Pathophysiologie und Klassifikation von Adhäsionen

Zühlke, H; Lorenz, E. M. P.; Straub, E.-M.; Savvas, V.

doi:10.1007/978-3-642-48163-5_212

Cited by 75 publications

(69 citation statements)

References 6 publications

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“…Adhesions were caused by ischemic injury as a result of suturing the lateral peritoneal wall and were scored only quantitatively, and not qualitatively. The adhesions found after this kind of severe trauma were mostly dense and thick (Zühlke type 2-3) [14]. An adhesion formation of 22% occurred in control rats.…”

Section: Discussionmentioning

confidence: 85%

Perioperative Lavage Promotes Intraperitoneal Adhesion in the Rat

et al. 1999

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This study was designed to study the effect of peritoneal lavage solutions on postsurgical adhesion formation in rats undergoing laparotomy and standardized ischemic injury to the lateral peritoneum with sutures. This reproducible model enabled semiquantitative scoring of adhesion formation. Adhesions were induced in 33 adult female Wistar rats. The solutions RPMI medium, NaCl (0.9%), Viaspan^® and both povidone-iodine (1%) and chlorhexidine (0.02%) in dilution were evaluated. In the control group that was operated upon (without peritoneal lavage), a mean adhesion percentage of 22.5% was scored. All solutions used for abdominal lavage in this rat model induced significantly (p = 0.0001) more adhesions (40.6–70.8%). Not all solutions induced an equal effect. The results found in the present in vivo study correlate with observations in previous in vitro experiments i.e. exposure of peritoneal areas to lavage solutions enhances peritoneal activation and thus promotes intra-abdominal adhesion formation.

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Section: Discussionmentioning

confidence: 85%

Perioperative Lavage Promotes Intraperitoneal Adhesion in the Rat

et al. 1999

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“…In addition, adhesions were scored using the macroscopic classification according to Zühlke (Table 1). 27 One to three samples of adhesions were taken. These samples were fixed in 4% formaldehyde, put in paraffin, sectioned (six micron), and stained with hematoxylin and eosin (H&E) and periodic acid Schiff's reagens.…”

Section: Methodsmentioning

confidence: 99%

Foreign Material in Postoperative Adhesions

Luijendijk¹,

Lange²,

et al. 1996

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Objective: The authors determined the prevalence of foreign body granulomas in intra-abdominal adhesions in patients with a history of abdominal surgery.Patients and Methods: In a cross-sectional, multicenter, multinational study, adult patients with a history of one or more previous abdominal operations and scheduled for laparotomy between 1991 and 1993 were examined during surgery.Patients in whom adhesions were present were selected for study. Quantity, distribution, and quality of adhesions were scored, and adhesion samples were taken for histologic examination.Results: In 448 studied patients, the adhesions were most frequently attached to the omentum (68%) and the small bowel (67%). The amount of adhesions was significantly smaller in patients with a history of only one minor operation or one major operation, compared with those with multiple laparotomies (p < 0.001).Significantly more adhesions were found in patients with a history of adhesions at previous laparotomy (p < 0.001), with presence of abdominal abscess, hematoma, and intestinal leakage as complications after former surgery (p = 0.01, p = 0.002, and p < 0.001, respectively), and with a history of an unoperated inflammatory process (p = 0.04).Granulomas were found in 26% of all patients. Suture granulomas were found in 25% of the patients. Starch granulomas were present in 5% of the operated patients whose surgeons wore starch-containing gloves. When suture granulomas were present, the median interval between the present and the most recent previous laparotomy was 13 months. When suture granulomas were absent, this interval was significantly longer-i.e., 30 months (p = 0.002). The percentage of patients with suture granulomas decreased gradually from 37% if the previous laparotomy had occurred up to 6 months before the present operation, to 18% if the previous laparotomy had occurred more than 2 years ago (p < 0.001).Conclusions: The number of adhesions found at laparotomy was significantly larger in patients with a history of multiple laparotomies, unoperated intraabdominal inflammatory disease, and previous postoperative intra-abdominal complications, and when adhesions were already present at previous laparotomy. In recent adhesions, suture granulomas occurred in a large percentage. This suggests that the intra-abdominal presence of foreign material is an important cause of adhesion formation. Therefore intra-abdominal contamination with foreign material should be minimized.

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“…The extent was quantified by estimation of the involvement of the eight areas of 12.5% on the traumatized peritoneum, as previously described [15]. The quality of adhesions was scored using the Zühlke classification [16]; type 1 adhesion: filmy adhesion, easy to separate by blunt dissection; type 2: stronger adhesion; blunt dissection possible, partly sharp dissection necessary, beginning of vascularization; type 3: strong adhesion, lysis possible by sharp dissection only, clear vascularization; type 4: very strong adhesion, lysis possible by sharp dissection only, organs strongly attached with severe adhesions, damage of organs hardly preventable.…”

Section: Experiments 1: Effect Of Ha On Intra-abdominal Adhesion Formamentioning

confidence: 99%

Hyaluronan-Based Antiadhesive Membrane Has No Major Effect on Intraperitoneal Growth of Colonic Tumour Cells

Sikkink¹,

Postma²,

Reijnen³

et al. 2004

Eur Surg Res

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Background: A relationship between post-surgical adhesion formation and peritoneal tumour implantation has been proposed. Hyaluronan (HA)-based agents reduce adhesion formation, but the effect on peritoneal tumour is not established. This study investigated the influence of a HA-containing agent on intraperitoneal tumour in an experimental model. Methods: 66 Balb/c mice underwent laparotomy and damage was inflicted to the parietal peritoneum. The animals were randomized into five groups. Groups 1 and 2 received HA-carboxymethylcellulose bioresorbable membrane and no treatment, respectively. Mice in groups 3–5 were injected intraperitoneally with 10⁵ colon 26-B cells after the laparotomy. Treatment consisted of HA membrane, no HA agent and placement of HA membrane on the non-traumatized peritoneal wall, respectively. Animals were killed after 14 days; adhesions were scored in groups 1 and 2, and the tumour mass in groups 3–5. 45 Wag/Rij rats underwent the same procedures and treatment as mice in groups 3–5. In rats, 10⁶ CC-531 cells were injected. Rats were killed after 3 weeks and the tumour mass was scored. Results: HA membrane resulted in a significant reduction of adhesions, but had no major effect on the intraperitoneal tumour mass in mice and rats. Conclusion: HA-carboxymethylcellulose bioresorbable membrane has no major effect on intraperitoneal tumour implantation and growth in an experimental model.

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Pathophysiologie und Klassifikation von Adhäsionen

Cited by 75 publications

References 6 publications

Perioperative Lavage Promotes Intraperitoneal Adhesion in the Rat

Perioperative Lavage Promotes Intraperitoneal Adhesion in the Rat

Foreign Material in Postoperative Adhesions

Hyaluronan-Based Antiadhesive Membrane Has No Major Effect on Intraperitoneal Growth of Colonic Tumour Cells

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