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Arjmand MH. The association between visceral adiposity with systemic inflammation, oxidative stress, and risk of post-surgical adhesion. Arch Physiol Biochem 2022; 128:869-874. [PMID: 32141779 DOI: 10.1080/13813455.2020.1733617] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abdominal and pelvic adhesions are common post-operative complications. Despite new medical technologies, these adhesions are appearing to be unavoidable and little is known about their causation; for example, why certain patients/or tissues are more prone to adhesions. There have been no clinical studies about increasing the risk adhesions in obese patients, but there is some evidence about the molecular mechanisms involving visceral fat (VF) that may lead to profibrotic conditions. VF is an endocrine/inflammatory organ which produces many biologically active molecules such as adipokines and inflammatory cytokines. Inflammatory conditions, oxidative stress, and the expression some fibrotic molecules in the VF may induce pathological conditions in the abdominal cavity that predispose to the formation of fibrotic bands.
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Affiliation(s)
- Mohammad-Hassan Arjmand
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
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2
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Kastelein AW, Vos LM, de Jong KH, van Baal JO, Nieuwland R, van Noorden CJ, Roovers JPW, Lok CA. Embryology, anatomy, physiology and pathophysiology of the peritoneum and the peritoneal vasculature. Semin Cell Dev Biol 2019; 92:27-36. [DOI: 10.1016/j.semcdb.2018.09.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 08/29/2018] [Accepted: 09/18/2018] [Indexed: 01/25/2023]
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3
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Koninckx PR, Gomel V, Ussia A, Adamyan L. Role of the peritoneal cavity in the prevention of postoperative adhesions, pain, and fatigue. Fertil Steril 2016; 106:998-1010. [PMID: 27523299 DOI: 10.1016/j.fertnstert.2016.08.012] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/30/2016] [Accepted: 08/02/2016] [Indexed: 02/08/2023]
Abstract
A surgical trauma results within minutes in exudation, platelets, and fibrin deposition. Within hours, the denuded area is covered by tissue repair cells/macrophages, starting a cascade of events. Epithelial repair starts on day 1 and is terminated by day 3. If repair is delayed by decreased fibrinolysis, local inflammation, or factors in peritoneal fluid, fibroblast growth starting on day 3 and angiogenesis starting on day 5 results in adhesion formation. For adhesion formation, quantitatively more important are factors released into the peritoneal fluid after retraction of the fragile mesothelial cells and acute inflammation of the entire peritoneal cavity. This is caused by mechanical trauma, hypoxia (e.g., CO2 pneumoperitoneum), reactive oxygen species (ROS; e.g., open surgery), desiccation, or presence of blood, and this is more severe at higher temperatures. The inflammation at trauma sites is delayed by necrotic tissue, resorbable sutures, vascularization damage, and oxidative stress. Prevention of adhesion formation therefore consists of the prevention of acute inflammation in the peritoneal cavity by means of gentle tissue handling, the addition of more than 5% N2O to the CO2 pneumoperitoneum, cooling the abdomen to 30°C, prevention of desiccation, a short duration of surgery, and, at the end of surgery, meticulous hemostasis, thorough lavage, application of a barrier to injury sites, and administration of dexamethasone. With this combined therapy, nearly adhesion-free surgery can be performed today. Conditioning alone results in some 85% adhesion prevention, barriers alone in 40%-50%.
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Affiliation(s)
- Philippe R Koninckx
- Department of Obstetrics and Gynecology, Catholic University Leuven, University Hospital, Gasthuisberg, Leuven, Belgium; Gruppo Italo Belga, Villa del Rosario and Gemelli Hospitals Università Cattolica, Rome, Italy.
| | - Victor Gomel
- Department of Obstetrics and Gynecology, University of British Columbia, Women's Hospital, Vancouver, British Columbia, Canada
| | - Anastasia Ussia
- Gruppo Italo Belga, Villa del Rosario and Gemelli Hospitals Università Cattolica, Rome, Italy
| | - Leila Adamyan
- Department of Operative Gynecology, Federal State Budget Institution V. I. Kulakov Research Center for Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, Moscow, Russia; Department of Reproductive Medicine and Surgery, Moscow State University of Medicine and Dentistry, Moscow, Russia, Russian Federation
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Özdemir-van Brunschot DMD, van Laarhoven KCJHM, Scheffer GJ, Pouwels S, Wever KE, Warlé MC. What is the evidence for the use of low-pressure pneumoperitoneum? A systematic review. Surg Endosc 2015; 30:2049-65. [PMID: 26275545 PMCID: PMC4848341 DOI: 10.1007/s00464-015-4454-9] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/16/2015] [Indexed: 12/20/2022]
Abstract
Background Laparoscopic surgery has several advantages when compared to open surgery, including faster postoperative recovery and lower pain scores. However, for laparoscopy, a pneumoperitoneum is required to create workspace between the abdominal wall and intraabdominal organs. Increased intraabdominal pressure may also have negative implications on cardiovascular, pulmonary, and intraabdominal organ functionings. To overcome these negative consequences, several trials have been performed comparing low- versus standard-pressure pneumoperitoneum. Methods A systematic review of all randomized controlled clinical trials and observational studies comparing low- versus standard-pressure pneumoperitoneum. Results and conclusions Quality assessment showed that the overall quality of evidence was moderate to low. Postoperative pain scores were reduced by the use of low-pressure pneumoperitoneum. With appropriate perioperative measures, the use of low-pressure pneumoperitoneum does not seem to have clinical advantages as compared to standard pressure on cardiac and pulmonary function. Although there are indications that low-pressure pneumoperitoneum is associated with less liver and kidney injury when compared to standard-pressure pneumoperitoneum, this does not seem to have clinical implications for healthy individuals. The influence of low-pressure pneumoperitoneum on adhesion formation, anastomosis healing, tumor metastasis, intraocular and intracerebral pressure, and thromboembolic complications remains uncertain, as no human clinical trials have been performed. The influence of pressure on surgical conditions and safety has not been established to date. In conclusion, the most important benefit of low-pressure pneumoperitoneum is lower postoperative pain scores, supported by a moderate quality of evidence. However, the quality of surgical conditions and safety of the use of low-pressure pneumoperitoneum need to be established, as are the values and preferences of physicians and patients regarding the potential benefits and risks. Therefore, the recommendation to use low-pressure pneumoperitoneum during laparoscopy is weak, and more studies are required.
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Affiliation(s)
- Denise M D Özdemir-van Brunschot
- Division of Vascular and Transplant Surgery, Department of Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Kees C J H M van Laarhoven
- Division of Vascular and Transplant Surgery, Department of Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Gert-Jan Scheffer
- Department of Anesthesiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sjaak Pouwels
- Division of Vascular and Transplant Surgery, Department of Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Kim E Wever
- Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michiel C Warlé
- Division of Vascular and Transplant Surgery, Department of Surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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Beyene RT, Kavalukas SL, Barbul A. Intra-abdominal adhesions: Anatomy, physiology, pathophysiology, and treatment. Curr Probl Surg 2015; 52:271-319. [PMID: 26258583 DOI: 10.1067/j.cpsurg.2015.05.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/12/2015] [Indexed: 12/18/2022]
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Cassidy MR, Sheldon HK, Gainsbury ML, Gillespie E, Kosaka H, Heydrick S, Stucchi AF. The neurokinin 1 receptor regulates peritoneal fibrinolytic activity and postoperative adhesion formation. J Surg Res 2014; 191:12-8. [PMID: 24836694 DOI: 10.1016/j.jss.2014.04.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 04/01/2014] [Accepted: 04/15/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Intra-abdominal adhesions are a common source of postoperative morbidity. Previous studies in our laboratory have shown that a neurokinin 1 receptor antagonist (NK-1RA) reduces abdominal adhesion formation and increases peritoneal fibrinolytic activity. However, the cellular pathway by which the antagonist exerts its effects is unclear, as cultured peritoneal mesothelial cells exposed to the NK-1RA show increases in fibrinolytic activity despite having very low expression of neurokinin 1 receptor (NK-1R) messenger RNA and protein. Our aim was to determine whether the NK-1R plays an essential role in the adhesion-reducing effects of the NK-1RA, or if the NK-1RA is acting independently of the receptor. METHODS Homozygous NK-1R knockout mice and age matched wild-type mice underwent laparotomy with cecal cautery to induce adhesions. At the time of surgery, mice received a single intraperitoneal dose of either NK-1RA (25 mg/kg) or saline alone. Adhesion severity at the site of cecal cautery was assessed on postoperative day 7. In a separate experiment, peritoneal fluid was collected from wild type and NK-1R knockout mice 24 h after laparotomy with cecal cautery and administration of either NK-1RA or saline. Tissue plasminogen activator levels, representative of total fibrinolytic activity, were then measured in peritoneal fluid. RESULTS In wild-type mice, NK-1RA administration significantly decreased adhesion formation compared with saline controls. Among the NK-1R knockout mice, there was no significant reduction in adhesion formation by the NK-1RA. Fibrinolytic activity increased 244% in wild-type mice administered NK-1RA compared with saline controls; however, the NK-1RA did not raise fibrinolytic activity above saline controls in NK-1R knockout mice. CONCLUSIONS These data indicate that the NK-1R mediates the adhesion-reducing effects of the NK-1RA, in part, by the upregulation of peritoneal fibrinolysis, and suggest that the NK-1R is a promising therapeutic target for adhesion prevention.
