Electrocautery causes more ischemic peritoneal tissue damage than ultrasonic dissection

Broek, Richard P. G. ten; Wilbers, Joyce; Goor, Harry van

doi:10.1007/s00464-010-1474-3

Cited by 24 publications

(12 citation statements)

References 38 publications

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“…In support of this hypothesis, it was recently found that acute inflammation in the mouse peritoneal cavity was associated with increased incidence and severity of adhesion development [Corona et al 2011]. Additionally, minimizing inflammation, which results from surgery, was also found to significantly reduce adhesion development [Pismensky et al 2011;ten Broek et al 2011].…”

Section: Discussionmentioning

confidence: 60%

“…Pelvic adhesions may form in response to intraperitoneal inflammatory processes, as a result of tissue handling, introduction of foreign bodies, tissue dryness, and size of the midline incision [Corona et al 2011;Pismensky et al 2011;ten Broek et al 2011]. Trauma to the peritoneal surface is known to decrease tissue plasminogen activator Figure 1.…”

Section: Discussionmentioning

confidence: 99%

“…Injury of the peritoneum leads to an inflammatory response consisting of hyperemia, fluid exudation, recruitment of floating mesothelial cells, and release of white blood cells and platelets into the cavity peritoneal [Corona et al 2011;diZerega 1997;Pismensky et al 2011;ten Broek et al 2011]. Injury to the mesothelial cell layer exposes the underlying connective tissue to the peritoneal fluid.…”

Section: Introductionmentioning

confidence: 99%

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Effects of hypoxia on the expression of inflammatory markers IL-6 and TNF-a in human normal peritoneal and adhesion fibroblasts

Ambler¹,

Fletcher

Diamond³

et al. 2012

Systems Biology in Reproductive Medicine

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Inflammation is known to be involved in the postoperative adhesion development. Interleukin (IL)-6 and tumor necrosis factor (TNF)-α are cytokines that stimulate the acute-phase reaction, which leads to a systemic reaction including inflammation, fever, and activation of the complement and clotting cascades. The goal of this study was to examine the expression of these inflammatory markers, under normal and hypoxic conditions, in normal and adhesion fibroblasts. Primary cultures of fibroblasts were established from normal peritoneum and adhesion tissues from the same patient(s) and cultured under 20% O 2 or hypoxic 2% O 2 conditions for 24 hours. Cells were harvested and total RNA was isolated. Complimentary DNA was generated by reverse transcription and subjected to realtime RT-PCR using specific primers for IL-6 and TNF-α. Both normal peritoneal and adhesion fibroblasts expressed IL-6 and TNF-α. Adhesion fibroblasts exhibited significantly higher levels of IL-6 and TNF-α mRNA as compared to normal peritoneal fibroblasts ( p < 0.05). Both IL-6 and TNF-α mRNA levels were upregulated in response to hypoxia in both normal peritoneal and adhesion fibroblasts. The increase in IL-6 and TNF-α mRNA levels of normal fibroblasts reached the levels observed in adhesion fibroblasts. Our results suggest that hypoxia promotes the development of the adhesion phenotype by the induction of inflammatory markers, which may contribute to the development of postoperative adhesions. The inhibition of inflammation may be a potential therapeutic approach in the prevention and/or reduction of postoperative adhesion development.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of hypoxia on the expression of inflammatory markers IL-6 and TNF-a in human normal peritoneal and adhesion fibroblasts

Ambler¹,

Fletcher

Diamond³

et al. 2012

Systems Biology in Reproductive Medicine

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“…This is mainly due to fear of loss of vision and risk of conversion to open technique. Tissue charring, damage to fine nerves, increased inflammatory responses, transmitted energy damage can result in local seroma formation, increased Postoperative pain, possible chronic groin pain and rarely transmitted energy damage to intra and extraperitoneal structures [3,4]. Excessive electrocautery usage produces a lot of smoke which also hampers vision.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic TEP Inguinal Hernia Repair - Are We Overdoing It? A Comprehensive Study of 25 Cases of TEP Inguinal Hernia Repair Done Without the Use of Electrocautery and Without Any Mesh Fixation

