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Genoni S, Cinti F, Pilot M, Rossanese M, McCready D, Cantatore M. Stapled functional end-to-end intestinal anastomosis with endovascular gastrointestinal anastomosis staplers in cats and small dogs. J Small Anim Pract 2024. [PMID: 38988043 DOI: 10.1111/jsap.13756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/01/2024] [Accepted: 05/27/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVES To investigate the use of endovascular gastrointestinal stapling devices to perform intestinal functional end-to-end stapled anastomosis in small dogs and cats. MATERIALS AND METHODS Medical records of dogs (≤10 kg) and cats that underwent intestinal resection and functional end-to-end stapled anastomosis with an endovascular gastrointestinal anastomosis (endovascular-GIA) stapling device at five small animal referral centres between April 2014 and September 2023 were retrospectively reviewed. Data including clinical findings, surgical technique, histopathology and complications were collected. A minimum follow-up of 10 days was required. Patients with follow-up of less than 10 days were included if they developed a major complication. Outcome was obtained from assessing the clinical records and contacting the referring veterinarians or owners. Estimated survival was generated according to the Kaplan-Meier method. Differences between survival curves were tested by log-rank test. RESULTS Twenty-five patients (10 dogs and 15 cats) were included. The median bodyweight was 4.6 kg (range 2.6 to 10 kg). Nine patients were diagnosed with intestinal neoplasia, 16 with non-neoplastic intestinal disease. The median follow-up was 126 days (range 18 to 896 days). Five patients developed minor postoperative complications, including three superficial surgical site infections. No major postoperative complications were reported. Eighteen patients were alive at the end of the study, one patient was lost to follow-up. Kaplan-Meier estimated median survival time was not reached. Survival was significantly longer for patients with non-neoplastic versus neoplastic intestinal. CLINICAL SIGNIFICANCE The study suggests that the use of endovascular gastrointestinal anastomosis staplers is safe and effective to perform intestinal functional end-to-end stapled anastomosis in dogs ≤10 kg and cats.
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Affiliation(s)
- S Genoni
- Department of Surgery, The Ralph Veterinary Referral Centre, Marlow, UK
| | - F Cinti
- Department of Surgery, San Marco Veterinary Clinic and Laboratory, Padova, Italy
| | - M Pilot
- Langford Small Animal Hospital, Langford House, University of Bristol, Bristol, UK
| | - M Rossanese
- Queen Mother Hospital for Animals, Royal Veterinary College, Hatfield, UK
| | - D McCready
- Department of Surgery, The Ralph Veterinary Referral Centre, Marlow, UK
| | - M Cantatore
- Department of Surgery, Anderson Moores Veterinary Specialists, Winchester, UK
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Toriguchi K, Kaihara S, Kitamura K, Ishikawa T, Oshima N, Kondo M, Kobayashi H, Hashida H, Uryuhara K. Efficacy of surgical staple line reinforcement in Glissonean stapling: A single-center pilot study. Asian J Endosc Surg 2024; 17:e13293. [PMID: 38452773 DOI: 10.1111/ases.13293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/18/2024] [Accepted: 02/06/2024] [Indexed: 03/09/2024]
Abstract
Vascular staplers are routinely used in laparoscopic liver resection, which has become a standard procedure in advanced medical facilities. Although previous reports have outlined the benefits of staple line reinforcement (SLR), its application in Glissonean pedicle transection during hepatic resection remains poorly studied. This study investigated surgical SLR as a tool to enhance staple line strength and improve perioperative hemostasis. Here, 10 patients who underwent laparoscopic liver resection using the Tri-StapleTM2.0 Reinforced Reload were included. Patient characteristics, surgical details, and outcomes were assessed. The results demonstrated successful outcomes with no complications related to bile leakage or injuries during staple insertion. Overall, our findings suggest that SLR can be safely utilized in Glissonean pedicle transection during laparoscopic liver resections. Further studies are required to comprehensively evaluate its benefits compared with conventional surgical staplers.
