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Bi-layered carboxymethyl cellulose-collagen vitrigel dual-surface adhesion-prevention membrane. Carbohydr Polym 2022; 285:119223. [DOI: 10.1016/j.carbpol.2022.119223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/12/2021] [Accepted: 02/01/2022] [Indexed: 11/21/2022]
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Fatehi Hassanabad A, Zarzycki AN, Jeon K, Dundas JA, Vasanthan V, Deniset JF, Fedak PWM. Prevention of Post-Operative Adhesions: A Comprehensive Review of Present and Emerging Strategies. Biomolecules 2021; 11:biom11071027. [PMID: 34356652 PMCID: PMC8301806 DOI: 10.3390/biom11071027] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 02/06/2023] Open
Abstract
Post-operative adhesions affect patients undergoing all types of surgeries. They are associated with serious complications, including higher risk of morbidity and mortality. Given increased hospitalization, longer operative times, and longer length of hospital stay, post-surgical adhesions also pose a great financial burden. Although our knowledge of some of the underlying mechanisms driving adhesion formation has significantly improved over the past two decades, literature has yet to fully explain the pathogenesis and etiology of post-surgical adhesions. As a result, finding an ideal preventative strategy and leveraging appropriate tissue engineering strategies has proven to be difficult. Different products have been developed and enjoyed various levels of success along the translational tissue engineering research spectrum, but their clinical translation has been limited. Herein, we comprehensively review the agents and products that have been developed to mitigate post-operative adhesion formation. We also assess emerging strategies that aid in facilitating precision and personalized medicine to improve outcomes for patients and our healthcare system.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Anna N. Zarzycki
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Kristina Jeon
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R7, Canada;
| | - Jameson A. Dundas
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Vishnu Vasanthan
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Justin F. Deniset
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
- Department of Physiology and Pharmacology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Paul W. M. Fedak
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
- Correspondence:
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Abstract
The development of adhesions after gynecologic surgery is a severe problem with ramifications that go beyond the medical complications patients suffer (which most often include pain, obstruction and infertility), since they also impose a huge financial burden on the health care system and increase the workload of surgeons and all personnel involved in surgical follow-up care. Surgical techniques to avoid adhesion formation have not proven to be sufficient and pharmaceutical approaches for their prevention are even less effective, which means that the use of adhesion prevention devices is essential for achieving decent prophylaxis. This review explores the wide range of adhesion prevention products currently available on the market. Particular emphasis is put on prospective randomized controlled clinical trials that include second-look interventions, as these offer the most solid evidence of efficacy. We focused on adhesion scores, which are the most common way to quantify adhesion formation. This enables a direct comparison of the efficacies of different devices. While the greatest amount of data are available for oxidized regenerated cellulose, the outcomes with this adhesion barrier are mediocre and several studies have shown little efficacy. The best results have been achieved using adhesion barriers based on either modified starch, i.e., 4DryField® PH (PlantTec Medical GmbH, Lüneburg, Germany), or expanded polytetrafluoroethylene, i.e., GoreTex (W.L. Gore & Associates, Inc., Medical Products Division, Flagstaff, AZ), albeit the latter, as a non-resorbable barrier, has a huge disadvantage of having to be surgically removed again. Therefore, 4DryField® PH currently appears to be a promising approach and further studies are recommended.
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Li H, Wei X, Yi X, Tang S, He J, Huang Y, Cheng F. Antibacterial, hemostasis, adhesive, self-healing polysaccharides-based composite hydrogel wound dressing for the prevention and treatment of postoperative adhesion. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 123:111978. [PMID: 33812606 DOI: 10.1016/j.msec.2021.111978] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 12/13/2022]
Abstract
Herein, we fabricated novel self-healing, in situ injectable, biodegradable, and non-toxic hydrogels anti-adhesion barrier materials composed of N, O-carboxymethyl chitosan (N,O-CS) and oxidized dextran (ODA) without requiring any chemical cross-linking agent or external stimuli triggers for the prevention and treatment of post-operative peritoneal adhesions. The N,O-CS/ODA hydrogels have a good suitable gelation time, good cytocompatibility and hemocompatibility, good antibacterial activity, excellent biodegradable and biocompatible, and can effectively inhibit the adhesion of fibroblasts to the wound, thereby suggesting that N,O-CS/ODA hydrogels are suitable for preventing post-operative adhesion. Meanwhile, a rat injury sidewall-cecum abrasion model is developed to investigate the efficacy of these hydrogels in achieving post-operative anti-adhesion. A significant reduction of peritoneal adhesions (10% rat with lower score adhesion) is observed in the N,O-CS/ODA-hydrogel-treated group compared with the commercial hydrogel and control groups. These results demonstrated that N,O-CS/ODA hydrogel could effectively prevent post-operative peritoneal adhesion without side effects. Therefore, the N,O-CS/ODA hydrogels with multi-functional properties exhibit great potential for the prevention and treatment of postoperative adhesion.