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Affiliation(s)
- Michael R Cassidy
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Holly K Sheldon
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Melanie L Gainsbury
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Earl Gillespie
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Hisashi Kosaka
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Stanley Heydrick
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Arthur F Stucchi
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts.
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7
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de Vries A, Mårvik R, Kuhry E. Reply to the letter entitled 'An inexact study design produces misleading conclusions'. Int J Surg 2014; 12:251-2. [PMID: 24378912 DOI: 10.1016/j.ijsu.2013.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 12/13/2013] [Accepted: 12/19/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Arild de Vries
- Norwegian University of Science and Technology (NTNU), Department of Cancer Research and Molecular Medicine, Trondheim, Norway.
| | - Ronald Mårvik
- Norwegian University of Science and Technology (NTNU), Department of Cancer Research and Molecular Medicine, Trondheim, Norway; Trondheim University Hospital, National Center for Advanced Laparoscopic Surgery (NSALK), Department of Surgery, St. Olavs Hospital, Olav Kyrres Gate 17, 7491 Trondheim, Norway
| | - Esther Kuhry
- Norwegian University of Science and Technology (NTNU), Department of Cancer Research and Molecular Medicine, Trondheim, Norway; Trondheim University Hospital, National Center for Advanced Laparoscopic Surgery (NSALK), Department of Surgery, St. Olavs Hospital, Olav Kyrres Gate 17, 7491 Trondheim, Norway
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8
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de Vries A, Mårvik R, Kuhry E. To perform operative procedures in an optimized local atmosphere: can it reduce post-operative adhesion formation? Int J Surg 2013; 11:1118-22. [PMID: 24080114 DOI: 10.1016/j.ijsu.2013.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 09/10/2013] [Accepted: 09/12/2013] [Indexed: 01/12/2023]
Abstract
BACKGROUND Adhesion formation is a major problem following abdominal surgery as it creates a considerable economic burden in addition to an increased risk for complications. In the present study, an effort was made to reduce post-operative adhesion formation by creating an artificial atmosphere within and around the abdominal cavity during an open surgical procedure. METHODS 82 Wistar male rats (Clr:WI) (200 gr, 7 weeks) were randomized into two groups. The abdominal cavity of the control group was exposed to the normal atmosphere of the operating-theatre during surgery (21% O₂, 21 °C, 40-47% relative humidity (RH)), while the abdominal cavity of the study group was exposed to an artificial atmosphere during surgery (3-6% O₂, >75% CO₂, 95-100% RH, 37 °C). Adhesion induction consisted of a laparotomy along linea-alba, four lesions in the anterior abdominal-wall, blood from the tail vein dripped inside the abdominal cavity and exposure to the atmosphere around the wound by use of self-retaining retractors. In addition, a liquid-sample for quantitative bacteriologic cultivation and bacterial load (CFU/ml) calculation was taken just before closure. After 3 weeks the abdominal cavity was scored for the extent, tenacity and severity of adhesions before the rats were euthanized. The two-sample-Wilcoxon-rank-sum test was used in the analysis. RESULTS Highly significant differences in postoperative total adhesion score, extent-, severity- and tenacity-score were found (P < 0.01). No differences were found between the two groups regarding mean bacterial load (P > 0.05). CONCLUSIONS The rats exposed to the warmed and humidified artificial atmosphere consisting of more than 75% carbon dioxide and 3-4% oxygen during surgery had more severe and more post-operative adhesions compared to the rats that were exposed to the ambient air during surgery.
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Affiliation(s)
- Arild de Vries
- Norwegian University of Science and Technology (NTNU), Department of Cancer Research and Molecular Medicine, Trondheim, Norway.
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Nair S, Saed GM, Atta HM, Rajaratnam V, Diamond MP, Curiel DT, Al-Hendy A. Towards gene therapy of postoperative adhesions: fiber and transcriptional modifications enhance adenovirus targeting towards human adhesion cells. Gynecol Obstet Invest 2013; 76:119-24. [PMID: 23920223 DOI: 10.1159/000353426] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 05/30/2013] [Indexed: 01/26/2023]
Abstract
Postoperative abdominal/pelvic peritoneal adhesions are a major source of morbidity (bowel obstruction, infertility, ectopic gestation as well as chronic pelvic pain) in women. In this study, we screened various transduction and transcription modifications of adenovirus (Ad) to identify those that support maximal Ad-mediated gene delivery to human adhesion fibroblasts, which in turn would enhance the efficacy of this novel treatment/preventative strategy for postoperative adhesions. We transduced primary cultures of human peritoneal adhesion fibroblasts with fiber-modified Ad vectors Ad5-RGD-luc, Ad5-Sigma-luc, Ad5/3-luc and Ad5-CAV2-luc as well as transcriptional targeting viruses Ad5-survivin-luc, Ad5-heparanase-luc, Ad5-mesothelin (MSLN)-CRAd-luc and Ad5-secretory leukoprotease inhibitor (SLPI)-luc, and compared their activity to wild-type Ad5-luc. At 48 h, luciferase activity was measured and normalized to the total protein content in the cells. Among the fiber-modified Ad vectors, Ad5-Sigma-luc and among the transcriptional targeting modified Ad vectors, Ad5-MSLN-CRAd-luc showed significantly increased expression levels of luciferase activity at 5, 10 and 50 plaque forming units/cell in adhesion fibroblast cells compared with wild-type Ad5-luc (p < 0.05). Specific modifications of Ad improve their gene delivery efficiency towards human peritoneal adhesion fibroblasts. Developing a safe localized method to prevent/treat postoperative adhesion formation would have a major impact on women health.
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Affiliation(s)
- S Nair
- Center for Women's Health Research, Department of Obstetrics and Gynecology, Meharry Medical College, Nashville, Tenn., USA
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10
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Tarhan OR, Barut I, Ozogul C, Bozkurt S, Baykara B, Bulbul M. Structural deteriorations of the human peritoneum during laparoscopic cholecystectomy. A transmission electron microscopic study. Surg Endosc 2013; 27:2744-50. [PMID: 23392979 DOI: 10.1007/s00464-013-2801-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 12/31/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND In previous studies, changes in the surface of the peritoneum during laparoscopic surgery are well defined. Nevertheless, almost all of these studies were performed on rodents via scanning electron microscopy. In the present study, structural alterations of the mesothelial cells of peritoneum were examined during laparoscopic cholecystectomy using transmission electron microscopy. METHODS Twenty patients with symptomatic cholelithiasis were included in the study. Peritoneal biopsy was performed immediately after CO2 pneumoperitoneum creation and at the end of surgery just before gallbladder removal. Biopsies were taken from the right upper quadrant, i.e., apart from operative manipulation. Peritoneal sample cross-sections were compared using transmission electron microscopy. RESULTS The carbon dioxide pneumoperitoneum during laparoscopic cholecystectomy caused deteriorations of the peritoneal mesothelium. Apoptosis were developed in mesothelial cells. Bulging of mesothelial cells, irregular cell junctions, focal intercellular clefts, apical cell membrane degeneration, deep nuclear invaginations, and lipid droplets in the cytoplasm of the mesothelial cells were other remarkable findings. Mesothelial edema also was determined. DISCUSSION As seen in previous studies, basement membrane nudity appeared after carbon dioxide pneumoperitoneum could be attributable to mesothelial cell apoptosis, deterioration of the cell structure, and cell organelles.
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Affiliation(s)
- Omer Ridvan Tarhan
- Department of General Surgery, Faculty of Medicine, Suleyman Demirel University, Mehmet Tonge Mah. Unikent Sitesi 23/A, 32000 Isparta, Turkey.
