsequent operation if adhesiolysis is performed. These complications include bowel perforation, ureteral or bladder injury, and vascular injury. In order to minimize the risk of these complications, adhesiolysis should only be performed by experienced surgeons, and intraoperative strategies must be adopted. The reduction of the overall incidence of adhesions is essential for subsequent surgical treatments. Anti-adhesion strategies must be adopted for preventing the reoccurrence of adhesions after abdominopelvic operations. The strategies employed to reduce the risk and the overall incidence of adhesions have been elucidated in this article.
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Montalvo-Javé EE, Mendoza-Barrera GE, García-Pineda MA, Jaime Limón ÁR, Montalvo-Arenas C, Castell Rodríguez AE, Tapia Jurado J. Histological Analysis of Intra-Abdominal Adhesions Treated with Sodium Hyaluronate and Carboxymethylcellulose Gel. J INVEST SURG 2015; 29:80-7. [DOI: 10.3109/08941939.2015.1076911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Poehnert D, Abbas M, Maegel L, Sambale F, Lavrentieva A, Kreipe HH, Klempnauer J, Winny M. Evaluation of the biological tolerability of the starch-based medical device 4DryField® PH in vitro and in vivo a rat model. J Biomater Appl 2015; 30:463-71. [PMID: 26116021 DOI: 10.1177/0885328215592257] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate in vitro cytotoxicity/biocompatibility as well as in vivo tolerability of the novel polysaccharide 4DryField® PH, certified for haemostasis and adhesion prevention. METHODS In vitro cytotoxicity/viability testing according to ISO EN 10,993 using murine and human tumour cell lines incubated with 4DryField® PH (PlantTec Medical GmbH). Using a rat model the impact of 4DryField® PH on animals viability and in vivo effects were macro- and micropathologically assessed. RESULTS In vitro testing revealed no cytotoxic effect of 4DryField® PH nor enhancement of viability to tumour cell lines. In vivo viability of rats was unimpaired by 4DryField® PH. Bodyweight loss in animals with abdominal injury plus treatment with 4DryField® PH was in the range of controls and less than in injured rats without treatment. At day 7 after surgery no formation of adhesions, neither macroscopic nor histological remnants nor signs of foreign body reaction were present in animals without injury. In animals with peritoneal injury and 4DryField® PH application, histopathological observation revealed minor residuals of polysaccharide in the depth of wound cavity embedded in a thickened subperitoneal layer; however, with a suggested intact neoperitoneum. The presence of mononuclear cells surrounding polysaccharide particles in varying states of degradation was observable as well. CONCLUSION 4DryField® PH is not cytotoxic and does not enhance viability of tumour cell lines. High dose of 4DryField® PH of 1.09 g/kg bodyweight is well tolerated and reduces weight loss in animals with peritoneal injury. The biocompatibility of 4DryField® PH can be rated as being excellent.
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Affiliation(s)
- Daniel Poehnert
- Department of General, Abdominal and Transplantation Surgery, Hannover Medical School, Germany
| | - Mahmoud Abbas
- Department of Pathology, Hannover Medical School, Germany
| | - Lavinia Maegel
- Department of Pathology, Hannover Medical School, Germany
| | - Franziska Sambale
- Institute of Technical Chemistry, Leibniz University Hannover, Germany
| | | | | | - Jürgen Klempnauer
- Department of General, Abdominal and Transplantation Surgery, Hannover Medical School, Germany
| | - Markus Winny
- Department of General, Abdominal and Transplantation Surgery, Hannover Medical School, Germany
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Insufflation with humidified and heated carbon dioxide in short-term laparoscopy: a double-blinded randomized controlled trial. BIOMED RESEARCH INTERNATIONAL 2015; 2015:412618. [PMID: 25722977 PMCID: PMC4324813 DOI: 10.1155/2015/412618] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/07/2015] [Indexed: 11/18/2022]
Abstract
Background. We tested the hypothesis that warm-humidified carbon dioxide (CO2) insufflation would reduce postoperative pain and morphine requirement compared to cold-dry CO2 insufflation. Methods. A double-blinded, randomized, controlled trial was conducted to compare warm, humidified CO2 and cold-dry CO2. Patients with benign uterine diseases were randomized to either treatment (n = 48) or control (n = 49) group during laparoscopically assisted vaginal hysterectomy. Primary endpoints of the study were rest pain, movement pain, shoulder-tip pain, and cough pain at 2, 4, 6, 24, and 48 hours postoperatively, measured by visual analogue scale. Secondary outcomes were morphine consumption, rejected boli, temperature change, recovery room stay, and length of hospital stay. Results. There were no significant differences in all baseline characteristics. Shoulder-tip pain at 6 h postoperatively was significantly reduced in the intervention group. Pain at rest, movement pain, and cough pain did not differ. Total morphine consumption and rejected boli at 24 h postoperatively were significantly higher in the control group. Temperature change, recovery room stay, and length of hospital were similar. Conclusions. Warm, humidified insufflation gas significantly reduces postoperative shoulder-tip pain as well as morphine demand. This trial is registered with Clinical Trial Registration Number
DRKS00003853 (German Clinical Trials Register (DRKS)).