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Affiliation(s)
- Hongbin Li
- MIIT Key Laboratory of Critical Materials Technology for New Energy Conversion and Storage, School of Chemistry and Chemical Engineering, Harbin Institute of Technology, Harbin, Heilongjiang, 150001, PR China; College of Light Industry and Textile, Qiqihar University, Qiqihar, Heilongjiang, 161000, PR China
| | - Xinjing Wei
- MIIT Key Laboratory of Critical Materials Technology for New Energy Conversion and Storage, School of Chemistry and Chemical Engineering, Harbin Institute of Technology, Harbin, Heilongjiang, 150001, PR China
| | - Xiaotong Yi
- MIIT Key Laboratory of Critical Materials Technology for New Energy Conversion and Storage, School of Chemistry and Chemical Engineering, Harbin Institute of Technology, Harbin, Heilongjiang, 150001, PR China
| | - Shize Tang
- MIIT Key Laboratory of Critical Materials Technology for New Energy Conversion and Storage, School of Chemistry and Chemical Engineering, Harbin Institute of Technology, Harbin, Heilongjiang, 150001, PR China
| | - Jinmei He
- MIIT Key Laboratory of Critical Materials Technology for New Energy Conversion and Storage, School of Chemistry and Chemical Engineering, Harbin Institute of Technology, Harbin, Heilongjiang, 150001, PR China.
| | - Yudong Huang
- MIIT Key Laboratory of Critical Materials Technology for New Energy Conversion and Storage, School of Chemistry and Chemical Engineering, Harbin Institute of Technology, Harbin, Heilongjiang, 150001, PR China
| | - Feng Cheng
- MIIT Key Laboratory of Critical Materials Technology for New Energy Conversion and Storage, School of Chemistry and Chemical Engineering, Harbin Institute of Technology, Harbin, Heilongjiang, 150001, PR China.
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Li Z, Liu L, Chen Y. Dual dynamically crosslinked thermosensitive hydrogel with self-fixing as a postoperative anti-adhesion barrier. Acta Biomater 2020; 110:119-128. [PMID: 32438111 DOI: 10.1016/j.actbio.2020.04.034] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/08/2020] [Accepted: 04/20/2020] [Indexed: 11/30/2022]
Abstract
Tissue adhesion is a severe postoperative complication. Various strategies have been developed to minimize postoperative adhesion, but the clinical efficacy is still far from satisfactory. Herein, we present a dual dynamically crosslinked hydrogel to serve as a physical postoperative anti-adhesion barrier. The hydrogel was generated by dynamic chemical oxime bonding from alkoxyamine-terminated Pluronic F127 (AOP127) and oxidized hyaluronic acid (OHA), as well as hydrophobic association of AOP127. Rheological analysis demonstrated that the hydrogel exhibits temperature sensitivity. At 37 °C, it shows much higher modulus and higher stability than the Pluronic F127 hydrogel. Hemolytic assays suggested that the hydrogel undergoes low hemolysis. In addition, it exhibited anti-adhesion to blood cells in blood cell adhesion tests. It also showed an anti-attachment effect to fibroblasts and biocompatibility in vitro cell studies. Macroscopic evaluation and lap-shear tests revealed that the hydrogel has a moderate adhesive capacity to tissue, which is important for self-fixation. A rat model of sidewall defect-bowel abrasion was established to evaluate the anti-adhesion effect in vivo. The gross observation and pathological analysis revealed a significant reduction in postoperative peritoneal adhesion in the AOP127/OHA hydrogel-treated group than those treated with normal saline or Pluronic F127 hydrogel. Hence, the dual dynamically crosslinked hydrogel with self-fixable capacity may be suitable as a physical barrier for postoperative adhesion prevention. STATEMENT OF SIGNIFICANCE: Despite the development of numerous postoperative anti-adhesion barriers, their anti-adhesion efficacy is still limited in clinical trials due to poor tissue adhesion and rapid clearance from injured areas. Herein, we have developed a dual dynamic crosslinked hydrogel, generated by dynamic oxime bonds and hydrophobic interactions. The hydrogel is temperature-sensitive and demonstrates moderate tissue adhesion capacity, which allows for self-fixation when applied to defects. The introduction of dynamic covalent bonds improves the stability of the hydrogel. Moreover, the hydrogel not only displays appropriate hemocompatibility, cytocompatibility and anti-adhesion of blood cells and fibroblasts, but it also effectively contributes to preventing postoperative peritoneal adhesions in vivo. Hence, this dual dynamic crosslinked hydrogel may have potential applications as a physical barrier in clinical practice.