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Shimomura M, Hinoi T, Ikeda S, Adachi T, Kawaguchi Y, Tokunaga M, Sasada T, Egi H, Tanabe K, Okajima M, Ohdan H. Preservation of peritoneal fibrinolysis owing to decreased transcription of plasminogen activator inhibitor-1 in peritoneal mesothelial cells suppresses postoperative adhesion formation in laparoscopic surgery. Surgery 2012; 153:344-56. [PMID: 23218127 DOI: 10.1016/j.surg.2012.07.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 07/25/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Postoperative adhesion formation is regulated by peritoneal fibrinolysis, which is determined by tissue-type plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1). This study compared peritoneal fibrinolysis and adhesion formation after laparoscopic surgery (LAP) and open surgery (OP). METHODS We divided 154 male rats into 3 groups after cecal cauterization: Control, no treatment; LAP, CO2 pneumoperitoneum at 5 mmHg for 60 minutes; and OP, laparotomy for 60 minutes. Adhesions were quantified at day 7. The activity and mRNA level of tPA and PAI-1 were determined by enzyme-linked immunosorbent assay in plasma and peritoneal lavage and by real-time polymerase chain reaction in peritoneal mesothelial cells from omentum. We also examined peritoneal fibrinolysis in human gastric cancer patients treated with LAP (n = 14) or OP (n = 10). RESULTS In the animal study, adhesion scores, PAI-1 activity in peritoneal lavage fluid, and PAI-1 mRNA levels in peritoneal mesothelium were significantly greater in the OP group than the control and LAP groups. In the human study, postoperative PAI-1 mRNA levels were significantly greater in the OP group than the LAP group. Additionally, PAI-1 mRNA levels and subsequent adhesion formation were induced by prolonged operative time in the OP group, but not the LAP group. CONCLUSION Preservation of peritoneal fibrinolysis owing to decreased PAI-1 expression at the transcriptional level in peritoneal mesothelial cells is associated with suppression of postoperative adhesion formation in LAP. PAI-1 mRNA levels and subsequent adhesion formation were not induced by prolonged operative time in LAP. These results highlight the less invasiveness nature of LAP.
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Affiliation(s)
- Manabu Shimomura
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Hirschelmann A, Wallwiener CW, Wallwiener M, Weyhe D, Tchartchian G, Hackethal A, De Wilde RL. Is Patient Education About Adhesions a Requirement in Abdominopelvic Surgery? Geburtshilfe Frauenheilkd 2012; 72:299-304. [PMID: 25284835 DOI: 10.1055/s-0031-1298425] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 02/17/2012] [Accepted: 02/28/2012] [Indexed: 12/14/2022] Open
Abstract
Background: Over the past decades, our knowledge and understanding of adhesions and adhesion-related complications has increasingly grown and it has become evident that adhesions have significant implications for patients, physicians and the healthcare system. The question arises whether this has resulted in greater awareness of adhesion-related problems among practicing physicians and appropriate patient education on this topic in daily practice. The following article provides a brief overview of the important subject of adhesions, discusses current awareness of adhesions among patients and doctors and addresses the consequences of failure to provide patient education and consent from a medical perspective. Methods: Selective literature searches were conducted in PubMed and the Cochrane Library. A patient information and consent form was developed based on several years' experience and expertise in the field of adhesions. Results: Adhesions are the most common type of complication in abdominopelvic surgery today, with devastating consequences for some patients. Surveys investigating the awareness of adhesions among physicians and patients clearly showed that even well-informed physicians fail to educate their patients adequately. Such failure could potentially lead to successful medical malpractice lawsuits against doctors. Conclusion: Considering their clear clinical impact, adhesions and related consequences should always be discussed with patients preoperatively. A newly developed consent form that specifically addresses adhesion formation may serve to thoroughly educate patients preoperatively and to adequately document the process of doing so.
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Affiliation(s)
- A Hirschelmann
- Department of Gynaecology, Obstetrics and Gynaecological Oncology, Pius-Hospital, Oldenburg
| | - C W Wallwiener
- Division of Gynaecological Surgery, Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen
| | - M Wallwiener
- Department of Obstetrics and Gynaecology, University of Heidelberg, Heidelberg
| | - D Weyhe
- Department of General and Visceral Surgery, Pius-Hospital, Oldenburg
| | - G Tchartchian
- Clinic for Minimal Invasive Surgery, Berlin-Zehlendorf
| | - A Hackethal
- Queensland Centre for Gynaecological Cancer, Royal Brisbane and Women's Hospital, Herston, Queensland, Austria
| | - R L De Wilde
- Department of Gynaecology, Obstetrics and Gynaecological Oncology, Pius-Hospital, Oldenburg
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Atta HM. Prevention of peritoneal adhesions: a promising role for gene therapy. World J Gastroenterol 2011; 17:5049-58. [PMID: 22171139 PMCID: PMC3235588 DOI: 10.3748/wjg.v17.i46.5049] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 07/14/2011] [Accepted: 07/21/2011] [Indexed: 02/06/2023] Open
Abstract
Adhesions are the most frequent complication of abdominopelvic surgery, yet the extent of the problem, and its serious consequences, has not been adequately recognized. Adhesions evolved as a life-saving mechanism to limit the spread of intraperitoneal inflammatory conditions. Three different pathophysiological mechanisms can independently trigger adhesion formation. Mesothelial cell injury and loss during operations, tissue hypoxia and inflammation each promotes adhesion formation separately, and potentiate the effect of each other. Studies have repeatedly demonstrated that interruption of a single pathway does not completely prevent adhesion formation. This review summarizes the pathogenesis of adhesion formation and the results of single gene therapy interventions. It explores the promising role of combinatorial gene therapy and vector modifications for the prevention of adhesion formation in order to stimulate new ideas and encourage rapid advancements in this field.
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14
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Hellebrekers BWJ, Kooistra T. Pathogenesis of postoperative adhesion formation. Br J Surg 2011; 98:1503-16. [DOI: 10.1002/bjs.7657] [Citation(s) in RCA: 148] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2011] [Indexed: 01/13/2023]
Abstract
Abstract
Background
Current views on the pathogenesis of adhesion formation are based on the ‘classical concept of adhesion formation’, namely that a reduction in peritoneal fibrinolytic activity following peritoneal trauma is of key importance in adhesion development.
Methods
A non-systematic literature search (1960–2010) was performed in PubMed to identify all original articles on the pathogenesis of adhesion formation. Information was sought on the role of the fibrinolytic, coagulatory and inflammatory systems in the disease process.
Results
One unifying concept emerged when assessing 50 years of studies in animals and humans on the pathogenesis of adhesion formation. Peritoneal damage inflicted by surgical trauma or other insults evokes an inflammatory response, thereby promoting procoagulatory and antifibrinolytic reactions, and a subsequent significant increase in fibrin formation. Importantly, peritoneal inflammatory status seems a crucial factor in determining the duration and extent of the imbalance between fibrin formation and fibrin dissolution, and therefore in the persistence of fibrin deposits, determining whether or not adhesions develop.
Conclusion
Suppression of inflammation, manipulation of coagulation as well as direct augmentation of fibrinolytic activity may be promising antiadhesion treatment strategies.
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Affiliation(s)
- B W J Hellebrekers
- Department of Obstetrics and Gynaecology, Haga Teaching Hospital, The Hague, The Netherlands
| | - T Kooistra
- TNO Prevention and Health, Department of Biosciences, Gaubius Laboratory, Leiden, The Netherlands
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Corona R, Verguts J, Binda MM, Molinas CR, Schonman R, Koninckx PR. The impact of the learning curve on adhesion formation in a laparoscopic mouse model. Fertil Steril 2011; 96:193-7. [PMID: 21601846 DOI: 10.1016/j.fertnstert.2011.04.057] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 04/15/2011] [Accepted: 04/15/2011] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the impact of surgeon training on adhesion formation in a laparoscopic mouse model. Laparoscopic surgery and bowel manipulation was demonstrated to enhance postoperative adhesion formation. DESIGN Prospective randomized, controlled trial. SETTING University laboratory research center. ANIMAL(S) 200 BALB/c and 200 Swiss female mice. INTERVENTION(S) Adhesions were induced by opposing bipolar lesions and 60 minutes of pneumoperitoneum. Each surgeon operated on 80 mice (40 Swiss and 40 BALB/c), the only variable thus being his/her increasing experience. Some surgeons were already experienced gynecologists, others were starting their training. MAIN OUTCOME MEASURE(S) End points were the duration of surgery while performing the lesions. The adhesion formation was scored quantitatively (proportion and total) and qualitatively (extent, type, and tenacity) after 7 days. RESULT(S) With training, duration of surgery and adhesion formation decreased exponentially for all surgeons, whether experienced or not. Experienced surgeons had initially a shorter duration of surgery, less adhesion formation, and less de novo adhesions than inexperienced surgeons. CONCLUSION(S) These data suggest that laparoscopic skills improve with training, leading to a decrease in the duration of surgery and formation of adhesions. Therefore completion of a standardized learning curve should be mandatory when initiating adhesion formation studies both in laboratory or clinical setting.
