Adhesion prevention in gynecologic surgery

Tulandi, Togas; Alshahrani, Abdulaziz

doi:10.1097/01.gco.0000175357.25932.89

Cited by 24 publications

(19 citation statements)

References 19 publications

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“…A more recent review considered the application of hyaluronic acid, hydrogel, viscoelastic gel, vitamin E and other substances, as well as modifications of surgical technique (peritoneal non-closure, temporary abdominal oophoropexy, or changing the temperature, humidity or consistency of the gas used in laparoscopic surgery). 18 All of these articles concluded that none of the interventions available provided reliable effectiveness in the prevention of adhesion.…”

Section: Discussionmentioning

confidence: 99%

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Prevention of Gynaecological Adhesions using Haemostatic Fleece in a Rabbit Model

2006

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This pre-clinical study was performed to investigate the ability of the haemostatic fleece TachoComb ® to prevent adhesion formation following uterine surgery. Thirty rabbits were randomized to receive TachoComb ® or no intervention following incision to the right uterine horn. After 14 days, the animals were killed and examined for the presence of adhesion. The lengths of any adhesions were measured and the severity was recorded as a score (0, no adhesion; 1, adhesion easy to lyse; 2, adhesion lysed with traction; 3, adhesion separated by sharp dissection). The incidence of adhesions was 100% in the control group compared with 33% in the TachoComb ® -treated animals. The mean adhesion score was significantly lower (0.7 versus 2.2) and the mean adhesion length category was significantly shorter (0.4 versus 2.0) with TachoComb ® than in the control group. This study indicates that TachoComb ® is a well-tolerated and effective means of preventing adhesion following gynaecological surgery.

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Section: Discussionmentioning

confidence: 99%

“…1 A variety of complications may result, including pain, infertility and bowel obstruction, and re-operation may be required. Adhesion is responsible for a large number of hospitalizations and substantial financial cost.…”

Section: Introductionmentioning

confidence: 99%

Prevention of Gynaecological Adhesions using Haemostatic Fleece in a Rabbit Model

2006

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“…However, the clotting cascade as a result of tissue injury, exudate formation rich in protein-containing substances, the development of fibrin deposits from this protein mass, destruction of these fibrin tissues by plasminogen activators in healthy tissues, collagen storing by fibroblasts after four to five days, and formation of permanent fibrous adhesions are well-known processes contributing to the formation of adhesions (27)(28)(29)(30)(31).…”

Section: Discussionmentioning

confidence: 99%

Evaluating the effect of polytetrafluoroethylene and extractum cepae-heparin-allantoin gel in peripheral nerve injuries in a rat model

Kahraman

Kahveci

2015

CAN J PLAST SURG

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P eripheral nerves can be injured by congenital, mechanical, thermal or chemical causes. Peripheral nerve injuries are increasing in frequency, particularly in countries that are becoming more industrialized. Nerve and extremity injuries result in work loss and high treatment costs, and lead to separation of patients from their social environment. Failure of nerve repair causes muscle functional losses, sensory losses and painful neuropathies.Depending on injury severity, structural and functional changes occur in nerves. The segment distal to the injury undergoes Wallerian degeneration, which prepares the tube for axonal regeneration. During the healing process, collagen synthesis due to fibroblastic activity increases in the endoneurium and the perineurium. Scar tissue formation just outside the injured nerve causes adhesion of nerve fibres to neighbouring tissues, decreases mobility and causes vasospasm and traction injuries in the nerve vessels. Furthermore, it decreases nutrition by diffusion, inhibits nerve repair, slows axoplasmic flow and negatively effects nerve degeneration, resulting in ischemia and irreversible injury to the nerve. During the healing process, scar tissue forming on the incision line blocks axonal growth by forming a mechanical barrier. Scar tissue formation is a component of the wound healing process (1,2). If the re-innervation is prolonged, collagen becomes denser and the endoneural tube narrows further, thus slowing progression of regeneration to the distal site of the injury; this is referred to as 'delayed scar'.For primary peripheral nerve injuries in which the severed nerve endings can be easily reapproximated, primary suturing is the most common first-line repair method. However, despite highly developed surgical techniques and postoperative programs, intra-and extraneural adhesions following nerve surgery remain an important problem. To prevent irreversible nerve injury, and to increase axonal regeneration and prevent adhesions, many methods and materials such as antitransforming growth factor-beta anti-core (3,4), aprotinin (5), hyaluronic acid (6,7), human amniotic membrane (8,9), citicoline (10) and ADCON-T/N (11) have been used. Although these agents have inhibited the formation of adhesions, they have not been able to eliminate them completely (12,13).The present study used a rat model to compare the effects of polytetrafluoroethylene (PTFE) and PTFE-extractum cepae-heparinallantoin (PTFE-EHA) gel compound on nerve histopathology and functional recovery after total peripheral nerve injury repaired by primary suture, and the prevention of adhesions and scar tissue formation. PTFE is a synthetic biomaterial that is inert, nonadhesive, BACKgROUND: Peripheral nerves can be injured by congenital, mechanical, thermal or chemical causes. Peripheral nerve injuries are increasing in frequency, particularly in countries that are becoming more industrialized. Nerve and extremity injuries result in work loss and high treatment costs, and can lead to separation of patients from thei...

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“…17,[19][20][21][22][23][24][25][26] In this study most patients (94.4%) have a history of laparotomy. However there are not significant differences in PAI score based on previous surgical access (open vs laparoscopic, P=0.352).…”

Section: Figure 1 Peritoneal Adhesion Index (Pai)mentioning

confidence: 99%

“…Adhesions occur after 50-100% of surgical interventions. 1,2 They are often responsible for small bowel obstructions, 3,4 secondary female infertility, ectopic gestation 5,6 and chronic abdominal pains. [7][8][9] The impact of adhesions on surgeon workload and on the healthcare cost is significant.…”

Section: Introductionmentioning

confidence: 99%

Validation of peritoneal adhesion index as a standardized classification to universalize peritoneal adhesions definition

et al. 2017

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Peritoneal adhesion index (PAI) is a score based on appearance and distribution of peritoneal adhesions. The study aims to assess the validity of PAI in order to standardize the definition of peritoneal adhesions. The study includes an expert survey to assess the feasibility of the score and a prospective observational and multicenter trial to assess its validity. 96% of surgeons of the survey consider PAI a useful tool. From January 2013 to March 2015, 205 patients were enrolled to undergo a surgical intervention for bowel obstruction caused by peritoneal adhesions in 21 centers. PAI was significantly higher in the population with previous surgery (P=0.043) and in patients who underwent two previous surgical interventions, if compared to those with only one previous intervention (P=0.012). Length of surgery was significantly longer in patients with higher PAI (P<0.001). Patients with a higher PAI showed a clinically higher risk for early bowel re-obstruction and for early re-intervention. The AUC of the ROC curve for early re-occlusion is 0.8. PAI can be considered a feasible and useful score.

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Adhesion prevention in gynecologic surgery

Cited by 24 publications

References 19 publications

Prevention of Gynaecological Adhesions using Haemostatic Fleece in a Rabbit Model

Prevention of Gynaecological Adhesions using Haemostatic Fleece in a Rabbit Model

Evaluating the effect of polytetrafluoroethylene and extractum cepae-heparin-allantoin gel in peripheral nerve injuries in a rat model

Validation of peritoneal adhesion index as a standardized classification to universalize peritoneal adhesions definition

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