Efficiency of TachoSil® to prevent postsurgical adhesion development on laparoscopic rat model

Hemostatic sponge effect on adhesion prevention in a porcine model

BACKGROUND

In this work, we aimed to assess the preventive effect of an absorbable hemostatic collagen sponge (HCS) on the reduction of postsurgical gynecological adhesions in a porcine model.

MATERIALS AND METHODS

Forty female pigs were subjected to a right uterine horn myotomy and left uterine horn deserosation. They were randomly divided into two groups, HCS application and control, which were rearranged into laparotomy and laparoscopy groups. Resulting adhesions were macroscopically and microscopically semiquantitatively analyzed after a 5 mo follow-up.

RESULTS

The incidence of adhesion-free animals did not significantly differ between groups, although it increased when the HCS was placed in both laparotomy (from 10%-12.5%) and laparoscopy groups (from 20%-50%). On the contrary, a significant reduction was observed in adhesion severity when the HCS was applied in the laparotomy groups (P < 0.01). Regarding microscopic study, hemostatic sponge application significantly reduced the inflammation score in the laparoscopic approach (P < 0.01). Fibrosis, unlike inflammation, differs between both approaches. In the laparoscopic group, fibrosis was reduced with application of the HCS, whereas in the laparotomy group greater fibrosis was observed within the HCS group.

CONCLUSIONS

HCS has shown to be safe for gynecological use. Although number and extent of adhesions did not decrease with HCS, inflammation and adhesions' severity were reduced in the laparoscopic and laparotomy approaches, respectively.

The use of TachoSil as sealant in an experimental model of colonic perforation

BACKGROUND

The suture dehiscence has traditionally represented a major surgical problem that has not fully resolved. Surgeons should perform sutures in nonoptimal conditions using different methods of sealing and/or reinforcement of suture. The aim is to assess the effectiveness of TachoSil in an experimental model of colon perforations in a simulated precarious situation.

METHODS

Forty Wistar rats of both genders (14-24 weeks old) were equally divided in 2 groups; study group was submitted to extended starvation and segmental ischemia. The surgical complications analyzed were animal death, colonic leaks, or intra-abdominal infection, either as local abscesses or diffuse peritonitis. The burst pressure was measured in millimeters of mercury. The histological analysis was performed according to Ehrlich and Hunt numerical scale modified by Phillips.

RESULTS

Only 1 animal belonging to the study group died as a consequence of the colonic ischemia. The eventual colonic leak or diffuse peritonitis was reported. Three local abscesses were observed in the study group and one in the control group, and numerous microscopic abscesses in histological analysis (12 vs. 11) were detected. The average burst pressure in the study group was 209.47 ± 50.274 versus 203 ± 51.514 mm Hg in the control group. No differences were observed in any of the variables analyzed in the histological activity.

CONCLUSION

TachoSil has proven useful as a sealant of colonic perforations in our experimental study. We therefore conclude that its use in situations of insecurity may be adequate, even in optimal conditions in which reinforcement of previous suture is not strictly required.

Effectiveness of Hyalobarrier and Seprafilm to prevent polypropylene mesh shrinkage: a macroscopic and histological experimental study

INTRODUCTION AND HYPOTHESIS

Polypropylene (PP) mesh shrinkage represents a serious complication, as a significant cause of pain and recurrence of pelvic organ prolapse or ventral hernias, frequently requiring several surgical interventions. The retraction seems to be caused by the host, in response to the implantation, through the occurrence of periprosthetic adhesions and fibrosis. We hypothesized that avoiding the postoperative adhesions can prevent PP mesh shrinkage.

METHODS

Sixty rats were randomly assigned to three groups. A standardized hernia defect was induced on the abdominal wall, which was repaired using an extraperitoneal PP mesh alone (group 1), with application of a hyaluronate carboxymethylcellulose-based bioresorbable membrane (Seprafilm, group 2), or an auto-cross-linked polysaccharide hyaluronan-based solution (Hyalobarrier gel, group 3). Eight weeks after the procedure, a repeat laparotomy was performed. After scoring the adhesion and measuring the mesh surface, a microscopic study of the prosthesis-host tissue interfaces was performed.

RESULTS

Group 1 displayed a median shrinkage of 29% of the mesh. The Seprafilm group (p = 0.0238) and Hyalobarrier gel group (p = 0.0072) displayed a significantly smaller reduction of 19.12 and 17 %, respectively. Control group 1 displayed a significantly greater adhesion score (30.40) than the Seprafilm (11.67, p = 0.0028) and Hyalobarrier gel groups (11.19, p = 0.0013). The fibrosis was reduced in the Hyalobarrier gel group only.

CONCLUSION

This experimental study revealed that Hyalobarrier gel and Seprafilm can prevent PP mesh shrinkage and postoperative adhesions. They might be integrated in a mesh size-saving strategy, which should preserve the quality and durability of the surgical repair and limit the postoperative pain.

Experience with TachoSil in obstetric and gynecologic surgery

OBJECTIVE

To evaluate the feasibility and effectiveness of using TachoSil during obstetric and gynecologic surgery.

METHODS

The retrospective cohort study, conducted at a French university hospital, included women who experienced perioperative bleeding requiring the use of TachoSil during 2007-2009. The following information was collected: patient age, indication for the use of TachoSil, need for a blood transfusion, type of surgery performed, postoperative course, and traceability of TachoSil.

RESULTS

TachoSil was used in 84 women. The main indications for the surgical interventions requiring TachoSil were ovarian malignancy (n=18), fibroma (n=17), breast cancer (n=11), and endometrial cancer (n=10). In 16 women, TachoSil was applied to the uterine serosa, particularly after cesarean delivery or polymyomectomy; in 7 women, it was applied to the major vascular axis. Red cell packs were infused in 24 women during surgery (average 3 packs per woman). Three women required repeat surgery. The use of TachoSil was not recorded in the operative reports of 43 (51%) women.

CONCLUSION

The present findings confirm that the use of TachoSil in gynecologic and obstetric surgeries is effective and well tolerated. Measures to improve the traceability of TachoSil use are recommended.