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Affiliation(s)
- Roberta Corona
- Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
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Corona R, Verguts J, Schonman R, Binda MM, Mailova K, Koninckx PR. Postoperative inflammation in the abdominal cavity increases adhesion formation in a laparoscopic mouse model. Fertil Steril 2011; 95:1224-8. [PMID: 21295297 DOI: 10.1016/j.fertnstert.2011.01.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 11/25/2010] [Accepted: 01/04/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate acute inflammation in the peritoneal cavity in adhesion formation. DESIGN Prospective randomized, controlled trial. SETTING University laboratory research center. ANIMAL(S) 9- to 10-week-old BALB/c female mice. INTERVENTION(S) In a laparoscopic mouse model, acute inflammation in the peritoneal cavity evaluated in CO(2) pneumoperitoneum enhanced adhesions, by CO(2) pneumoperitoneum plus manipulation, and in the latter group plus dexamethasone. MAIN OUTCOME MEASURE(S) Qualitative and quantitative adhesion scores and an acute inflammation score (neoangiogenesis, diapedesis, and leukocyte accumulation). RESULT(S) Adhesions at the lesion site were enhanced by the CO(2) pneumoperitoneum, further enhanced by manipulation, and decreased by the administration of dexamethasone. The acute inflammation scores (total, neoangiogenesis, diapedesis, and leukocyte accumulation) strongly correlated with the total adhesion score. Inflammation scores were similar at both the surgical lesion and the parietal peritoneum. CONCLUSION(S) Acute inflammation of the entire peritoneum cavity is an important mechanism involved in adhesion formation and enhances adhesion formation at the lesion site.
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Affiliation(s)
- Roberta Corona
- Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Leuven, Belgium.
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Brokelman WJA, Lensvelt M, Borel Rinkes IHM, Klinkenbijl JHG, Reijnen MMPJ. Peritoneal changes due to laparoscopic surgery. Surg Endosc 2010; 25:1-9. [PMID: 20552372 PMCID: PMC3003799 DOI: 10.1007/s00464-010-1139-2] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2009] [Accepted: 04/30/2010] [Indexed: 12/01/2022]
Abstract
Background Laparoscopic surgery has been incorporated into common surgical practice. The peritoneum is an organ with various biologic functions that may be affected in different ways by laparoscopic and open techniques. Clinically, these alterations may be important in issues such as peritoneal metastasis and adhesion formation. Methods A literature search using the Pubmed and Cochrane databases identified articles focusing on the key issues of laparoscopy, peritoneum, inflammation, morphology, immunology, and fibrinolysis. Results Laparoscopic surgery induces alterations in the peritoneal integrity and causes local acidosis, probably due to peritoneal hypoxia. The local immune system and inflammation are modulated by a pneumoperitoneum. Additionally, the peritoneal plasmin system is inhibited, leading to peritoneal hypofibrinolysis. Conclusion Similar to open surgery, laparoscopic surgery affects both the integrity and biology of the peritoneum. These observations may have implications for various clinical conditions.
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Affiliation(s)
- W J A Brokelman
- Department of Surgery, Jeroen Bosch Hospital, P.O. Box 1101, 5200 BD, 's-Hertogenbosch, The Netherlands.
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Carbon dioxide pneumoperitoneum, intraperitoneal pressure, and peritoneal tissue hypoxia: a mouse study with controlled respiratory support. Surg Endosc 2010; 24:2871-80. [DOI: 10.1007/s00464-010-1069-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 04/02/2010] [Indexed: 11/25/2022]
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Binda MM, Koninckx PR. Hyperoxia and prevention of adhesion formation: a laparoscopic mouse model for open surgery. BJOG 2009; 117:331-9. [DOI: 10.1111/j.1471-0528.2009.02370.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schonman R, Corona R, Bastidas A, De Cicco C, Mailova K, Koninckx PR. Intercoat gel (oxiplex): efficacy, safety, and tissue response in a laparoscopic mouse model. J Minim Invasive Gynecol 2009; 16:188-94. [PMID: 19249707 DOI: 10.1016/j.jmig.2008.12.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2008] [Revised: 12/12/2008] [Accepted: 12/18/2008] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVE To study the efficacy and safety of Intercoat gel in a laparoscopic mouse model with pneumoperitoneum-enhanced adhesion formation. DESIGN Randomized controlled trial. Evidence obtained from a properly designed, randomized, controlled trial (Canadian Task Force classification I). SETTING University laboratory research center. SUBJECTS Balb\c female mice 9 to 10 weeks old. INTERVENTIONS Two laparoscopic mouse models for adhesion formation were used. In the first model, adhesions following bipolar opposing lesions in the pelvis were enhanced by 60 minutes of carbon-dioxide pneumoperitoneum. In the second model, adhesions were further enhanced by bowel manipulation. The first experiment evaluated the efficacy of Intercoat in both models. The second experiment evaluated the efficacy of Intercoat in the first model, when applied immediately on the lesion, when applied at the end of the pneumoperitoneum, and when applied in the upper abdomen. Biopsy specimens were taken after 7 days and were evaluated after hematoxylin-eosin and CD45 staining. MEASUREMENTS AND MAIN RESULTS Qualitative and quantitative adhesion scoring. Morphology was evaluated by standard light microscopy. In both models, Intercoat decreased adhesion formation whether applied immediately on the lesion or at the end of the pneumoperitoneum (qualitative and quantitative scoring p <.0001 and p <.0001, respectively). Intercoat application is associated with tissue redness, vascular congestion, and cellular edema but without an inflammatory reaction. Applied in the upper abdomen, Intercoat does not increase adhesions, but decreases adhesions at higher doses (p =.0024). Intercoat in high doses had a toxic effect (p =.0058). CONCLUSION Intercoat is an effective antiadhesion product. It is associated with tissue edema and vasodilatation as observed after 7 days both macroscopically and by histology.
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Affiliation(s)
- Ron Schonman
- Departments of Obstetrics and Gynecology at University Hospital Leuven, Belgium.
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Schonman R, Corona R, Bastidas A, De Cicco C, Koninckx PR. Effect of Upper Abdomen Tissue Manipulation on Adhesion Formation between Injured Areas in a Laparoscopic Mouse Model. J Minim Invasive Gynecol 2009; 16:307-12. [DOI: 10.1016/j.jmig.2009.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Revised: 12/25/2008] [Accepted: 01/08/2009] [Indexed: 01/12/2023]
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Mynbaev OA, Corona R. Possible mechanisms of peritoneal tissue-oxygen tension changes during CO2-pneumoperitoneum: the role of design, methodology and animal models. Hum Reprod 2009; 24:1242-6. [PMID: 19258347 DOI: 10.1093/humrep/dep025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Ospan A Mynbaev
- Moscow State University of Medicine and Dentistry, Delegatskaya str. 20/1 127473, Moscow, Russian Federation.