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Affiliation(s)
- Kan Toriguchi
- Department of Surgery, Kobe Medical Center General Hospital, Kobe city, Hyogo, Japan
| | - Satoshi Kaihara
- Department of Surgery, Kobe Medical Center General Hospital, Kobe city, Hyogo, Japan
| | - Koji Kitamura
- Department of Surgery, Kobe Medical Center General Hospital, Kobe city, Hyogo, Japan
| | - Tatsuki Ishikawa
- Department of Surgery, Kobe Medical Center General Hospital, Kobe city, Hyogo, Japan
| | - Nobu Oshima
- Department of Surgery, Kobe Medical Center General Hospital, Kobe city, Hyogo, Japan
| | - Masato Kondo
- Department of Surgery, Kobe Medical Center General Hospital, Kobe city, Hyogo, Japan
| | - Hiroyuki Kobayashi
- Department of Surgery, Kobe Medical Center General Hospital, Kobe city, Hyogo, Japan
| | - Hiroki Hashida
- Department of Surgery, Kobe Medical Center General Hospital, Kobe city, Hyogo, Japan
| | - Kenji Uryuhara
- Department of Surgery, Kobe Medical Center General Hospital, Kobe city, Hyogo, Japan
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Takayama S, Tomoda K, Ishikawa K, Sakamoto M, Hasegawa T, Eguchi T, Takayama S, Mase T. A Retrospective Study About the Effectiveness of Anastomosis With a Polyglycolic Acid Sheet in Colorectal Cancer. Cureus 2024; 16:e56415. [PMID: 38638760 PMCID: PMC11024388 DOI: 10.7759/cureus.56415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction Anastomotic leakage is a serious complication in colon and rectal cancer surgeries, contributing to increased mortality rates and extended hospital stays. Despite various preventive measures, including intraoperative assessments and transanal drains, the incidence of anastomotic leakage remains a significant concern. This study investigates the potential efficacy of polyglycolic acid (PGA) sheets in reducing anastomotic leakage rates in gastrointestinal surgeries. Materials & methods A retrospective cohort study was conducted between January 2021 and January 2023 at Nagoya Tokushukai General Hospital, Ogaki Tokushukai Hospital, and Haibara General Hospital. A total of 239 patients undergoing colon or rectal cancer surgery were included. Anastomoses were performed with or without PGA sheets, and groups were compared using statistical analyses, including t-tests, Mann-Whitney U tests, and chi-square tests. The primary endpoint was the incidence of anastomotic leakage. Results Of the 239 patients, anastomotic leakage occurred in 14 (6%). The PGA use group (52 patients) showed no instances of anastomotic leakage while the PGA non-use group (187 patients) had 14 cases. Comparisons revealed significant differences in anastomotic leakage rates (p=0.04) between the two groups. Univariate analysis demonstrated a lower incidence of anastomotic leakage associated with PGA use (p=0.04). However, no significant differences were observed for transanal drainage (p=0.66), smoking (p=0.76), steroid use (p=1), and preoperative chemotherapy (p=0.07). Conclusion This study suggests that the use of PGA sheets in gastrointestinal anastomosis may contribute to a lower incidence of anastomotic leakage. The findings highlight the need for further prospective studies with a larger sample size, distinguishing between colon and rectum surgeries. Despite the limitations of this retrospective study, the observed reduction in anastomotic leakage frequency with PGA sheet use is noteworthy, emphasizing the potential significance of this approach in preventing a critical complication in colorectal surgeries.
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Affiliation(s)
| | - Keisuke Tomoda
- Surgery, Nagoya Tokushukai General Hospital, Kasugai, JPN
| | - Ken Ishikawa
- Surgery, Nagoya Tokushukai General Hospital, Kasugai, JPN
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Moroi R, Shiga H, Nochioka K, Chiba H, Shimoyama Y, Kuroha M, Tosa M, Kakuta Y, Kayaba S, Takahashi S, Kinouchi Y, Masamune A. Endoscopic radial incision and cutting for benign stenosis of the lower gastrointestinal tract: An investigation of novel endoscopic treatment in multicenter trial. J Gastroenterol Hepatol 2022; 37:1554-1560. [PMID: 35506307 DOI: 10.1111/jgh.15882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/11/2022] [Accepted: 04/30/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM The standard therapies for benign gastrointestinal stenosis are endoscopic balloon dilation or surgery; each have their advantages and disadvantages. In contrast, radial incision and cutting (RIC) is a novel approach for such stenosis. This study aimed to investigate the feasibility, safety, and effectiveness of RIC. METHODS We enrolled 20 patients with benign stenosis of the lower gastrointestinal tract developed by various causes and conducted RIC. We evaluated the re-intervention free rate 52 weeks after RIC, technical success rate, adverse events, procedure time, and improvement of symptoms using a visual analog scale. RESULTS We performed 20 sessions of first RIC for 20 lesions and seven sessions of additional RIC due to re-stenosis. The cumulative re-intervention-free survival rate 52 weeks after the first RIC was 55.8%. The technical success rate of the first RIC was 100% (20/20) while that of the additional RIC was 85.7% (6/7). One case developed perforation during the additional RIC and urgent surgery was performed. The additional RIC tended to show worse results in adverse events and procedure time compared with the first RIC. The patients' symptoms including abdominal bloating and dyschezia were significantly improved. CONCLUSIONS Although RIC demonstrated a higher technical success rate for lower gastrointestinal stricture and subsequent improvement of patient symptoms, several issues including preventing delayed bleeding, perforation, and the long-term prognosis should be solved and clarified in further investigations.