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Affiliation(s)
- Ziyi Li
- School of Materials Science and Engineering, Key Laboratory of Polymeric Composite Materials and Functional Materials of Ministry of Education, GD Research Center for Functional Biomaterials Engineering and Technology, Sun Yat-sen University, Guangzhou 510275, China
| | - Lixin Liu
- School of Materials Science and Engineering, Key Laboratory of Polymeric Composite Materials and Functional Materials of Ministry of Education, GD Research Center for Functional Biomaterials Engineering and Technology, Sun Yat-sen University, Guangzhou 510275, China
| | - Yongming Chen
- School of Materials Science and Engineering, Key Laboratory of Polymeric Composite Materials and Functional Materials of Ministry of Education, GD Research Center for Functional Biomaterials Engineering and Technology, Sun Yat-sen University, Guangzhou 510275, China.
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Ohta S, Toda T, Inagaki F, Omichi K, Shimizu A, Kokudo N, Hasegawa K, Ito T. The Prevention of Hepatectomy-Induced Adhesions by Bilayer Sponge Composed of Ultrapure Alginate. J Surg Res 2019; 242:286-295. [PMID: 31125842 DOI: 10.1016/j.jss.2019.04.063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 03/28/2019] [Accepted: 04/24/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Adhesion formation is a critical issue in surgery, particularly in hepatectomy. The present study aimed to develop a bilayer adhesion barrier comprising alginate (Alg) of different molecular weight (Mw). It was expected that a slowly dissolving layer remains on the cut surface, functioning as a physical barrier, whereas a rapidly dissolving layer widely distributes in the peritoneal cavity to prevent de novo adhesions. METHODS Bilayer Alg sponges were fabricated using low Mw Alg for the upper layer and high Mw Alg for the bottom layer. The dissolution behavior of each layer was evaluated in vitro in peritoneum-like environments. We constructed a Pean crush hepatectomy-induced adhesion model in rats. The effects of the bilayer sponge on cut surface and de novo adhesions were separately evaluated in terms of their extent and grade. RESULTS The Alg sponge layer with low Mw dissolved faster than that with high Mw in vitro. One week after the hepatectomy, although no significant decrease in adhesion extent on the cut surface was observed in rats that received Seprafilm and Interceed, treatment with Alg bilayer sponge significantly decreased the adhesion extent to 38% of that without treatment. Moreover, a significant decrease in de novo adhesion extent was observed in the Alg bilayer sponge compared with the Interceed group. CONCLUSIONS The Alg bilayer sponge was effective for preventing both cut surface and de novo adhesions in the rat Pean crush hepatectomy model. The simple yet functional design of the Alg bilayer sponge can facilitate its use in future clinical practice.
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Affiliation(s)
- Seiichi Ohta
- Center for Disease Biology and Integrative Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeo Toda
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Fuyuki Inagaki
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kiyohiko Omichi
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Atsushi Shimizu
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Taichi Ito
- Center for Disease Biology and Integrative Medicine, The University of Tokyo, Tokyo, Japan.
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Zhang E, Li J, Zhou Y, Che P, Ren B, Qin Z, Ma L, Cui J, Sun H, Yao F. Biodegradable and injectable thermoreversible xyloglucan based hydrogel for prevention of postoperative adhesion. Acta Biomater 2017; 55:420-433. [PMID: 28391053 DOI: 10.1016/j.actbio.2017.04.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/21/2017] [Accepted: 04/03/2017] [Indexed: 11/19/2022]
Abstract
Peritoneal adhesion is very common after abdominal and pelvic surgery, which leads to a variety of severe complications. Although numerous pharmacological treatments and barrier-based devices have been investigated to minimize or prevent postoperative adhesion, the clinical efficacy is not very encouraging. In this work, a biodegradable and thermoreversible galactose modified xyloglucan (mXG) hydrogel was developed and the efficacy of mXG hydrogel in preventing postoperative peritoneal adhesion was investigated. The 4% (w/v) mXG solution was a free flowing sol at low temperature, but could rapidly convert into a physical hydrogel at body temperature without any extra additives or chemical reactions. In vitro cell tests showed that mXG hydrogel was non-toxic and could effectively resist the adhesion of fibroblasts. Moreover, in vitro and in vivo degradation experiments exhibited that mXG hydrogel was degradable and biocompatible. Finally, the rat model of sidewall defect-cecum abrasion was employed to evaluate the anti-adhesion efficacy of the mXG hydrogel. The results demonstrated that mXG hydrogel could effectively prevent postoperative peritoneal adhesion without side effects. The combination of suitable gel temperature, appropriate biodegradation period, and excellent postoperative anti-adhesion efficacy make mXG hydrogel a promising candidate for the prevention of postsurgical peritoneal adhesion. STATEMENT OF SIGNIFICANCE Despite numerous drugs or barrier-based devices have been developed to prevent postoperative adhesion, few solutions have proven to be uniformly effective in subsequent clinical trials. In the present study, we developed a biodegradable and thermoreversible galactose modified xyloglucan (mXG) hydrogel by green enzymatic reaction without using any organic reagents. The developed physical mXG hydrogel not only showed excellent injectability, appropriate gelation time and temperature, but also exhibited excellent biocompatibility and biodegradability both in vitro and in vivo. In addition, mXG hydrogel was easy to handle and could effectively prevent postoperative adhesion without side effects in a rat model of sidewall defect-bowel abrasion. Our study provide a safe and effective postoperative anti-adhesion material which may have potential applications in clinical practice.
