Barrier materials for prevention of surgical adhesions: systematic review

Waldron, Michael; Judge, Conor; Farina, Laura; O’Shaughnessy, Aoife; O’Halloran, Martin

doi:10.1093/bjsopen/zrac075

Cited by 16 publications

(6 citation statements)

References 189 publications

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“…Creating an animal model of abdominal adhesions with consistent, reliable and reproducible results for positive control is a major challenge. Currently, researches are ongoing to find more efficient anti-adhesion agents and components [7,13,15]. In this experimental study, anti-adhesion agents, such as mezogel, metronidazole, dextran, and contrykal, were used.…”

Section: Resultsmentioning

confidence: 99%

Types and Localization of Abdominal Adhesions after Open Operations (Experimental Study)

Akhmedov¹

2022

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There is a great need for more efficient and more widely used preventive treatment of post-operative abdominal adhesions. Objective - to study the type of adhesions in the abdominal cavity after open operations in the experiment. Materials and methods. The study was conducted on 90 white outbred rats divided into three groups. We mechanically damaged the surface of the small bowel segment in all rats. The control group (group 1) included 30 rats not administered any drugs into the abdominal cavity after the small bowel segment damage. The comparison group (group 2) consisted of 30 rats, which were introduced one mL of mezogel. The study group comprised 30 rats, which were administered a 1 mL mixture of metronidazole, dextran, contrykal (in a ratio of 1:1:0.1, respectively) + O2 into the abdominal cavity; the wound of the latter was closed using a layered suture technique. On days 5, 10 and 21, the tissues taken from the suture site, peritoneum, damaged small bowel segment, liver, and omentum were analysed histologically. Results. On day 10 in groups 1 and 2, compared to day 5, the proportion of filmy adhesions decreased by 45.9% (p=0.004), but the proportion of dense adhesions increased by 64.7%. The comparative between-group analysis on day 5 in groups 1 and 2 revealed no difference in the proportion of filmy adhesions, whereas in group 3 the proportion of filmy adhesions was 4% higher and the proportion of dense adhesions was 16.5% lower. Planar adhesions predominated in all groups. Conclusions. There were more filmy adhesions seen on day 1, and the complete dense adhesion formation was observed by day 21. Planar adhesions predominated (54.5  60.0%). The area of postoperative sutures was involved in the adhesion formation. The adhesions in the sutures - peritoneum area as well as the omental adhesions were detected in all animals. Introduction of drugs, mezogel or a mixture of metronidazole, dextran, contrykal + O2, into the abdominal cavity contributed to the reduction of adhesions between the small bowel loops. The experiments with laboratory animals were provided in accordance with all bioethical norms and guidelines. No conflict of interests was declared by the author.

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Section: Resultsmentioning

confidence: 99%

Types and Localization of Abdominal Adhesions after Open Operations (Experimental Study)

Akhmedov¹

2022

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“…Barriers were demonstrated to reduce postoperative adhesion in animal experiments and showed positive results in humans according to a systematic review, but none of them has been used commonly worldwide. Titanized mesh has not been included in the evaluation [101] The design of titanium coated mesh (Biocer ® ) may be responsible for an increased recurrence after TAPP bilateral medial inguinal hernia repair [102]. Comparable functional results (recurrence), fewer postoperative complications (Seroma, foreign body sensation, sensitivity to weather changes), and improved quality of life can be achieved according to Horstmann, et al (2006) In clinical studies, the titanium-coated polypropylene mesh shows in inguinal hernia repair certain benefits compared with the use of older heavy-weight meshes.…”

Section: Titanium Coated Meshmentioning

confidence: 99%

A Narrative Review on Polypropylene Mesh Complications in Inguinal Hernia Repair - is Titanized Mesh an Option?