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Affiliation(s)
- Rintaro Moroi
- Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan
| | - Hisashi Shiga
- Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan
| | - Kotaro Nochioka
- Clinical Research, Innovation and Education Center, Tohoku University Hospital, Sendai, Japan
| | - Hirofumi Chiba
- Division of Gastroenterology, Iwate Prefectural Isawa Hospital, Oshu, Japan
| | - Yusuke Shimoyama
- Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan
| | - Masatake Kuroha
- Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan
| | - Masaki Tosa
- Division of Gastroenterology, Iwaki City Medical center, Iwaki, Japan
| | - Yoichi Kakuta
- Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan
| | - Shoichi Kayaba
- Division of Gastroenterology, Iwate Prefectural Isawa Hospital, Oshu, Japan
| | - Seiichi Takahashi
- Division of Gastroenterology, Iwaki City Medical center, Iwaki, Japan
| | | | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan
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Tokat T, Muderris T, Aysel A, Sari E, Erol F. The efficiency of polyglycolic acid felt in the prevention of pharyngocutaneous fistula after total laryngectomy. Am J Otolaryngol 2021; 42:103164. [PMID: 34352675 DOI: 10.1016/j.amjoto.2021.103164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 07/17/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Taskin Tokat
- Department of Otolaryngology - Head and Neck Surgery, Sakarya University Education and Research Hospital, Sakarya, Turkey.
| | - Togay Muderris
- Department of Otolaryngology - Head and Neck Surgery, Bakircay University, Faculty of Medicine, Izmir, Turkey
| | - Abdulhalim Aysel
- Department of Otolaryngology - Head and Neck Surgery, Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Elif Sari
- Department of Otolaryngology - Head and Neck Surgery, Mustafa Kemal University Faculty of Medicine, Hatay, Turkey
| | - Ferda Erol
- Department of Otolaryngology - Head and Neck Surgery, Bozyaka Education and Research Hospital, Izmir, Turkey
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Charalabopoulos A, Davakis S, Paraskeva P, Machairas N, Kapelouzou A, Kordzadeh A, Sakarellos P, Vailas M, Baili E, Bakoyiannis C, Felekouras E. Feasibility and Short-Term Outcomes of Three-Dimensional Hand-Sewn Esophago-Jejunal Anastomosis in Completely Laparoscopic Total Gastrectomy for Cancer. Cancers (Basel) 2021; 13:4709. [PMID: 34572936 PMCID: PMC8468311 DOI: 10.3390/cancers13184709] [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: 08/18/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 12/16/2022] Open
Abstract
Laparoscopic total gastrectomy is on the rise. One of the most technically demanding steps of the approach is the construction of esophago-jejunal anastomosis. Several laparoscopic anastomotic techniques have been described, like linear stapler side-to-side or circular stapler end-to-side anastomosis; limited data exist regarding hand-sewn esophago-jejunal anastomosis. The study took place between January 2018 and June 2021. Patients enrolled in this study were adults with proximal gastric or esophago-gastric junction Siewert type III tumors that underwent 3D-assisted laparoscopic total gastrectomy. A hand-sewn esophago-jejunal anastomosis was performed in all cases laparoscopically. Forty consecutive cases were performed during the study period. Median anastomotic suturing time was 55 min, with intra-operative methylene blue leak test being negative in all cases. Median operating time was 240 min, and there were no conversions to open. The anastomotic leak rate and postoperative stricture rate were zero. The 30- and 90-day mortality rates were zero. Laparoscopic manual esophago-jejunal anastomosis utilizing a 3D platform in total gastrectomy for cancer can be performed with excellent outcomes regarding anastomotic leak and stricture rate. This anastomotic approach, although technically challenging, is safe and reproducible, with prominent results that can be disseminated in the surgical community.