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Effect of Reteplase™ and PAI-1 antibodies on postoperative adhesion formation in a laparoscopic mouse model. Surg Endosc 2008; 23:1018-25. [DOI: 10.1007/s00464-008-0111-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 06/21/2008] [Accepted: 07/20/2008] [Indexed: 11/26/2022]
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Binda MM, Molinas CR, Bastidas A, Jansen M, Koninckx PR. Efficacy of barriers and hypoxia-inducible factor inhibitors to prevent CO(2) pneumoperitoneum-enhanced adhesions in a laparoscopic mouse model. J Minim Invasive Gynecol 2007; 14:591-9. [PMID: 17848320 DOI: 10.1016/j.jmig.2007.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Revised: 03/23/2007] [Accepted: 04/02/2007] [Indexed: 01/14/2023]
Abstract
STUDY OBJECTIVE To investigate the effects of hypoxia-inducible factor (HIF) inhibitors, flotation agents, barriers, and a surfactant on pneumoperitoneum-enhanced adhesions in a laparoscopic mouse model. DESIGN Prospective randomized trial (Canadian Task Force classification I). SETTING Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Catholic University of Leuven. SUBJECTS One hundred fourteen female BALB/c mice. INTERVENTIONS Adhesions were induced during laparoscopy in BALB/c female mice. Pneumoperitoneum was maintained for 60 minutes with humidified CO(2). In 3 experiments the effects of HIF inhibitors such as 17-allylamino 17-demethoxygeldanamycin, radicicol, rapamycin, and wortmanin, flotation agents such as Hyskon and carboxymethylcellulose, barriers such as Hyalobarrier gel and SprayGel, and surfactant such as phospholipids were evaluated. MEASUREMENTS AND MAIN RESULTS Adhesions were scored after 7 days during laparotomy. Adhesion formation decreased with the administration of wortmannin (p <.01), phospholipids (p <.01), Hyalobarrier Gel (p <.01), and SprayGel (p <.01). CONCLUSIONS These experiments confirm the efficacy of barriers and phospholipids to separate or lubricate damaged surfaces. They also confirm the role of mesothelial hypoxia in this model by the efficacy of the HIF inhibitor wortmannin.
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Affiliation(s)
- Maria Mercedes Binda
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
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Tarhan OR, Barut I, Akdeniz Y, Sutcu R, Cerci C, Bulbul M. Fibrinolytic responses of human peritoneal fluid in laparoscopic cholecystectomy: a prospective clinical study. Surg Endosc 2007; 22:1008-13. [PMID: 17763904 DOI: 10.1007/s00464-007-9566-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Revised: 09/07/2006] [Accepted: 09/15/2006] [Indexed: 01/28/2023]
Abstract
BACKGROUND The reduction in peritoneal fibrinolysis is believed to be the pathogenetic mechanism of adhesion formation. The general conclusion based on previous clinical and experimental studies is that laparoscopic procedures produce less adhesion formation. The association between this beneficial effect of laparoscopic cholecystectomy and peritoneal fibrinolytic changes is not clear. Therefore, the authors aimed to compare the effects of open and laparoscopic cholecystectomy on peritoneal fibrinolysis. For this purpose, fibrinolytic parameters in peritoneal fluid were investigated 24 h after laparoscopic and open cholecystectomies. METHODS In a prospective clinical study, peritoneal fluid was sampled via a drain 24 h after laparoscopic (n = 10) and open (n = 9) cholecystectomies. Activities and concentrations of tissue plasminogen activator (tPA), plasminogen activator inhibitor type 1 (PAI-1), and tPA/PAI-1 complex were determined by enzyme-linked immunosorbent assay (ELISA) kits. RESULTS In peritoneal fluids, tPA and tPA/PAI-1 complex concentrations were higher in the open cholecystectomy group (p = 0.009 and p < 0.001, respectively), but tPA activity and PAI-1 concentrations did not differ between the groups (p = 0.514 and p = 0.716, respectively). CONCLUSIONS Fibrinolytic changes in peritoneal fluid have several similarities in open and laparoscopic cholecystectomies with regard to tPA activity and PAI-1 levels. However, higher tPA levels after the open procedure probably are secondary to more intense tissue handling leading to mesothelial release of tPA.
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Affiliation(s)
- O R Tarhan
- Department of General Surgery, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey.
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26
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Binda MM, Molinas CR, Bastidas A, Koninckx PR. Effect of reactive oxygen species scavengers, antiinflammatory drugs, and calcium-channel blockers on carbon dioxide pneumoperitoneum-enhanced adhesions in a laparoscopic mouse model. Surg Endosc 2007; 21:1826-34. [PMID: 17479336 DOI: 10.1007/s00464-007-9296-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Accepted: 01/17/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND Postoperative adhesions are a clinical problem. They can cause female infertility, intestinal obstruction, chronic pelvic pain, and difficulties at the time of reoperation. A variety of approaches described to prevent adhesions have shown variable and inconsistent results. Therefore, this study aimed to evaluate most known substances in a laparoscopic mouse model to obtain quantitative and comprehensive information on adhesion prevention. Specifically, this first study aimed to investigate the effects of reactive oxygen species (ROS) scavengers, antiinflammatory agents, and a calcium-channel blocker on pneumoperitoneum-enhanced adhesions. METHODS Adhesions were induced during laparoscopy in BALB/c female mice by creation of a bipolar lesion. Carbon dioxide (CO2) pneumoperitoneum was maintained for 60 min using humidified CO2. Six experiments were conducted to evaluate the effects of ROS scavengers (superoxide dismutase [SOD], catalase, melatonin, and ascorbic acid), antiinflammatory agents (dexamethasone, tenoxicam, ibuprofen, parecoxib, nimesulide, anti-tumor necrosis factor [TNF]-alpha), and a calcium-channel blocker (diltiazem). Adhesions were scored after 7 days during laparotomy. RESULTS Adhesions were reduced by SOD (p < 0.01, proc general linear methods (GLM) of experiments 1 and 2), diltiazem (p = 0.05, Wilcoxon), and dexamethasone (p < 0.03), but not by nonsteroidal antiinflammatory drugs (NSAIDs) nor by anti-TNF-alpha. When all the experiments were grouped for analysis, adhesions also decreased with one and three doses of SOD (p < 0.01 and p < 0.01, respectively) and with one and three doses of ascorbic acid (p < 0.02 and p = 0.05, respectively). CONCLUSIONS These experiments confirm that SOD, diltiazem, and dexamethasone can decrease adhesion formation. The absence of effect from the other antiinflammatory drugs and anti-TNF-alpha is surprising.
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Affiliation(s)
- M M Binda
- Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Herestraat 49 Bus 611, B3000, Leuven, Belgium.
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Nappi C, Di Spiezio Sardo A, Greco E, Guida M, Bettocchi S, Bifulco G. Prevention of adhesions in gynaecological endoscopy. Hum Reprod Update 2007; 13:379-94. [PMID: 17452399 DOI: 10.1093/humupd/dml061] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Adhesions resulting from gynaecological endoscopic procedures are a major clinical, social and economic concern, as they may result in pelvic pain, infertility, bowel obstruction and additional surgery to resolve such adhesion-related complications. Although the minimally invasive endoscopic approach has been shown to be less adhesiogenic than traditional surgery, at least with regard to selected procedures, it does not totally eliminate the problem. Consequently, many attempts have been made to further reduce adhesion formation and reformation following endoscopic procedures, and a wide variety of strategies, including surgical techniques, pharmacological agents and mechanical barriers have been advocated to address this issue. The present review clearly indicates that there is no single modality proven to be unequivocally effective in preventing post-operative adhesion formation either for laparoscopic or for hysteroscopic surgery. Furthermore, the available adhesion-reducing substances are rather expensive. Since excellent surgical technique alone seems insufficient, further research is needed on an adjunctive therapy for the prevention and/or reduction of adhesion formation following gynaecological endoscopic procedures.
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Affiliation(s)
- C Nappi
- Department of Gynaecology and Obstetrics, and Pathophysiology of Human Reproduction, University of Naples 'Federico II', Via Pansini 5, Naples, Italy
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Szabó G, Mikó I, Nagy P, Bráth E, Peto K, Furka I, Gamal EM. Adhesion formation with open versus laparoscopic cholecystectomy: an immunologic and histologic study. Surg Endosc 2007; 21:253-7. [PMID: 17146599 DOI: 10.1007/s00464-005-0015-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Accepted: 03/01/2005] [Indexed: 10/23/2022]
Abstract
BACKGROUND This randomized study aimed to compare the reaction of the immune system to the process of postoperative adhesion formation after open and laparoscopic cholecystectomy. METHODS In this study, 20 mongrel dogs were used: 10 each in the laparoscopic and open cholecystectomy groups. Blood and peritoneal lavage samples were taken up to postoperative day 14, followed by second-look laparoscopy and reoperation to detect the rate of adhesion formation. Also, specimens were obtained from the liver bed for histology. RESULTS In the open cholecystectomy group, the white blood cell count was higher in blood samples and lower in lavage specimens. Adhesion formation was extensive, and the histologic immune reaction was more intensive in the open cholecystectomy group. CONCLUSION This randomized study proved that laparoscopic cholecystectomy was associated with less immune suppression, less inflammatory reaction, and therefore less adhesion formation than open cholecystectomy.