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Affiliation(s)
- Ershuai Zhang
- School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China; Department of Basic Medical Sciences, North China University of Science and Technology, Tangshan 063000, China
| | - Junjie Li
- Department of Advanced Interdisciplinary Studies, Institute of Basic Medical Sciences and Tissue Engineering Research Center, Academy of Military Medical Sciences, Beijing 100850, China
| | - Yuhang Zhou
- School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China
| | - Pengcheng Che
- Department of Basic Medical Sciences, North China University of Science and Technology, Tangshan 063000, China
| | - Bohua Ren
- School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China
| | - Zhihui Qin
- School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China
| | - Litao Ma
- Department of Basic Medical Sciences, North China University of Science and Technology, Tangshan 063000, China
| | - Jing Cui
- Department of Basic Medical Sciences, North China University of Science and Technology, Tangshan 063000, China
| | - Hong Sun
- Department of Basic Medical Sciences, North China University of Science and Technology, Tangshan 063000, China; School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China.
| | - Fanglian Yao
- School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China; Key Laboratory of Systems Bioengineering of Ministry of Education, Tianjin University, Tianjin 300350, China.
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Giusto G, Vercelli C, Iussich S, Audisio A, Morello E, Odore R, Gandini M. A pectin-honey hydrogel prevents postoperative intraperitoneal adhesions in a rat model. BMC Vet Res 2017; 13:55. [PMID: 28212637 PMCID: PMC5314697 DOI: 10.1186/s12917-017-0965-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 02/03/2017] [Indexed: 12/21/2022] Open
Abstract
Background Adhesions are a common postoperative surgical complication. Liquid honey has been used intraperitoneally to reduce the incidence of these adhesions. However, solid barriers are considered more effective than liquids in decreasing postoperative intra-abdominal adhesion formation; therefore, a new pectin-honey hydrogel (PHH) was produced and its effectiveness was evaluated in a rat cecal abrasion model. Standardized cecal/peritoneal abrasion was performed through laparotomy in 48 adult Sprague-Dawley rats to induce peritoneal adhesion formation. Rats were randomly assigned to a control (C) and treatment (T) group. In group T, PHHs were placed between the injured peritoneum and cecum. Animals were euthanized on day 15 after surgery. Adhesions were evaluated macroscopically and adhesion scores were recorded and compared between the two groups. Inflammation, fibrosis, and neovascularization were histologically graded and compared between the groups. Results In group C, 17 of 24 (70.8%) animals developed adhesions between the cecum and peritoneum, while in group T only 5 of 24 (20.8%) did (p = 0.0012). In group C, one rat had an adhesion score of 3, sixteen had scores of 2, and seven rats had scores of 0. In group T, four rats had adhesion scores of 2, one rat had an adhesion score of 1 and nineteen have score 0 (p = 0.0003). Significantly lower grades of inflammation, fibrosis, and neovascularization were seen in group T (p = 0.006, p = 0.001, p = 0.002, respectively). Conclusion PHH is a novel absorbable barrier that is effective in preventing intra-abdominal adhesions in a cecal abrasion model in rats. Electronic supplementary material The online version of this article (doi:10.1186/s12917-017-0965-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gessica Giusto
- Department of Veterinary Sciences, University of Turin, Largo Paolo Braccini, n. 2, Grugliasco, Turin, 10095, Italy.