2022

J Surg

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Introduction: Since the introduction of mesh in Inguinal Hernia Repair (IHR) the recurrence rate was lowered. Instead, postoperative pain which may be related to mesh side effects e.g. fibrosis, foreign body reaction, erosion and migration, and infection, has been recognized as the relevant outcome factor. The long-term effects of mesh and composite mesh need to be analyzed.Methods: Pubmed, google scholar search using the search terms: polypropylene mesh, titanized mesh, TiMesh ® ; about polypropylene mesh the following terms: adhesion, erosion, infection, shrinkage, migration, seroma, degradation, pain; biocompatibility, foreign body reaction. Also, a bibliography of relevant articles and product-related information was searched.Results: Mesh properties are determined by tensile strength, pore size, weight, reactivity and biocompatibility, elasticity, constitution, and shrinkage. PolyPropylene Mesh (PP) is associated with actual and long-term complications more than expected. These complications are associated with mesh structure-lightweight meshes showed fewer risks for complication as infection, pain, mesh migration, foreign body response, erosion, adhesion, shrinkage, pain, seroma, and recurrence. TiMesh ® showed an advantage in in-vitro and animal studies which were supported by clinical studies. There is a shorter convalescence, and lesser foreign material sensitivity with comparable results in complications (Chronic pain, infection, recurrence). Conclusion:Polypropylene mesh has been successful in inguinal hernia repair for decades. However, in recent years complications of PP became evident in scientific reports and the public. Complications seem to be related to the material and structure of the mesh but also to the surgeon's expertise and patient's characteristics. It became evident that more complications appear long-term. The true rate of complications could be higher. There are a few clinical reports on titanium-coated mesh (TiMesh) in TAPP and TEP inguinal hernia repair. Experience with TiMesh in laparoscopic procedures long-term and open IHR are missing. Especially about the long-term effects of coating PP with titanium we need to have a better understanding of the interaction of soft tissue and mesh. There are promising results of pure titanium mesh for inguinal hernia repair which need to be confirmed in further controlled clinical studies.

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“…Adhesions may be symptomatic and also play a major role in subfertility in patients with endometriosis ( Tanbo and Fedorcsak, 2017 ). Different approaches have been developed in order to avoid postoperative adhesion formation in patients with endometriosis, such as transient or permanent ovarian fixation ( Dhanawat et al, 2020 ), consideration of microsurgical principles ( Gomel and Koninckx, 2016 ) and the intraperitoneal application of barrier preparations ( Waldron et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Postoperative Peritoneal Granulomatous Inflammation After the Application of Potato Starch-Based Anti-Adhesive Agent in Laparoscopic Endometriosis Surgery

Krentel,

Naem,

Tannapfel

et al. 2023

Facts Views Vis ObGyn

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Background: Endometriosis is a chronic inflammatory oestrogen-dependent disease. It is characterised by elevated inflammatory markers in the peritoneal milieu with subsequent adhesiogenesis. Nowadays, excisional, and ablative surgeries are considered the main treatment of endometriosis, and adhesiolysis is being performed almost routinely during these procedures. Postoperative adhesion formation is a significant concern for many surgeons, especially as endometriosis patients are assumed to be predisposed to adhesiogenesis. In order to minimise adhesiogenesis after endometriosis surgery, the usage of different barrier methods have been discussed in the literature. Recent studies aim to investigate the effect of potato starch preparations on adhesion formation in endometriosis patients. Objectives: We aim to describe the findings of a second-look laparoscopy on patients who received a starch-based anti-adhesive agent. Materials and Methods: We present a retrospective case series that included the medical, surgical, and histopathologic data of three patients. Main Outcome Measures: Intraperitoneal adhesion formation and peritoneal inflammation. Results: All three patients had de-novo adhesions during the second-look laparoscopy. Pathological examination revealed noncaseating granulomatosis of the peritoneum in all patients. Conclusion: The use of potato starch-based agents as a peritoneal adhesion prophylaxis in laparoscopic endometriosis surgery could lead to granulomatous peritoneal inflammation. Correct application by avoiding powder remnants through complete rinsing and transformation to gel seems to be an important factor to avoid this adverse effect. What is new? We aim to highlight that potato starch-based anti-adhesive agents similar to the one used in this study could be a cause of adhesiogenesis and peritoneal inflammation.

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Barrier materials for prevention of surgical adhesions: systematic review

Cited by 16 publications

References 189 publications

Types and Localization of Abdominal Adhesions after Open Operations (Experimental Study)

Types and Localization of Abdominal Adhesions after Open Operations (Experimental Study)

A Narrative Review on Polypropylene Mesh Complications in Inguinal Hernia Repair - is Titanized Mesh an Option?

Postoperative Peritoneal Granulomatous Inflammation After the Application of Potato Starch-Based Anti-Adhesive Agent in Laparoscopic Endometriosis Surgery

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