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Affiliation(s)
- Gy Szabó
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, Hungary.
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Gago LA, Saed G, Elhammady E, Diamond MP. Effect of oxidized regenerated cellulose (Interceed) on the expression of tissue plasminogen activator and plasminogen activator inhibitor-1 in human peritoneal fibroblasts and mesothelial cells. Fertil Steril 2006; 86:1223-7. [PMID: 17008148 DOI: 10.1016/j.fertnstert.2006.04.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2005] [Revised: 04/11/2006] [Accepted: 04/11/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To characterize the molecular changes that occur in normal fibroblasts, adhesion fibroblasts, and mesothelial cells as a result of exposure to oxidized regenerated cellulose (Interceed; Johnson & Johnson Medical, Inc., New Brunswick, NJ). DESIGN Control and Interceed-treated normal peritoneal fibroblasts, adhesion fibroblasts, and mesothelial cells in culture were assessed for messenger RNA levels of molecules known to be associated with adhesion development, using multiplex reverse transcriptase polymerase chain reaction (n = 4). SETTING University research laboratory. PATIENT(S) Normal and adhesion fibroblasts and mesothelial cells. INTERVENTION(S) Exposure of cells, normal fibroblasts, adhesion fibroblasts, and mesothelial cells to oxidized regenerated cellulose. MAIN OUTCOME MEASURE(S) Real-time reverse transcriptase polymerase chain reaction expression of messenger RNA tissue plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1), and tPA-PAI-1 ratio, an indicator of overall fibrinolytic activity. RESULT(S) Interceed treatment of normal peritoneal fibroblasts, adhesion fibroblasts, and mesothelial cells results in an increased expression of tPA in mesothelial cells and an increase in the tPA-PAI-1 ratio, signifying an overall increase in fibrinolytic activity. CONCLUSION(S) Interceed, which has been shown in multiple human in vivo studies to decrease postoperative adhesion development, increases the expression of tPA and the tPA-PAI-1 ratio (an indicator of overall fibrinolytic activity), thereby promoting dissolution of fibrin and healing without adhesion development. Thus, the ability of Interceed to reduce postoperative adhesion development may be derived from both a barrier and biologic effect.
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Affiliation(s)
- L April Gago
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
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Brokelman WJA, Holmdahl L, Bergström M, Falk P, Klinkenbijl JHG, Reijnen MMPJ. Peritoneal fibrinolytic response to various aspects of laparoscopic surgery: a randomized trial. J Surg Res 2006; 136:309-13. [PMID: 17054995 DOI: 10.1016/j.jss.2006.07.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2006] [Revised: 07/24/2006] [Accepted: 07/25/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Peritoneal fibrinolysis is important in peritoneal wound healing processes and adhesion formation. The peritoneal fibrinolytic response to laparoscopy is merely unknown. In the present study we investigate the effect of short-term laparoscopy on the peritoneal fibrinolytic response and the influence of intra-abdominal pressure, light intensity and choice of dissection device on this response. METHODS There were 50 patients scheduled for laparoscopic cholecystectomy randomized in five groups operated with various pressures, light intensities, and dissection devices. Peritoneal biopsies were taken at the beginning and the end of the procedure. Tissue concentrations of tissue-type plasminogen activator (tPA), urokinase-type plasminogen activator (uPA), plasminogen activator inhibitor type 1 (PAI-1), and the tPA-activity were measured using ELISA techniques. RESULTS There were no differences in tPA antigen, tPA-activity, uPA antigen, or PAI-1 antigen concentrations in biopsies taken at the beginning compared to samples taken at the end of the operation. Different intra-abdominal pressures, light intensities and the choice dissection device did not affect any of the measured parameters. CONCLUSION Short-term laparoscopy does not affect the peritoneal fibrinolytic activity. The used intra-abdominal pressure, light intensity and choice of dissection device do not affect peritoneal activity during short-term laparoscopy.
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Affiliation(s)
- Walter J A Brokelman
- Department of Surgery, Alysis Zorggroep, Locatie Rijnstate, Arnhem, The Netherlands.
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Binda MM, Molinas CR, Hansen P, Koninckx PR. Effect of desiccation and temperature during laparoscopy on adhesion formation in mice. Fertil Steril 2006; 86:166-75. [PMID: 16730008 DOI: 10.1016/j.fertnstert.2005.11.079] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2005] [Revised: 11/29/2005] [Accepted: 11/29/2005] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To investigate the effects of desiccation (without cooling) and of oversaturation of the pneumoperitoneum on adhesion formation. DESIGN Prospective randomized trial. SETTING Academic research center. ANIMAL(S) BALB/c and NMRI female mice. INTERVENTION(S) The effect of desiccation using nonhumidified CO(2) on adhesion formation was evaluated in a laparoscopic mouse model. Body temperature (BT) was maintained at 37 degrees C using a homeothermic blanket. In addition to controls without desiccation, the effect of both hypothermia and desiccation on adhesion formation was evaluated. Subsequently the effect of oversaturating the pneumoperitoneum using a high energy gas to avoid any desiccation was studied. MAIN OUTCOME MEASURE(S) During surgery BT, pneumoperitoneum temperature, and relative humidity were monitored. Adhesions were scored after 7 days. RESULT(S) Adhesions increased with increasing levels of desiccation when BT was kept at 37 degrees C. This was prevented with humidified gas. If BT decreased, adhesions were fewer. Oversaturating the pneumoperitoneum increased adhesions due to high energy gas causing an increase in both BT and pneumoperitoneum temperature. CONCLUSION(S) Adhesions increase with desiccation and decrease when BT is reduced. Adhesions are minimized when humidified gas is used. Since desiccation is associated with cooling, its effect is generally underestimated because of the counterbalance with cooling. The concept of combining controlled intraperitoneal cooling with a rigorous prevention of desiccation might be important for clinical adhesion prevention.
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Affiliation(s)
- Maria Mercedes Binda
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
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Molinas CR, Binda MM, Campo R, Koninckx PR. Adhesion formation and interanimal variability in a laparoscopic mouse model varies with strains. Fertil Steril 2006; 83:1871-4. [PMID: 15950670 DOI: 10.1016/j.fertnstert.2004.11.084] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2004] [Revised: 11/15/2004] [Accepted: 11/13/2004] [Indexed: 02/07/2023]
Abstract
Adhesion formation after laparoscopic surgery was evaluated in mice of different strains. More adhesions were observed in Swiss, NMRI, and BALB/c mice, with less interanimal variability in BALB/c mice. These data point to genetics effects on adhesion formation, which open new insights in its pathogenesis and indicate the importance of a careful strain selection for animal studies.
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Affiliation(s)
- Carlos Roger Molinas
- Laboratory of Experimental Gynecology, Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Belgium.
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Mirastschijski U, Johannesson K, Jeppsson B, Agren MS. Effect of a matrix metalloproteinase activity and TNF-alpha converting enzyme inhibitor on intra-abdominal adhesions. Eur Surg Res 2005; 37:68-75. [PMID: 15818044 DOI: 10.1159/000083150] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2004] [Accepted: 09/13/2004] [Indexed: 12/12/2022]
Abstract
BACKGROUND Formation of intra-abdominal adhesions depends, in part, on the activity of serine proteinases. Matrix metalloproteinases (MMP) are required for epithelialization of skin wounds but their involvement in mesothelialization of peritoneal wounds and in adhesion pathogenesis is not known. Early tumor necrosis factor-alpha (TNF-alpha) levels have been proposed to reflect propensity to adhesion formation. OBJECTIVE The impact of MMP activity and secreted TNF-alpha on peritoneal adhesion formation and healing was investigated through systemic administration of the synthetic broad-spectrum MMP and TNF-alpha-converting enzyme (TACE) inhibitor GM 6001. METHODS Female Sprague-Dawley rats of 4-6 weeks of age were injected subcutaneously daily with GM 6001 100 mg/kg (n = 12) or vehicle (n = 10) starting two days before surgery. In each rat, two standardized peritoneal wounds, 20 mm x 5 mm, were made. One peritoneal wound was sutured whereas the contralateral wound healed by secondary intention. Adhesion formation and peritoneal healing, cell proliferation, and hydroxyproline concentrations were evaluated on postoperative day 7. RESULTS Total serum TNF-alpha levels increased in vehicle-treated rats (p = 0.019) while GM 6001 treatment effectively prevented the rise in the postoperative phase (p < 0.001). No significant differences were observed in the extent of adhesion formation (p = 0.67) between control (65.0%) and GM 6001-treated (61.5%) animals, or peritoneal wound healing or cell proliferation. Hydroxyproline levels increased in the wounds (p = 0.014) but were not different between the two groups (p = 0.14). CONCLUSIONS Lack of a striking effect of the MMP and TACE antagonist GM 6001 on postoperative adhesions suggests that MMP activity and TNF-alpha might not be major adhesiogenic factors.
