The Morphopathogenetic Aspects of Intraabdominal Adhesions in Children under One Year of Age

Junga, Anna; Pilmane, Māra; Ābola, Zane; Volrāts, Olafs

doi:10.3390/medicina55090556

Cited by 5 publications

(4 citation statements)

References 55 publications

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“…Recently, 4DryField® has been evaluated to limit adhesion formation. 16 Pediatric patients are often affected by adhesion formation but data for 4DryField® have been lacking. In this retrospective cohort study, 4DryField® does not appear to significantly reduce adhesion formation in pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

“…8,11,14 The genesis of peritoneal adhesions is multifaceted and involves a complex interplay between inflammation, fibrinolysis, angiogenesis, and tissue repair processes, mediated by interactions between growth factors, interleukins, and metalloproteinases. 12,16 The most important factors for developing peritoneal adhesions are increased inflammation and fibrin formation with decreased fibrinolysis and a procoagulatory status. 17 Foremost among the intraoperative factors fostering the formation of adhesions is peritoneal injury.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of 4DryField® as an Adhesion Prophylaxis in Pediatric Patients: A Propensity-Score Matched Study

Klinke,

Dietze,

Trautmann

et al. 2024

Eur J Pediatr Surg

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Introduction: Abdominal adhesions following surgery can lead to complications like intestinal obstruction and pelvic pain. While no molecular therapies currently target the underlying adhesion formation process, various barrier agents exist. 4DryField® has shown promise in reducing bleeding and adhesions in adults. This study aimed to assess its effectiveness in children. Methods: The study examined all pediatric patients who underwent laparotomy between January 2018 and February 2022. It compared outcomes between those treated with 4DryField® and a control group. Key endpoints included surgical revision, adhesion recurrence, infections, insufficiencies, fever, CRP levels, and time to gastrointestinal passage. Results: In total, 233 children had surgery for bowel adhesions. After propensity score matching, 82 patients were included in the analysis: 39 in the control and 43 in the 4DryField® group. 4DryField® did not affect re-adhesion rate. Children in the treatment group had significantly more complications (47% vs. 15%, p=0.002), more often fever and higher CRP levels. Conclusions: 4DryField® did not show potential in reducing adhesion formation, but it was associated with significantly more complications in pediatric patients. Thus, future prospective studies to evaluate the safety and effectiveness of 4DryField® in children.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of 4DryField® as an Adhesion Prophylaxis in Pediatric Patients: A Propensity-Score Matched Study

Klinke,

Dietze,

Trautmann

et al. 2024

Eur J Pediatr Surg

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“…Antiadhesive applications used in other age groups cannot be used in pediatric and, particularly, neonatal patients due to pathophysiological differences in abdominal surgical interventions [ 22 ]. However, a gold standard application that can also be used for postoperative adhesion development in pediatric age groups has not been defined [ 23 ]. The search for an ideal and risk-free antiadhesive agent to be preferred in this special and sensitive patient group continues.…”

Section: Discussionmentioning

confidence: 99%

The effect of natural surfactants on the development of postoperative intraabdominal adhesion

GÜLER,

KARAKAYA,

DOĞAN

et al. 2023

Turkish Journal of Medical Sciences

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Background/aim The development of postoperative adhesion after abdominal surgery is sometimes a severe problem. Our study investigates the effectiveness of exogenous surfactant application in preventing adhesion development in the experimental adhesion model. Materials and methods This randomized-controlled interventional study was carried out in the animal laboratory of Kahramanmaraş Sütçü İmam University between March 1 and March 31, 2020. An experimental intra-abdominal adhesion model was established in 24 adult female rats by cecal abrasion. Rats were randomly divided into four groups. Groups I, II, and III were taken intraperitoneally as beractant, poractant, and calfactant applied groups, respectively. Group IV was the control group. Relaparotomy was performed in all groups on the 15th postoperative day, and intra-abdominal adhesions were scored macroscopically according to the Canbaz scoring system. In addition, the cecal regions were evaluated microscopically and scored according to the Zühlke microscopic classification system. The scores of the groups were compared statistically. Results The Zühlke adhesion development score was significantly lower in the exogenous surfactant applied groups. In addition, when the surfactant-applied groups were compared among themselves, it was seen that the adhesion score in the beractant group was significantly better than the other surfactant types (p < 0.01). Conclusion Our study results showed that prophylactic intraperitoneal surfactant application significantly reduced postoperative adhesion development, particularly beractant.

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“…Abdominal adhesions are the result of trauma at abdominal surgery and are formed in 93 % of cases. LAIO surgeries are complex interventions in pediatric surgery and are accompanied by a high recurrence rate [14,[17][18][19].…”

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confidence: 99%

Clinical cases of late postoperative adhesive intestinal obstruction after liver and kidney transplantation in children and surgical methods of their treatment

Bodnar¹,

Bocharov²,

Bodnar³

2021

COT

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Abdominal adhesions are one of the most common complications in abdominal surgery. In 56-70 % it is the cause of small bowel obstruction, which often requires repeated surgery. To date, a few cases of late adhesive intestinal obstruction (LAIO) as a complication of organ transplantation in children have been described. The purpose of the study was to investigate clinical cases of LAIO in a 9-year-old child after liver transplantation, and in an 8-year-old child after kidney transplantation. Materials and methods. Clinical case I. A 62-day-old girl was treated with Kasai procedure before a liver transplantation, according to type III atresia of the biliary tract. Orthotopic liver transplantation of the left-lateral section from living related donor was performed at the age of 9 months. The surgeries were accompanied by damage to the mesothelium and trauma of the serous membrane, which led to the formation of intraabdominal adhesions. With the growth of the child there was a growth of abdominal organs and adhesions stretching. LAIO was diagnosed 8 years after first surgery. Clinical case II. The boy was diagnosed with hypoplastic dysplasia of the right kidney, left-side ureterohydronephrosis, resulting in chronic end-stage renal disease. Peritoneal dialysis was performed at the age of 6 years. The effect of dialysate on the mesothelium led to the formation of small intestine pseudo-diverticula. At the age of 7 years a bilateral nephrectomy and kidney transplantation from a deceased donor were performed. At the age of 8 LAIO was diagnosed. In both cases, children underwent adhesiolysis. The peritoneum was sutured from the lower and upper edges of the wound to the middle, so that a hole remained in the middle of the wound. A Nelaton catheter was inserted through the hole and 250 ml of sodium hyaluronate solution "Defensal" was injected into the left-lateral part, small pelvis and right lateral abdominal cavity. Then anterior abdominal wall was sutured. Results. The successful surgical treatment of LAIO in children using local adhesiolysis in combination with sodium hyaluronate was performed. The careful handling of vascular anastomoses and changes in organ topography were required during surgery. The purpose of the surgery on LAIO was not only to restore the chyme transport in the gastrointestinal tract, but also to release the small intestine from the adhesions with the normal anatomy and function preservation. The observation of children for 5 years indicate the effectiveness of intraabdominal application of sodium hyaluronate solution.

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The Morphopathogenetic Aspects of Intraabdominal Adhesions in Children under One Year of Age

Cited by 5 publications

References 55 publications

Evaluation of 4DryField® as an Adhesion Prophylaxis in Pediatric Patients: A Propensity-Score Matched Study

Evaluation of 4DryField® as an Adhesion Prophylaxis in Pediatric Patients: A Propensity-Score Matched Study

The effect of natural surfactants on the development of postoperative intraabdominal adhesion

Clinical cases of late postoperative adhesive intestinal obstruction after liver and kidney transplantation in children and surgical methods of their treatment

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