Clearance Rates of Ringer's Lactate and Adept and the Effect of Full Conditioning: A Randomized Controlled Trial

VergutsJasper,; CoronaRoberta,; TimmermanDirk,; CraessaertsMarleen,; KoninckxPhilippe, R

doi:10.1089/gyn.2014.0052

Cited by 3 publications

(5 citation statements)

References 22 publications

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“…Lactated Ringer solution is slightly but significantly effective in a mouse model ( 98) of CO 2 pneumoperitoneum-enhanced adhesion formation. In human surgery, the efficacy of lactated Ringer solution remains debated, but this might have to be reconsidered because retention time of lactated Ringer solution is much longer in women with minimal mesothelial damage (99). Also, the use of Adept should be critically reconsidered.…”

Section: Figurementioning

confidence: 99%

“…Efficacy was low in both a Cochrane review (100) and the GENEVA trial (101). This is not surprising, given that Adept has an exponential clearance from the peritoneal cavity, with little volume remaining after 24 hours, similarly to lactated Ringer solution (99); the claimed long peritoneal retention time is probably not correct because it was observed in only nine patients undergoing intraperitoneal 5-fluorouracil treatment for colorectal cancer (102).…”

Section: Figurementioning

confidence: 99%

See 1 more Smart Citation

Role of the peritoneal cavity in the prevention of postoperative adhesions, pain, and fatigue

Koninckx¹,

Gomel

Ussia³

et al. 2016

Fertility and Sterility

Self Cite

113

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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., CO 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% NO to the CO 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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Section: Figurementioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Role of the peritoneal cavity in the prevention of postoperative adhesions, pain, and fatigue

Koninckx¹,

Gomel

Ussia³

et al. 2016

Fertility and Sterility

Self Cite

113

View full text Add to dashboard Cite

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“…1 filmy adhesion was found in 4 women of the full conditioning group; 12/16 were adhesion free. ( P = 0.0005) [ 19 ] Verguts 2015 Human Female Belgium Randomised control trial Group 1: CO 2 + Ringer’s lactate Group 2: CO 2 + Icodextrin 4% Group 3: CO 2 + 10% N 2 O + 4% O 2 + Ringer’s lactate a Group 4: CO 2 + 10% N 2 O + 4% O 2 + Icodextrin 4% a 15 15 15 15 5 5 5 5 Resorption rates of fluids used in the prevention of adhesion after laparoscopic surgery Group 3 showed a decreased resorption rate of Ringer’s lactate after 24, 48, and 72 h ( P = 0.03, 0.009, and NS vs group 1), respectively. Group 4 did not affect the resorption rate of Icodextrin (NS vs group 2) 20 Storme 2016 Human Female Belgium Randomised control trial Group 1: CO 2 Group 2: CO 2 + 10% N 2 O + 4% O 2 a 15 15 7 7 Adhesion score VAS score A significantly high number of adhesions were found in all control patients.…”

Section: Resultsmentioning

confidence: 99%

“…One randomised human study, comprising 20 female patients, utilised CO 2 + 10% N 2 O + 4% O 2 (as well as humidification and cooling) + Ringer’s lactate/icodextrin 4% [ 19 ]. This study compared the resorption rate of fluid barriers that prevent adhesion formation.…”

Section: Summary Of the Reviewed Literaturementioning

confidence: 99%

Use of mixed gas pneumoperitoneum during minimally invasive surgery: a systematic review of human and mouse modelled laparoscopic interventions

Chen,

Dasgupta,

Vasdev

2024

J Robotic Surg

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The formation of pneumoperitoneum involves the process of inflating the peritoneal cavity during laparoscopic and typically uses CO2 as the insufflation gas. This review aims to identify ideal gas mixtures for establishing the pneumoperitoneum with animal and human studies undertaken up to the writing of this review. A systematic search of PubMed, OVID, and clinicaltrials.gov was performed to identify studies on the utilisation of mixed gases in laparoscopic surgery, including non-randomised/randomised trials, animal and human studies, and studies with inflating pressures between 12 and 16 mmHg. ROBINS-I and RoB2 tool was used to assess the risk of bias. A narrative synthesis of results was performed due to the heterogeneity of the studies. 5 studies from the database search and 5 studies from citation search comprising 128 animal subjects and 61 human patients were found. These studies collated results based on adhesion formation (6 studies), pain scores (2 studies) and other outcomes, with results favouring the use of carbon dioxide + 10% nitrous oxide + 4% oxygen. This has shown a significant reduction in adhesion formation, pain scores and inflammation. The use of this gas mixture provides promising results for future practice. Several of the studies available require larger sample sizes to develop a more definitive answer on the effects of different gas mixtures. Furthermore, the number of confounding factors in randomised trials should be reduced so that each component of the current suggested gas mixture can be tested for safety and efficacy.

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“…However, the exact roles of the good surgical technique, laparoscopic technique, and icodextrin on this are unclear; one reason for this uncertainty is that our study is not a randomized controlled trial. Further, a recent pilot study indicated that after 72 h, most of the instilled icodextrin was absorbed from the abdominal cavity suggesting the role of icodextrin in adhesion prevention may be minor than previously thought [24]. Although there are studies reporting less adhesion formation and fewer adhesive small bowel obstructions compared to open surgery [25][26][27], a recent review suggests that although the laparoscopic technique reduces adhesion formation, the clinical benefit has not yet been proven [28].…”

Section: Discussionmentioning

confidence: 99%

Adhesion-related readmissions after surgery for deep endometriosis with the use of icodextrin—long-term results

et al. 2016

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Icodextrin (Adept®) has been shown to prevent postoperative adhesions in experimental and laparoscopic adhesiolysis surgery. However, the role of icodextrin in the prevention of adhesions in extensive gynecological surgery is unclear. The present study evaluated the effect of icodextrin on adhesion-related readmissions after extensive gynecological surgery. The hospital readmissions of 140 endometriosis patients operated on at Päijät-Häme Central Hospital in 2004-2008 with the use of icodextrin were retrospectively reviewed. The evaluation of readmissions focused on adhesion-related disorders and reoperations. If an abdominal or pelvic reoperation was performed, the extent of the adhesions was classified. The mean follow-up time was 6.53 years (range 0.21-9.83). After initial surgery, one patient (0.7 %) had adhesive small bowel obstruction. Another directly adhesion-related readmission occurred in two patients (1.4 %). The number of readmissions possibly related to adhesions was 3 (2.1 %). Abdominal or pelvic reoperation was performed on 54 patients (38.6 %): 4 in the open surgery group and 50 in the laparoscopic surgery group. The extent of the adhesions among the 54 reoperated patients was as follows: not mentioned in 16 patients, no adhesions in 14, mild in 18, moderate in 5, and severe in 1. There were two (3.7 %) bowel injuries (one enterotomy and one serosal lesion) in reoperations. The incidence of adhesion-related readmissions after the use of icodextrin is relatively low. This favorable result may be partly related to the laparoscopic technique. Despite the use of an anti-adhesion agent, in some patients, the extent of postoperative adhesions is severe.

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Clearance Rates of Ringer's Lactate and Adept and the Effect of Full Conditioning: A Randomized Controlled Trial

Cited by 3 publications

References 22 publications

Role of the peritoneal cavity in the prevention of postoperative adhesions, pain, and fatigue

Role of the peritoneal cavity in the prevention of postoperative adhesions, pain, and fatigue

Use of mixed gas pneumoperitoneum during minimally invasive surgery: a systematic review of human and mouse modelled laparoscopic interventions

Adhesion-related readmissions after surgery for deep endometriosis with the use of icodextrin—long-term results

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