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Affiliation(s)
- U Mirastschijski
- Department of Experimental Surgery, Malmo University Hospital, Lund University, Malmo, Sweden
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Ozel H, Avsar FM, Topaloglu S, Sahin M. Induction and assessment methods used in experimental adhesion studies. Wound Repair Regen 2005; 13:358-64. [PMID: 16008724 DOI: 10.1111/j.1067-1927.2005.130402.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Infertility and intestinal obstruction are well-known complications, arising from adhesion formation after intra-abdominal operations. Basic principles of adhesion formation have been found through animal studies. In addition, examination of agents for the prevention of adhesions can be easily made using experimental studies. However, lack of uniformity in study design makes assessment of the efficacy of any prophylactic regimen difficult. In this review, the material and methods used in experimental studies designed for adhesion formation or prevention were evaluated in detail, with experimental studies published in the literature from 1960 to 2003 being evaluated. Several methods for adhesion induction have been described in the literature. Severity of the adhesion varies from method to method, with the main problem being the lack of uniform expression of study results. Extensive use of complex adhesion classification systems should be used to resolve this discordance between experimental studies.
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Affiliation(s)
- Hakan Ozel
- First Department of Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
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Wang Z, Sosne G, Kurpakus-Wheater M. Plasminogen activator inhibitor-1 (PAI-1) stimulates human corneal epithelial cell adhesion and migration in vitro. Exp Eye Res 2005; 80:1-8. [PMID: 15652520 DOI: 10.1016/j.exer.2004.06.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2004] [Indexed: 10/26/2022]
Abstract
In addition to its role as an inhibitor of urokinase plasminogen activator (uPA), plasminogen activator inhibitor-1 (PAI-1) is hypothesized to regulate epithelial cell adhesion and migration. We have previously reported that PAI-1 may be an important regulatory factor of the uPA system in cornea. The purpose of this study was to extend those observations by determining the effect of exogenous PAI-1 on the migration and adhesion of human corneal epithelial cells (HCEC) in vitro. The expression of PAI-1 in non-transformed early passage HCEC was confirmed by immunofluorescence microscopy and Western blot analysis. Colorimetric assays coupled with function-inhibiting antibody studies using the matrix assembled in situ by cultured cells demonstrate that immobilized PAI-1 serves as an efficient substrate for HCEC adhesion. HCEC attachment to PAI-1 is comparable to that of laminin-10, a known strong adhesion protein for epithelial cells. In addition to serving as an adhesion substrate, PAI-1 also functions as a chemotactic agent for corneal epithelium. Additionally it promotes the random migration of HCEC, from an initial cell cluster, along a culture substrate. Our results in corneal epithelium are consistent with reports from other investigators showing that PAI-1 facilitates both epithelial adhesion and migration. From our studies we conclude that PAI-1 may play a dual role in corneal wound healing. Initially PAI-1 may function to stimulate migration and facilitate the reepithelialization of the wound bed. Post-reepithelization, PAI-1 may ensure corneal epithelial cell adhesion to matrix to promote successful wound healing.
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Affiliation(s)
- Zhiyu Wang
- Department of Anatomy and Cell Biology, Wayne State University School of Medicine, Detroit, MI 48201, USA
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Elkelani OA, Binda MM, Molinas CR, Koninckx PR. Effect of adding more than 3% oxygen to carbon dioxide pneumoperitoneum on adhesion formation in a laparoscopic mouse model. Fertil Steril 2005; 82:1616-22. [PMID: 15589868 DOI: 10.1016/j.fertnstert.2004.07.933] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2003] [Revised: 07/12/2004] [Accepted: 07/12/2004] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate the effect of the addition of 3% or higher oxygen concentrations to the carbon dioxide (CO2) pneumoperitoneum. DESIGN Prospective, randomized trial. SETTING Academic research center. ANIMAL(S) Female Naval Medical Research Institute mice (n = 100). INTERVENTION(S) Sixty minutes of CO2 pneumoperitoneum with 0%, 3%, 6%, 9%, or 12% oxygen; induction of adhesions by the creation of standardized peritoneal lesions during laparoscopy. MAIN OUTCOME MEASURE(S) Adhesions were quantitatively and qualitatively scored after 7 days during laparotomy to determine [1] the effect of 60 minutes of CO2 pneumoperitoneum with 0%, 3%, 6%, 9%, or 12% oxygen on adhesion formation, and [2] the effect of duration of CO2 pneumoperitoneum and insufflation pressure on adhesion formation with the addition of 0%, 3%, and 12% oxygen. RESULT(S) Compared with a CO2 pneumoperitoneum with 3% oxygen, adhesion formation is greater when either no oxygen or more than 3% oxygen is added to the CO2 pneumoperitoneum. These effects persisted at higher insufflation pressures and longer duration of pneumoperitoneum, both known to increase adhesion formation with pure CO2. CONCLUSION(S) This study confirms that adhesion formation is decreased with the addition of 3% oxygen to the CO2 pneumoperitoneum. The addition of higher oxygen concentrations, however, is deleterious. Adhesions always increase with time and duration of the pneumoperitoneum.
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Affiliation(s)
- Osama Ali Elkelani
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
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Gordts S, Brosens I, Gordts S, Puttemans P, Campo R. Progress in transvaginal hydrolaparoscopy. Obstet Gynecol Clin North Am 2004; 31:631-9, x. [PMID: 15450324 DOI: 10.1016/j.ogc.2004.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Reproductive performance is now more than ever determining the choice of treatment for each individual couple. The easy access to ART treatments, their financial benefits, and the relative high success rate per cycle are at the basis of a liberal referral to these treatments without an accurate diagnosis. The easy and comprehensive investigation by a transvaginal endoscopy as a first-line diagnostic procedure allows for an accurate diagnosis and the choice of the most appropriate treatment.
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Affiliation(s)
- Stephan Gordts
- Leuven Institute for Fertility and Embryology, Tiensevest 168, 3000 Leuven, Belgium.
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Molinas CR, Binda MM, Carmeliet P, Koninckx PR. Role of vascular endothelial growth factor receptor 1 in basal adhesion formation and in carbon dioxide pneumoperitoneum-enhanced adhesion formation after laparoscopic surgery in mice. Fertil Steril 2004; 82 Suppl 3:1149-53. [PMID: 15474088 DOI: 10.1016/j.fertnstert.2004.04.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2003] [Revised: 04/05/2004] [Accepted: 04/05/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the role of vascular endothelial growth factor receptor-1 (VEGFR-1) in adhesion formation after laparoscopic surgery. DESIGN Prospective, randomized study. SETTING Academic research center. ANIMAL(S) Forty female Swiss mice. INTERVENTION(S) Adhesions were induced by standardized lesions during laparoscopy. The CO2 pneumoperitoneum was maintained for the minimum time needed to perform the lesions (10 minutes) or for a longer period (60 minutes) to evaluate basal adhesions and pneumoperitoneum-enhanced adhesions, respectively. Mice were treated either with IgG or with antibodies against VEGFR-1. MAIN OUTCOME MEASUREMENT(S) Adhesions were quantitatively and qualitatively scored after 7 days during laparotomy. RESULT(S) In IgG-treated mice, 60 minutes of CO2 pneumoperitoneum increased basal adhesions. In VEGFR-1 antibody-treated mice, basal adhesions were similar to the control group and 60 minutes of CO2 pneumoperitoneum did not increase adhesions. Therefore, in these mice, pneumoperitoneum-enhanced adhesions were lower than in IgG-treated mice. CONCLUSION(S) The data confirm that CO2 pneumoperitoneum is a cofactor in adhesion formation and demonstrate that VEGFR-1 plays a role in pneumoperitoneum-enhanced adhesions, which is consistent with a role of placental growth factor, VEGF-A, and VEGF-B in pneumoperitoneum-enhanced adhesions. These observations give new insight into the pathogenesis of adhesion formation.