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41
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Seracchioli R, Di Donato N, Bertoldo V, La Marca A, Vicenzi C, Zannoni L, Villa G, Monti G, Leonardi D, Giovanardi G, Venturoli S, Montanari G. The Role of Ovarian Suspension in Endometriosis Surgery: A Randomized Controlled Trial. J Minim Invasive Gynecol 2014; 21:1029-35. [DOI: 10.1016/j.jmig.2014.04.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 04/25/2014] [Accepted: 04/29/2014] [Indexed: 10/25/2022]
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Shin YC, Yang WJ, Lee JH, Oh JW, Kim TW, Park JC, Hyon SH, Han DW. PLGA nanofiber membranes loaded with epigallocatechin-3-O-gallate are beneficial to prevention of postsurgical adhesions. Int J Nanomedicine 2014; 9:4067-78. [PMID: 25187710 PMCID: PMC4149440 DOI: 10.2147/ijn.s68197] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This study concentrates on the development of biodegradable nanofiber membranes with controlled drug release to ensure reduced tissue adhesion and accelerated healing. Nanofibers of poly(lactic-co-glycolic acid) (PLGA) loaded with epigallocatechin-3-O-gallate (EGCG), the most bioactive polyphenolic compound in green tea, were electrospun. The physicochemical and biomechanical properties of EGCG-releasing PLGA (E-PLGA) nanofiber membranes were characterized by atomic force microscopy, EGCG release and degradation profiles, and tensile testing. In vitro antioxidant activity and hemocompatibility were evaluated by measuring scavenged reactive oxygen species levels and activated partial thromboplastin time, respectively. In vivo antiadhesion efficacy was examined on the rat peritonea with a surgical incision. The average fiber diameter of E-PLGA membranes was approximately 300–500 nm, which was almost similar to that of pure PLGA equivalents. E-PLGA membranes showed sustained EGCG release mediated by controlled diffusion and PLGA degradation over 28 days. EGCG did not adversely affect the tensile strength of PLGA membranes, whereas it significantly decreased the elastic modulus and increased the strain at break. E-PLGA membranes were significantly effective in both scavenging reactive oxygen species and extending activated partial thromboplastin time. Macroscopic observation after 1 week of surgical treatment revealed that the antiadhesion efficacy of E-PLGA nanofiber membranes was significantly superior to those of untreated controls and pure PLGA equivalents, which was comparable to that of a commercial tissue-adhesion barrier. In conclusion, the E-PLGA hybrid nanofiber can be exploited to craft strategies for the prevention of postsurgical adhesions.
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Affiliation(s)
- Yong Cheol Shin
- Department of Cogno-Mechatronics Engineering, Pusan National University, Busan, Republic of Korea
| | - Won Jun Yang
- Department of Cogno-Mechatronics Engineering, Pusan National University, Busan, Republic of Korea
| | - Jong Ho Lee
- Department of Cogno-Mechatronics Engineering, Pusan National University, Busan, Republic of Korea
| | - Jin-Woo Oh
- Department of Nanomaterials Engineering, College of Nanoscience and Nanotechnology, Pusan National University, Busan, Republic of Korea
| | - Tai Wan Kim
- Department of Design, College of Arts, Pusan National University, Busan, Republic of Korea
| | - Jong-Chul Park
- Department of Medical Engineering, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suong-Hyu Hyon
- Center for Fiber and Textile Science, Kyoto Institute of Technology, Kyoto, Japan
| | - Dong-Wook Han
- Department of Cogno-Mechatronics Engineering, Pusan National University, Busan, Republic of Korea
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Consensus recommendations on adhesions (version 2014) for the ESGE Adhesions Research Working Group (European Society for Gynecological Endoscopy): an expert opinion. Arch Gynecol Obstet 2014; 290:581-2. [DOI: 10.1007/s00404-014-3312-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 06/02/2014] [Indexed: 11/29/2022]
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Tchartchian G, Hackethal A, Herrmann A, Bojahr B, Wallwiener C, Ohlinger R, Ebert AD, De Wilde RL. Evaluation of SprayShield™ Adhesion Barrier in a single center: randomized controlled study in 15 women undergoing reconstructive surgery after laparoscopic myomectomy. Arch Gynecol Obstet 2014; 290:697-704. [DOI: 10.1007/s00404-014-3251-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 04/03/2014] [Indexed: 12/15/2022]
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45
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Korell M. Combined Hemostasis and Adhesion Prevention with the Novel Agent 4DryField<sup>®</sup> PH—Initial Observations. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ss.2014.512081] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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The Impact of Socioeconomic and Anamnestic Characteristics on Quality of Life and Sexual Function in Women with Endometriosis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2013. [DOI: 10.5301/je.5000168] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose The aim of this study is to evaluate the impact of sociodemographic and anamnestic characteristics of women with deep infiltrating endometriosis (DIE) on the quality of life and sexual function. Methods It is a prospective cohort study including 200 women with pre-operative clinical and ultrasound diagnosis of DIE. They completed a pre-operative questionnaire regarding sociodemographic and anamnestic characteristics, a sexual activity questionnaire (Sexual Health Outcomes in Women Questionnaire [SHOW-Q]) and a quality of life questionnaire (Short Form-36 Health Survey [SF-36]). Results The mean values obtained for the SF-36 (50.7 ± 21.1) and SHOW-Q (56.4 ± 21.1) questionnaire showed an impairment of quality of life and sexual function. Women with a history of previous surgery had significantly lower scores of SF-36 and SHOW-Q questionnaires than women without (p< 0.05). The increase of body mass index (BMI) was positively correlated with an improvement of sexual function (p = 0.008). Postsecondary education was significantly associated with a better quality of life (p = 0.001). Conclusions Patients with DIE have an impairment of quality of life and sexual function. Educational level, BMI and previous surgery may influence quality of life and sexual function of women affected by DIE.