| | - Cristina Vercelli
- Department of Veterinary Sciences, University of Turin, Largo Paolo Braccini, n. 2, Grugliasco, Turin, 10095, Italy
| | - Selina Iussich
- Department of Veterinary Sciences, University of Turin, Largo Paolo Braccini, n. 2, Grugliasco, Turin, 10095, Italy
| | - Andrea Audisio
- Department of Veterinary Sciences, University of Turin, Largo Paolo Braccini, n. 2, Grugliasco, Turin, 10095, Italy
| | - Emanuela Morello
- Department of Veterinary Sciences, University of Turin, Largo Paolo Braccini, n. 2, Grugliasco, Turin, 10095, Italy
| | - Rosangela Odore
- Department of Veterinary Sciences, University of Turin, Largo Paolo Braccini, n. 2, Grugliasco, Turin, 10095, Italy
| | - Marco Gandini
- Department of Veterinary Sciences, University of Turin, Largo Paolo Braccini, n. 2, Grugliasco, Turin, 10095, Italy
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Abstract
PURPOSE The present study aimed to investigate the safety and the anti-postoperative peritoneal adhesion (PPA) characteristics of Sepramesh® (Davol), a composite mesh made of polypropylene covered with Seprafilm, when intraperitoneally placed in a rat model. METHODS Twenty male rats were randomized into a control group and a Sepramesh group. They underwent a primary surgical procedure aiming to induce a peritoneal injury in order to induce PPAs. In the Sepramesh group, the burnt peritoneum was covered with a 2-cm diameter disc of Sepramesh prosthesis. The mesh was fixed to the parietal peritoneum with four 3-0 absorbable stitches. PPAs were assessed during a second laparotomy 10 days later using quantitative and qualitative scoring systems. RESULTS There was no difference in terms of mean number of PPAs between both groups. All the rats from the control group developed PPAs. In the Sepramesh group, no adhesions were observed at the site of the injured peritoneum that had been covered with the Sepramesh prosthesis, but PPAs occurred at the extremities of the mesh, where there was close contact between polypropylene and viscera, or where the fixation sutures were placed. The severity and the type of adhesions were significantly higher in the control group. CONCLUSIONS This study demonstrated that for the Sepramesh prostheses, the Seprafilm layer might be effective in PPA prevention, but damage caused by the section and fixation of Sepramesh should be limited in order to limit PPAs.
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Affiliation(s)
- Willy Arung
- Centre De Recherche Et Développement En Chirurgie (CREDEC), GIGA – Cardiovascular Sciences, University of Liege (ULg), Liege, Belgium
- Department of General Surgery, Cliniques Universitaires De Lubumbashi, University of Lubumbashi, Lubumbashi, Katanga Province, Democratic Republic of Congo
| | - Pierre Drion
- Centre De Recherche Et Développement En Chirurgie (CREDEC), GIGA – Cardiovascular Sciences, University of Liege (ULg), Liege, Belgium
- Animal Facility, GIGA-R Cardiovascular Sciences, University of Liege (ULg), Liege, Belgium
| | - Olivier Detry
- Centre De Recherche Et Développement En Chirurgie (CREDEC), GIGA – Cardiovascular Sciences, University of Liege (ULg), Liege, Belgium
- Department of Abdominal Surgery and Transplantation, CHU Liege, University of Liege (ULg CHU), Liege, Belgium
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Discussion on. J Craniofac Surg 2016; 27:2041-2042. [DOI: 10.1097/scs.0000000000003144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Regulation of synthesis and roles of hyaluronan in peritoneal dialysis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:427038. [PMID: 26550568 PMCID: PMC4621352 DOI: 10.1155/2015/427038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 08/16/2015] [Indexed: 12/08/2022]
Abstract
Hyaluronan (HA) is a ubiquitous extracellular matrix glycosaminoglycan composed of repeated disaccharide units of alternating D-glucuronic acid and D-N-acetylglucosamine residues linked via alternating β-1,4 and β-1,3 glycosidic bonds. HA is synthesized in humans by HA synthase (HAS) enzymes 1, 2, and 3, which are encoded by the corresponding HAS genes. Previous in vitro studies have shown characteristic changes in HAS expression and increased HA synthesis in response to wounding and proinflammatory cytokines in human peritoneal mesothelial cells. In addition, in vivo models and human peritoneal biopsy samples have provided evidence of changes in HA metabolism in the fibrosis that at present accompanies peritoneal dialysis treatment. This review discusses these published observations and how they might contribute to improvement in peritoneal dialysis.
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Guillaume O, Teuschl AH, Gruber-Blum S, Fortelny RH, Redl H, Petter-Puchner A. Emerging Trends in Abdominal Wall Reinforcement: Bringing Bio-Functionality to Meshes. Adv Healthc Mater 2015; 4:1763-89. [PMID: 26111309 DOI: 10.1002/adhm.201500201] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/12/2015] [Indexed: 12/19/2022]
Abstract
Abdominal wall hernia is a recurrent issue world-wide and requires the implantation of over 1 million meshes per year. Because permanent meshes such as polypropylene and polyester are not free of complications after implantation, many mesh modifications and new functionalities have been investigated over the last decade. Indeed, mesh optimization is the focus of intense development and the biomaterials utilized are now envisioned as being bioactive substrates that trigger various physiological processes in order to prevent complications and to promote tissue integration. In this context, it is of paramount interest to review the most relevant bio-functionalities being brought to new meshes and to open new avenues for the innovative development of the next generation of meshes with enhanced properties for functional abdominal wall hernia repair.