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Affiliation(s)
- Carlos Roger Molinas
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
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Wang YL, Pan CE, Yang PL, Tian Y, Pei SW, Dong M. Effects of Antiadhesion preparation on free fibrinogen and fibrin degrading products in abdominal exudates of rabbits postoperatively. World J Gastroenterol 2004; 10:2762-6. [PMID: 15309738 PMCID: PMC4572212 DOI: 10.3748/wjg.v10.i18.2762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To observe effects of ACOL on fibrinogen (FIB), fibrin degrading products (FDP) and changes of FIB and FDP concentration in rabbits with intro-abdominal exudates during 7 d after major abdominal surgery.
METHODS: Sixty New Zealand rabbits were randomly divided into 4 groups: ACOL group, the control group, DCT group and the normal group. After being modeled, except the normal group, the other 3 groups were treated with different ways for a week; the intro-abdominal exudates of rabbits in the 4 groups were drawn for FIB and FDP measurement once daily during 7 d after major abdominal surgery.
RESULTS: FIB and FDP in the intro-abdominal exudates altered in a regular way and ACOL could change the concentration of FIB and FDP in the intra-abdominal exudates after major abdominal surgery.
CONCLUSION: ACOL can prevent intestinal adhesion by reducing the concentration of FIB and raising that of FDP in the intro-abdominal exudates after major abdominal surgery.
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Affiliation(s)
- You-Li Wang
- Department of Hepatobiliary Surgery, Xi'an Jiaotong University First Hospital, Xi'an 710061, Shaanxi Providence, China.
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Binda MM, Molinas CR, Mailova K, Koninckx PR. Effect of temperature upon adhesion formation in a laparoscopic mouse model. Hum Reprod 2004; 19:2626-32. [PMID: 15333592 DOI: 10.1093/humrep/deh495] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Pneumoperitoneum can be a cofactor in adhesion formation. Pneumoperitoneum with non-humidified gas causes desiccation in the peritoneal cavity which decreases temperature. The effect of desiccation upon adhesion formation is widely accepted. The specific effect of the associated cooling upon adhesion formation remains unexplored, and was addressed specifically in our laparoscopic mouse model. METHODS Adhesions were induced during laparoscopy and scored after 7 days during laparotomy. Pneumoperitoneum was performed using CO2 or CO2 with oxygen with or without humidification. Animals were placed at different environmental temperatures to modulate body and intraperitoneal temperature. RESULTS Anaesthesia, environment with a lower temperature and pneumoperitoneum all independently decrease body temperature. A decrease in body temperature decreases adhesion formation (P=0.004). Therefore, at 37 degrees C, pneumoperitoneum-enhanced adhesion formation is more important than at room temperature (P=0.04). As was observed at room temperature, adhesion formation at 37 degrees C increases with the duration (P=0.01) of pneumoperitoneum and decreases with the addition of 3% of oxygen (P=0.03). CONCLUSIONS Hypothermia reduces pneumoperitoneum-enhanced adhesion formation, which supports hypoxia as a driving mechanism, since hypothermia decreases the toxic effects of hypoxia and of the ischaemia-reperfusion process. These data could open up new possibilities for adhesion prevention in laparoscopic surgery.
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Affiliation(s)
- M M Binda
- Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Herestraat 49, B3000 Leuven, Belgium.
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Molinas CR, Tjwa M, Vanacker B, Binda MM, Elkelani O, Koninckx PR. Role of CO2 pneumoperitoneum-induced acidosis in CO2 pneumoperitoneum-enhanced adhesion formation in mice. Fertil Steril 2004; 81:708-11. [PMID: 15037429 DOI: 10.1016/j.fertnstert.2003.10.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2003] [Revised: 10/28/2003] [Accepted: 10/28/2003] [Indexed: 10/26/2022]
Abstract
The effect of assisted ventilation and CO(2) pneumoperitoneum during laparoscopic surgery upon blood gases and adhesion formation were evaluated in mice. We confirmed that the CO(2) pneumoperitoneum induces acidosis and enhances adhesion formation, and an association between both effects was demonstrated, together with its modulation by the assisted ventilation.
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Molinas CR, Campo R, Dewerchin M, Eriksson U, Carmeliet P, Koninckx PR. Role of vascular endothelial growth factor and placental growth factor in basal adhesion formation and in carbon dioxide pneumoperitoneum-enhanced adhesion formation after laparoscopic surgery in transgenic mice. Fertil Steril 2003; 80 Suppl 2:803-11. [PMID: 14505757 DOI: 10.1016/s0015-0282(03)00768-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the role of vascular endothelial growth factor (VEGF) and placental growth factor (PlGF) in adhesion formation after laparoscopic surgery. DESIGN Prospective, randomized study. SETTING Academic research center. ANIMAL(S) Female wild-type mice and transgenic mice (n = 110), expressing exclusively VEGF-A(164) (VEGF-A(164/164)) or deficient for VEGF-B (VEGF-B(-/-)) or for PlGF (PlGF(-/-)). INTERVENTION(S) Adhesions were induced during laparoscopy. To evaluate "basal adhesions" and "CO(2) pneumoperitoneum-enhanced adhesions," the pneumoperitoneum was maintained for a minimum (10 minutes) or prolonged (60 minutes) period. The role of PlGF was also evaluated by administration of antibodies. MAIN OUTCOME MEASURE(S) Adhesions were blindly scored after 7 days. RESULT(S) In all wild-type mice, CO(2) pneumoperitoneum enhanced adhesion formation. In comparison with wild-type mice, basal adhesions were higher in VEGF-A(164/164) mice and similar in VEGF-B(-/-) and PlGF(-/-) mice. Pneumoperitoneum did not enhance adhesions in any of these transgenic mice. The effects observed in PlGF(-/-) mice were confirmed in PlGF antibody-treated mice. CONCLUSION(S) The data demonstrate that the VEGF family plays a role in adhesion formation and confirm that CO(2) pneumoperitoneum enhances adhesions. VEGF-A(164) has a direct role in basal adhesions. Absence of pneumoperitoneum-enhanced adhesions in VEGF-A(164/164), VEGF-B(-/-), and PlGF(-/-) mice indicates up-regulation of VEGF-A(164), VEGF-B, and PlGF by CO(2) pneumoperitoneum as a mechanism for pneumoperitoneum-enhanced adhesion formation.
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Affiliation(s)
- Carlos Roger Molinas
- Center for Surgical Technologies, Katholieke Universiteit Leuven, Leuven, Belgium.
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Molinas CR, Campo R, Elkelani OA, Binda MM, Carmeliet P, Koninckx PR. Role of hypoxia inducible factors 1alpha and 2alpha in basal adhesion formation and in carbon dioxide pneumoperitoneum-enhanced adhesion formation after laparoscopic surgery in transgenic mice. Fertil Steril 2003; 80 Suppl 2:795-802. [PMID: 14505756 DOI: 10.1016/s0015-0282(03)00779-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the role of hypoxia inducible factors (HIFs) 1alpha and 2alpha in adhesion formation after laparoscopic surgery. DESIGN Prospective, randomized study. SETTING Academic research center. ANIMAL(S) Forty Swiss/129SvJ wild-type mice and transgenic mice partially deficient for the genes encoding for HIF-1alpha (HIF-1alpha(+/-)) or HIF-2alpha (HIF-2alpha(+/-)). INTERVENTION(S) Adhesions were induced by standardized lesions during laparoscopy. To evaluate "basal adhesions" and "pneumoperitoneum-enhanced adhesions," the pneumoperitoneum was maintained for a minimum (10 minutes) or prolonged (60 minutes) period, respectively. MAIN OUTCOME MEASURE(S) Adhesions were blindly scored after 7 days. RESULT(S) In both HIF-1alpha and HIF-2alpha wild-type mice, pneumoperitoneum enhanced adhesion formation. In comparison with wild-type mice, basal adhesions were lower in HIF-1alpha(+/-) and similar in HIF-2alpha(+/-) mice. Pneumoperitoneum did not enhance adhesion formation in HIF-1alpha(+/-) or in HIF-2alpha(+/-) mice. Therefore, in comparison with the correspondent wild-type mice, pneumoperitoneum-enhanced adhesions were lower in HIF-1alpha(+/-) and HIF-2alpha(+/-) mice. CONCLUSION(S) These data confirm that CO(2) pneumoperitoneum enhances adhesion formation and indicate that this effect is mediated, at least in part, by an up-regulation of HIF-1alpha and HIF-2alpha.
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Affiliation(s)
- Carlos Roger Molinas
- Center for Surgical Technologies, Katholieke Universiteit Leuven, Leuven, Belgium.
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