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Affiliation(s)
- Alexandros Charalabopoulos
- Upper Gastrointestinal and General Surgery Unit, First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Spyridon Davakis
- Upper Gastrointestinal and General Surgery Unit, First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Panorea Paraskeva
- Upper Gastrointestinal and General Surgery Unit, First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nikolaos Machairas
- Second Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Alkistis Kapelouzou
- Upper Gastrointestinal and General Surgery Unit, First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Ali Kordzadeh
- Department of Surgery, Broomfield Hospital, NHS Trust, Essex CM1 7ET, UK
| | - Panagiotis Sakarellos
- Upper Gastrointestinal and General Surgery Unit, First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Michail Vailas
- Upper Gastrointestinal and General Surgery Unit, First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Efstratia Baili
- Upper Gastrointestinal and General Surgery Unit, First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Christos Bakoyiannis
- Upper Gastrointestinal and General Surgery Unit, First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Evangelos Felekouras
- Upper Gastrointestinal and General Surgery Unit, First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
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Song YN, Qi Y, Zhang CY, Sheng YL, Wu K, Zhu SL, Han L, Shan TT, Ye GC, Zhang QY, Chen YL, Chen JW, Liu YF, Gao LB, Yang Y, He ZF, Zhu DY, Liu DL, Wen FB, Zheng TL, Li JL, Zhao S. A new technology for reducing anastomotic fistula in the neck after esophageal cancer surgery. J Thorac Dis 2019; 11:3084-3092. [PMID: 31463137 DOI: 10.21037/jtd.2019.07.28] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background To explore the risk factors and prevention methods of cervical mechanical anastomotic fistula and stenosis after the radical resection of esophageal cancer. Methods From March 2018 to November 2018, 128 patients undergoing mechanical anastomosis of esophageal cancer were selected from the Department of Thoracic Surgery of The First Affiliated Hospital of Zhengzhou University. All the enrolled patients were operated on using the Mckeown method, and a retrospective study was conducted. Data for preoperative and postoperative test indices, intraoperative embedding materials, postoperative complications, and preoperative and postoperative treatment were collected, and the relationship between various factors and the incidence of cervical anastomotic fistula and stenosis was analysed. Univariate analysis was conducted using t tests or Fisher's exact probability method, and multivariate analysis was conducted using logistic regression models. Results All 128 patients successfully underwent surgery without dying. The enrolled patients were evaluated using the Stooler classification, with 28 patients having grade 0, 41 patients having grade 1, 34 patients having grade 2, 21 patients having grade 3, and 4 patients having grade 4 stenosis. Patients with stenosis of grade 3 or above had obvious choking sensation, which could only be relieved by balloon dilation. Symptoms in all patients with stenosis were relieved by balloon dilation. There were no significant differences between the two groups regarding embedding materials, preoperative choking history, history of alcohol consumption, history of hypertension, history of coronary heart disease, history of diabetes, postoperative calcium concentration, average albumin concentration, average platelet concentration, body mass index, anastomotic fistula, preoperative chemotherapy, postoperative chemotherapy, or postoperative cough (P>0.05). There were significant differences in postoperative reflux (χ2=11.338, P<0.05) and scar constitution (χ2=12.497, P<0.05). The effects of embedding materials in patients with anastomotic fistula were significantly different (χ2=4.372, P<0.05). Conclusions Postoperative reflux and scar constitution may be risk factors for postoperative anastomotic stenosis after resection of esophageal cancer. There was almost no difference in the effects on esophageal anastomotic stenosis between embedding materials and the omentum majus, but Neoveil® may have certain advantages in preventing cervical anastomotic fistula, and thus may have certain clinical application value.
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Affiliation(s)
- Ya-Nan Song
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Yu Qi
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Chun-Yang Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Yin-Liang Sheng
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Kai Wu
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Sen-Lin Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Lu Han
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Ting-Ting Shan
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Guan-Chao Ye
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Qing-Yi Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Yan-Li Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Jin-Wei Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Ya-Fei Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Lu-Bing Gao
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Yang Yang
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Zhan-Feng He
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Deng-Yan Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Dong-Lei Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Feng-Biao Wen
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Tian-Liang Zheng
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Ji-Lun Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Song Zhao
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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Newly Developed Polyglycolic Acid Reinforcement Unified with Sodium Alginate to Prevent Adhesion. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4515949. [PMID: 29850517 PMCID: PMC5903349 DOI: 10.1155/2018/4515949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/26/2017] [Accepted: 11/07/2017] [Indexed: 11/24/2022]
Abstract
Polyglycolic acid (PGA) mesh fabric is widely used for reinforcing injured tissues during surgeries. However, PGA induces chronic inflammation and adhesion. The purpose of this study is to develop PGA reinforcement “without PGA-induced adhesion.” We developed a reinforcement fabric unified with PGA mesh and alginate foam. The antiadhesive effects of sodium alginate foam and calcium alginate foam were evaluated in rats. Sodium alginate foam unified with PGA mesh fabric exhibited strong effects that limit the extent and severity of adhesion, whereas calcium alginate foam unified with PGA mesh was less effective in preventing adhesion. In the sodium alginate group, fibroblasts and collagen fibers around implanted sites were sparse and the material degraded rapidly by macrophage ingestion. Fibroblasts and collagen fibers play a major role in adhesion formation and their excessive proliferation results in postoperative adhesion. Thus, inhibiting their increase is the key in preventing PGA-induced adhesion. The reinforcement that is composed of PGA mesh unified with sodium alginate foam strongly inhibited PGA-induced adhesion and showed excellent handling during surgery and could be easily applied with a one-step procedure.
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