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Affiliation(s)
- Olivier Guillaume
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
| | - Andreas Herbert Teuschl
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
- University of Applied Sciences Technikum Wien; Department of Biochemical Engineering; Höchstädtplatz 5 1200 Vienna Austria
| | - Simone Gruber-Blum
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
- Department of General Visceral and Oncological Surgery; Wilhelminenspital der Stadt Wien; Montleartstraße 37 A-1171 Vienna Austria
| | - René Hartmann Fortelny
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
- Department of General Visceral and Oncological Surgery; Wilhelminenspital der Stadt Wien; Montleartstraße 37 A-1171 Vienna Austria
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
| | - Alexander Petter-Puchner
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology; Donaueschingenstraße 13 A-1200 Vienna Austria
- Austrian Cluster for Tissue Regeneration; Donaueschingenstrasse 13 A-1200 Vienna Austria
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Inagaki NF, Inagaki FF, Kokudo N, Miyajima A. Cell-based therapy for preventing postoperative adhesion and promoting regeneration after hepatectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2015; 22:524-30. [PMID: 25877017 DOI: 10.1002/jhbp.247] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 03/12/2015] [Indexed: 12/31/2022]
Abstract
Postoperative adhesion is a critical clinical issue after almost all abdominal or pelvic surgeries including liver surgery. Postoperative adhesion causes several complications, such as small bowel obstruction and chronic abdominal pain. Furthermore, it makes reoperation much more difficult, leading to increased mortality and morbidity rate. Postoperative adhesion is particularly problematic for repeated hepatectomy, since hepatic malignant neoplasm recurs frequently and repeated hepatectomy is widely used as one of the most curative treatments. Several treatments to reduce postoperative adhesion have been developed, which include laparoscopic surgery, administration of pharmacological agents and use of prophylactic barrier materials. However, none of them are optimal. We have proposed a novel treatment using a cell sheet of fetal liver mesothelial cells (FL-MCs) to prevent postoperative adhesion in a novel mouse model. Besides adhesion, repeated hepatectomy has another serious problem; although the liver has a remarkable ability to regenerate, the recovery of liver mass and function of the remnant liver after multiple repeated hepatectomy is limited. The FL-MC cell sheet enhances proliferation of hepatocytes after hepatectomy by providing growth factors for hepatocytes. Thus the FL-MC sheet could simultaneously solve the two problems associated with repeated hepatectomy.
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Affiliation(s)
- Natsuko F Inagaki
- Institute of Molecular and Cellular Biosciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo, 113-0032, Japan
| | - Fuyuki F Inagaki
- Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Atsushi Miyajima
- Institute of Molecular and Cellular Biosciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo, 113-0032, Japan.
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New hepatectomy-induced postoperative adhesion model in rats, and evaluation of the efficacy of anti-adhesion materials. Surg Today 2013; 44:314-23. [PMID: 23504003 DOI: 10.1007/s00595-013-0530-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 11/15/2012] [Indexed: 12/19/2022]
Abstract
PURPOSE Repeated hepatic resections are not uncommon during the surgical management of liver tumors. Postoperative adhesions induced by hepatectomies can have a significant negative impact on subsequent surgeries. We recently developed a new hepatectomy-induced postoperative adhesion animal model to evaluate the anti-adhesion efficacy of commercially available sheet materials (Seprafilm(®) and Interceed(®)) and the recently reported hyaluronan-based in situ cross-linkable hydrogels. METHODS The median lobe (ML) and the left lateral lobe (LLL) of the liver (approximately 70 % of the total liver) of 43 male Sprague-Dawley rats were resected based on the classical procedure; anti-adhesion materials were then applied. A relaparotomy was performed 1 week later to evaluate the adhesions and histopathological findings. RESULTS The rats without the application of anti-adhesion materials (n = 14) showed the most severe adhesions (grade 3) between the cut surface of the liver and the small bowel or omentum. All the barrier materials produced slight anti-adhesion effects. Adhesions between the liver surface and the diaphragm and adhesions around the hepatic hilum were less severe, but were not remarkably reduced, by the anti-adhesion materials. CONCLUSION We successfully established a new hepatectomy-induced animal adhesion model, which may be useful for the development of new anti-adhesion materials.