Kiran¹

2018

Clin Med Rev Case Rep

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Objectives: As one of the most effective and accepted minimally invasive techniques for inguinal hernia repair Laparoscopic Totally Extraperitoneal (TEP) repair is met with a learning curve and caution towards injury of major vessels/ nerves and mesh migration. Less experienced surgeon may tend to use excessive cautery and overzealous mesh fixation. Such practices in surgery can be avoided without any changes in immediate or late outcomes of the procedure. Methods: Our case series of 25 patients who underwent the laparoscopic TEP inguinal hernia repair without use of cautery and without mesh fixation done over 2 years suggest the effcacy and outcomes of such practices allowing smooth and uneventful postoperative recovery and encouraging day care surgery. Results: Assessment of patients for the outcomes of the said practice in laparoscopic TEP surgery included pain score assessment along with identification of early and late complications like Postoperative pain, seroma, infection, groin pain, and recurrence. Apart from a few patients having Postoperative pain responding to NSAIDs (non-steroidal anti-inflammatory drugs), none of the other complications were seen in the patient group. Conclusion: Laparoscopic TEP for inguinal hernia repair does not need excessive cautery for plane dissection and also does not need mesh fixation necessarily. These practices have negligible outcome on hernia recurrence and enable smooth Postoperative recovery.

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“…1 Sutures and ligation are unavoidable in almost all abdominal and pelvic surgeries; such operations will induce local tissue ischemia, which can cause inflammatory responses of the peritoneum, thus leading to the formation of adhesions. 3 The formed adhesions can attach to various structures in the peritoneum, such as the omentum, small intestine, large intestine, and even the liver, which creates an extremely hazardous situation for the patient. 4 Thus, there is an urgent need to prevent or reduce ischemia-induced postoperative peritoneal adhesion formation.…”

Section: Introductionmentioning

confidence: 99%

Biodegradable and thermosensitive micelles inhibit ischemia-induced postoperative peritoneal adhesion

Wu¹,

Li²,

Wang³

et al. 2014

IJN

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Ischemia-induced adhesion is very common after surgery, and leads to severe abdominal adhesions. Unfortunately, many existing barrier agents used for adhesion prevention have only limited success. The objective of this study is to evaluate the efficacy of biodegradable and thermosensitive poly(ε-caprolactone)–poly(ethylene glycol)–poly(ε-caprolactone) (PCL–PEG–PCL) micelles for the prevention of postoperative ischemia-induced adhesion. We found that the synthesized PCL–PEG–PCL copolymer could self-assemble in an aqueous solution to form micelles with a mean size of 40.1±2.7 nm at 10°C, and the self-assembled micelles could instantly turn into a nonflowing gel at body temperature. In vitro cytotoxicity tests suggested that the copolymer showed little toxicity on NIH-3T3 cells even at amounts up to 1,000 μg/mL. In the in vivo test, the postsurgical ischemic-induced peritoneal adhesion model was established and then treated with the biodegradable and thermosensitive micelles. In the control group (n=12), all animals developed adhesions (mean score, 3.58±0.51), whereas three rats in the micelles-treated group (n=12) did not develop any adhesions (mean score, 0.67±0.78; P <0.001, Mann–Whitney U -test). Both hematoxylin and eosin and Masson trichrome staining of the ischemic tissues indicated that the micelles demonstrated excellent therapeutic effects on ischemia-induced adhesion. On Day 7 after micelle treatment, a layer of neo-mesothelial cells emerged on the injured tissues, which confirmed the antiadhesion effect of the micelles. The thermosensitive micelles had no significant side effects in the in vivo experiments. These results suggested that biodegradable and thermosensitive PCL–PEG–PCL micelles could serve as a potential barrier agent to reduce the severity of and even prevent the formation of ischemia-induced adhesions.

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Electrocautery causes more ischemic peritoneal tissue damage than ultrasonic dissection

Cited by 24 publications

References 38 publications

Effects of hypoxia on the expression of inflammatory markers IL-6 and TNF-a in human normal peritoneal and adhesion fibroblasts

Effects of hypoxia on the expression of inflammatory markers IL-6 and TNF-a in human normal peritoneal and adhesion fibroblasts

Laparoscopic TEP Inguinal Hernia Repair - Are We Overdoing It? A Comprehensive Study of 25 Cases of TEP Inguinal Hernia Repair Done Without the Use of Electrocautery and Without Any Mesh Fixation

Biodegradable and thermosensitive micelles inhibit ischemia-induced postoperative peritoneal adhesion

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