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Alkhamesi NA, Schlachta CM. The role of aerosolized intraperitoneal heparin and hyaluronic acid in the prevention of postoperative abdominal adhesions. Surg Endosc 2013; 27:4663-9. [DOI: 10.1007/s00464-013-3102-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Accepted: 07/02/2013] [Indexed: 12/11/2022]
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Pinto E, Trovão A, Leitão S, Pina C, Mak FK, Lanhoso A. Conservative laparoscopic approach to a perforated pyomyoma after uterine artery embolization. J Minim Invasive Gynecol 2012; 19:775-9. [PMID: 23084686 DOI: 10.1016/j.jmig.2012.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 07/04/2012] [Accepted: 07/12/2012] [Indexed: 11/16/2022]
Abstract
We describe a conservative laparoscopic approach to treatment of a perforated pyomyoma after uterine artery embolization. A 36-year-old woman came to our emergency department 8 weeks after undergoing uterine artery embolization. She reported painful abdominal cramps. Physical examination revealed fever, tachycardia, hypotension, abdominal pain with rebound tenderness and pain during bimanual examination. Ultrasonography showed a fundal/subserosal leiomyoma and a moderate amount of fluid in the abdominal cavity. Because the patient desired preservation of the uterus, a laparoscopic approach was used for drainage and lavage of a perforated pyomyoma. The patient had an uneventful recovery and remained well at follow-up visits. Second-look diagnostic laparoscopy enabled treatment of the adhesions formed and revealed patent fallopian tubes. Surgery has been the primary approach to pyomyoma. However, hysterectomy leads to irreversible sterility and myomectomy can be difficult to perform. Therefore, there is need for a less invasive intervention in women who seek conservative treatment. Recently, computed tomography-guided drainage was successfully performed in two patients with pyomyoma. To our knowledge, this is the first report of a successful conservative laparoscopic approach to pyomyoma.
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Affiliation(s)
- Evelin Pinto
- Department of Gynecology, Vila Nova de Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal.
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Prevention of adhesions in gynaecological surgery: the 2012 European field guideline. ACTA ACUST UNITED AC 2012; 9:365-368. [PMID: 23144639 PMCID: PMC3491197 DOI: 10.1007/s10397-012-0764-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 08/06/2012] [Indexed: 01/28/2023]
Abstract
Postoperative adhesions have become the most common complication of open or laparoscopic abdominal surgery and a source of major concern because of their potentially dramatic consequences. The proposed guideline is the beginning of a major campaign to enhance the awareness of adhesions and to provide surgeons with a reference guide to adhesion prevention adapted to the conditions of their daily practice. The risk of postoperative adhesions should be systematically discussed with any patient scheduled for open or laparoscopic abdominal surgery prior to obtaining her informed consent. Surgeons should adopt a routine adhesion reduction strategy with good surgical technique. Anti-adhesion agents are an additional option, especially in procedures with a high risk of adhesion formation, such as ovarian, endometriosis and tubal surgery and myomectomy. We conclude that good surgical practice is paramount to reduce adhesion formation and that anti-adhesion agents may contribute to adhesion prevention in certain cases.
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Wallwiener M, Brölmann H, Koninckx PR, Lundorff P, Lower AM, Wattiez A, Mara M, De Wilde RL. "Adhesions after abdominal, pelvic and intra-uterine surgery and their prevention". ACTA ACUST UNITED AC 2012; 9:465-466. [PMID: 23144644 PMCID: PMC3491202 DOI: 10.1007/s10397-012-0762-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 07/28/2012] [Indexed: 12/31/2022]
Abstract
We here present the full text of a patient leaflet we have designed, and routinely use, to provide preoperative education about adhesions to patients undergoing open or laparoscopic gynaecological surgery. The leaflet presents appropriate, patient-orientated information on the nature of adhesions, their causes and the health risks they may involve as well as on adhesiolysis and modern methods of adhesion prevention. As adhesion formation is not specific to gynaecological surgery, the leaflet can also be adapted for the purposes of general abdominal surgery.
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Affiliation(s)
- Markus Wallwiener
- Department of Obstetrics and Gynaecology, University of Heidelberg, Vosstr. 9, 69115 Heidelberg, Germany
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