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Brochhausen C, Schmitt VH, Planck CNE, Rajab TK, Hollemann D, Tapprich C, Krämer B, Wallwiener C, Hierlemann H, Zehbe R, Planck H, Kirkpatrick CJ. Current strategies and future perspectives for intraperitoneal adhesion prevention. J Gastrointest Surg 2012; 16:1256-74. [PMID: 22297658 DOI: 10.1007/s11605-011-1819-9] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 12/28/2011] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The formation of peritoneal adhesions still is a relevant clinical problem after abdominal surgery. Until today, the most important clinical strategies for adhesion prevention are accurate surgical technique and the physical separation of traumatized serosal areas. Despite a variety of barriers which are available in clinical use, the optimal material has not yet been found. DISCUSSION Mesothelial cells play a crucial physiological role in friction less gliding of the serosa and the maintenance of anantiadhesive surface. The formation of postoperative adhesions results from a cascade of events and is regulated by various cellular and humoral factors. Therefore, optimization or functionalization of barrier materials by developments interacting with this cascade on a structural or pharmacological level could give an innovative input for future strategies in peritoneal adhesion prevention. For this purpose, the proper understanding of the formal pathogenesis of adhesion formation is essential. Based on the physiology of the serosa and the pathophysiology of adhesion formation, the available barriers in current clinical practice as well as new innovations are discussed in the present review.
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Affiliation(s)
- Christoph Brochhausen
- REPAIR-lab, Institute of Pathology, University Medical Centre, Johannes Gutenberg-University, Langenbeckstraße 1,55101 Mainz, Germany.
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Ambler DR, Golden AM, Gell JS, Saed GM, Carey DJ, Diamond MP. Microarray expression profiling in adhesion and normal peritoneal tissues. Fertil Steril 2012; 97:1158-64.e1-4. [DOI: 10.1016/j.fertnstert.2012.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 02/01/2012] [Accepted: 02/02/2012] [Indexed: 11/27/2022]
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A sprayable hyaluronate/carboxymethylcellulose adhesion barrier exhibits regional adhesion reduction efficacy and does not impair intestinal healing. J Gastrointest Surg 2012; 16:325-33. [PMID: 21983948 DOI: 10.1007/s11605-011-1709-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 09/20/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND While bioresorbable solid barriers such as Seprafilm® prevent adhesions, their efficacy is limited to sites of application. The aim of this study was to assess the effectiveness of the sprayable adhesion barrier Sepraspray® in preventing adhesions to sites of direct application and to remote sites. METHODS Intraabdominal adhesions were induced in 30 rats by creating three ischemic buttons on each side of a midline incision. To assess efficacy, Sepraspray (5 mg/button) or Seprafilm (1 cm(2)/button) was applied over three buttons on one side of the peritoneum. Operated control animals received no treatment. On day 7, adhesions were scored as percent of buttons with adhesions. To assess safety, 81 rats underwent a colonic transection repaired with an end-to-end anastomosis. Both barriers were applied circumferentially to anastomoses. Controls received no product. The integrity of healing anastomosed colonic wounds was assessed by burst pressure and tensile strength at days 3, 5, and 7 postoperatively. RESULTS The direct application of both Sepraspray and Seprafilm significantly (p < 0.001) reduced adhesion formation compared to controls. While Seprafilm had no remote effect on adhesion formation, Sepraspray significantly (p < 0.001) reduced adhesion formation to contralateral ischemic buttons. Neither barrier affected anastomotic integrity at any time point. CONCLUSIONS Sepraspray has widespread efficacy throughout the peritoneum in reducing adhesions without compromising intestinal healing. Furthermore, this sprayable alternative offers the potential for easier intraabdominal application.
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Bates GW, Shomento S. Adhesion prevention in patients with multiple cesarean deliveries. Am J Obstet Gynecol 2011; 205:S19-24. [PMID: 22114994 DOI: 10.1016/j.ajog.2011.09.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 08/09/2011] [Accepted: 09/29/2011] [Indexed: 11/18/2022]
Abstract
Adhesion formation is a well-known complication of abdominal surgery. Although one third of all deliveries in the United States are by cesarean delivery (CD), little is known about adhesions in the obstetric setting. Various surgical techniques for reducing adhesion formation following CD have been investigated. The relative benefits of peritoneal closure and single-layer uterine closure are areas of continued research and debate. Adhesion prevention products are also becoming more commonplace in gynecologic surgery. Two membrane/adhesion barriers have been approved in the United States. A barrier consisting of oxidized regenerated cellulose (Interceed absorbable adhesion barrier) has been shown to reduce adhesions during microsurgery. Its use may be limited following CD because complete hemostasis is crucial to its efficacy. Seprafilm adhesion barrier, composed of hyaluronic acid and carboxymethylcellulose, is approved for use in abdominal or pelvic laparotomy. Preliminary data suggest that it may be effective for reducing adhesions following CD. This article discusses what is currently known about adhesion prevention in the obstetric population and highlights the paucity of level I evidence available to clinicians in this setting.
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Affiliation(s)
- Gordon Wright Bates
- Department of Obstetrics and Gynecology, University of Alabama-Birmingham, Birmingham, AL 35233, USA.
