Comparison between the intraoperative use of polyvinyl chloride cover and surgical compresses for preventing postoperative adhesions

BACKGROUND/PURPOSE

Surgical compresses used for retraction during major abdominal and pelvic procedures lead to postoperative adhesion formation resulting from damage to the visceral peritoneum. This study investigates whether polyvinyl chloride (PVC) covers cause less postsurgical adhesion and inflammation than surgical compresses in an animal model.

METHODS

Female Wistar albino rats (n = 160) were divided into three groups (compress, PVC cover and control), which were then divided into 16 subgroups (n = 10/group). All animals underwent midline laparotomy and cecal abrasion. A metal retractor, which applies a constant force, was then placed on the small intestine for 2 h. In the control group, no material was placed under the retractor, whereas a surgical compress or PVC cover was placed in the experimental animals. Full-thickness small intestinal biopsies were obtained and examined by light and electron microscopy. The following parameters were evaluated: congestion, mesothelial proliferation, leukocyte migration and collagenization. Adhesions were scored according to the Nair, Knightly and Mazuji scoring systems.

RESULTS

All inflammation scores were significantly higher in the compress group than in the other two groups. However, no significant difference was observed between the PVC cover and control groups. Adhesions were more frequent in the compress group than in the other two groups, regardless of the scoring system used.

CONCLUSIONS

Surgical compresses used in abdominal and pelvic surgeries cause inflammation and adhesion. Contrary to surgical compresses, PVC covers do not cause inflammation and adhesion, which may considerably reduce adhesion-related complications in abdominopelvic surgeries.

Type 2 diabetes mellitus in a patient with malignant insulinoma manifesting following surgery

BACKGROUND

Insulinomas, although they are rare, are the most common of pancreatic islet cell tumours. The incidence is estimated at only four per million person-years and only 5-12% of reported cases are malignant. Distinction between malignant and benign tumours can only be made by the presence of metastasis, as there are no specific morphologic, biochemical or genetic features distinguishing them. Most patients with malignant insulinoma have lymph node or liver metastases and, rarely, bone involvement. The coincidence of insulinoma and diabetes mellitus is an extremely rare condition and reported only in a few cases.

CASE REPORT

We report a 45-year-old woman who was diagnosed with insulinoma on the basis of clinical and laboratory findings and endoscopic examination. Histopathological diagnosis revealed well-differentiated endocrine carcinoma of the pancreas with lymph node metastases. The case was accepted as malignant insulinoma and the patient underwent surgery. Interestingly, hyperglycaemia occurred after the removal of the insulinoma, with the requirement for insulin in the post-operative 3 weeks, which was changed to oral anti-diabetic agents as a permanent treatment. The patient is still being treated with oral anti-diabetic agents. We think that the patient might have had diabetes mellitus, because of insulin resistance that developed with a high-caloric intake stimulated by hypoglycaemia, and which had been masked for many years, but manifested overtly after removal of the tumour.

CONCLUSIONS

Although this is a rare condition, clinicians should bear in mind that insulinomas may exist together with diabetes mellitus, and it is important to have this suspicion when considering the perioperative approach and for the prevention of morbidities.