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Differential mRNA expression of TACR1 after ischemic peritoneal trauma: a pilot animal study. Arch Gynecol Obstet 2011; 285:717-20. [DOI: 10.1007/s00404-011-2041-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 07/28/2011] [Indexed: 11/25/2022]
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Murano E, Perin D, Khan R, Bergamin M. Hyaluronan: From Biomimetic to Industrial Business Strategy. Nat Prod Commun 2011. [DOI: 10.1177/1934578x1100600415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hyaluronan (hyaluronic acid) is a naturally occurring polysaccharide of a linear repeating disaccharide unit consisting of β-(1→4)-linked D-glucopyranuronic acid and β-(1→3)-linked 2-acetamido-2-deoxy-D-glucopyranose, which is present in extracellular matrices, the synovial fluid of joints, and scaffolding that comprises cartilage. In its mechanism of synthesis, its size, and its physico-chemical properties, hyaluronan is unique amongst other glycosaminoglycans. The network-forming, viscoelastic and its charge characteristics are important to many biochemical properties of living tissues. It is an important pericellular and cell surface constituent; its interaction with other macromolecules such as proteins, participates in regulating cell behavior during numerous morphogenic, restorative, and pathological processes in the body. The knowledge of HA in diseases such as various forms of cancers, arthritis and osteoporosis has led to new impetus in research and development in the preparation of biomaterials for surgical implants and drug conjugates for targeted delivery. A concise and focused review on hyaluronan is timely. This review will cover the following important aspects of hyaluronan: (i) biological functions and synthesis in nature; (ii) current industrial production and potential biosynthetic processes of hyaluronan; (iii) chemical modifications of hyaluronan leading to products of commercial significance; and (iv) and the global market position and manufacturers of hyaluronan.
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Affiliation(s)
- Erminio Murano
- PROTOS Research Institute, via Flavia 23/1c/o BIC Incubatori FVG, 34148, Trieste, Italy
- NEALYS srl, via Flavia 23/1c/o BIC Incubatori FVG, 34148, Trieste, Italy
| | - Danilo Perin
- PROTOS Research Institute, via Flavia 23/1c/o BIC Incubatori FVG, 34148, Trieste, Italy
| | - Riaz Khan
- PROTOS Research Institute, via Flavia 23/1c/o BIC Incubatori FVG, 34148, Trieste, Italy
| | - Massimo Bergamin
- PROTOS Research Institute, via Flavia 23/1c/o BIC Incubatori FVG, 34148, Trieste, Italy
- NEALYS srl, via Flavia 23/1c/o BIC Incubatori FVG, 34148, Trieste, Italy
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Kim HM, Kang DI, Shim BS, Min KS. Early experience with hyaluronic Acid instillation to assist with visual internal urethrotomy for urethral stricture. Korean J Urol 2010; 51:853-7. [PMID: 21221206 PMCID: PMC3016432 DOI: 10.4111/kju.2010.51.12.853] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 10/20/2010] [Indexed: 12/04/2022] Open
Abstract
Purpose The clinical usefulness of hyaluronic acid (HA) instillation during visual internal urethrotomy (VIU) for decreasing the incidence of recurrent urethral stricture was assessed. Materials and Methods Twenty-eight patients were treated by VIU with HA instillation between May 2007 and June 2009. After insertion of a Foley catheter following urethrotomy, HA was instilled via an 18-gauge tube catheter between the urethral lumen and Foley catheter. Seventeen cases were analyzed retrospectively 12 months postoperatively. We evaluated the success rate of this procedure by comparing retrograde urethrography (RGU) results, maximum flow rates, and postvoid residual urine volumes preoperatively and 3 and 12 months postoperatively. Success was defined as either a maximum flow rate of at least 15 ml/s or no visible urethral stricture on RGU at 12 months postoperatively. Results Total success rates were 76.5% (13/17) and 52.9% (9/17) at 3 and 12 months postoperatively, respectively. By etiology, success rates at 3 and 12 months postoperatively, respectively, were 66.7% and 33.3% for inflammation, 66.7% and 50.0% for trauma, and 83.3% and 66.7% for unknown causes. Success rates were 63.6% for strictures less than 10 mm in length and 33.3% for strictures of 10 mm or more in length at 12 months postoperatively. Success rates were 61.5% for single strictures and 25% for multiple strictures at 12 months postoperatively. Conclusions The success rate of VIU with HA instillation was not better than that observed in the literature for conventional VIU.
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Affiliation(s)
- Hak Min Kim
- Department of Urology, Inje University College of Medicine, Busan, Korea
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Chu DI, Stucchi AF, Becker JM. A "solution" to the application of an effective physical barrier for the prevention of intra-abdominal adhesions. J Surg Res 2010; 167:33-6. [PMID: 20828754 DOI: 10.1016/j.jss.2010.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 05/10/2010] [Accepted: 06/01/2010] [Indexed: 10/19/2022]
Affiliation(s)
- Daniel I Chu
- Department of Surgery, Boston University Medical Center, Boston, Massachusetts 02118, USA
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