New quantitative variables to measure postoperative pericardial adhesions: useful tools in experimental research

Abstract

PURPOSE: To improve the measurement system, during a research for the prevention of adhesions, we explored the feasibility of introducing three continuous numeric variables to quantify the intensity of pericardial adhesions. METHODS: To validate these three new numeric variables - time spent to dissect the adhesions (Δt), the amount of sharp dissection (ShpD) and the adhesion's collagen area (ACA) - as useful tools in measuring the severity of pericardial adhesions, data from a randomized study on adhesion prevention enrolling twenty-four swine, were analysed. A statistical Spearman's test and regressions models were applied to verify the correlation and the relationship between the results of a standard severity score (SS) and Δt, between SS and ShpD used in adhesiolysis and, also, between SS and ACA. RESULTS: There was a statistically significant correlation between SS and Δt, between SS and ShpD, as well as between SS and ACA, all measured by the Spearman's test (r=0.897, r=0.932, r=0.66; p<0.01, respectively). Through a non-linear regression, an exponential relation of SS with ShpD (R²=0.915) and SS with Δt (R²= 0.917) was found. CONCLUSION: The time spent to dissect the adhesions (Δt) and the amount of sharp dissection (ShpD) are new powerful measurement tools in evaluating outcomes of the methods used to prevent pericardial adhesions.

Clorhexidine as a factor that promotes peritoneal adhesions in rats with induced peritonitis

“…Typically adhesions are categorized according to a subjective system that encompasses a grading severity score 7 , and such methods are very valuable in helping surgeons to recognize critical situations and to adopt more effective measures 8 . Most published indexes are based on the number of fibrotic strands formed, the extension of the contact area between the structures and the strength required to separate them 3,9-14 .…”

Combined use of barrier methods to prevent pericardial adhesions: Is it always better?

“…A qualitative grading system was used to evaluate the tenacity of the adhesions: 0, without adhesions; 1, filmy, light, with a foamy dissection plane without bleeding; 2, required some sharp dissection, but most of them were lyzed by digital manipulation and this process resulted in moderate bleeding; 3, dense, easily bleeding, with marked obliteration of tissue planes and required exclusive sharp dissection. [19] The en bloc specimens were embedded fixed in 10% formaldehyde. Full-thickness gross sections from sternal internal periosteum to right ventricular myocardium were taken from each specimen at the site where the maximum adhesions were observed.…”

Novel Trilaminar Polymeric Antiadhesion Membrane Prevents Postoperative Pericardial Adhesion

“…The severity of adhesion formation was evaluated on the beating heart macroscopically according to the grading score excogitated by Lopes and colleagues, 18 which was significantly correlated with the amount of sharp dissection required for the dismounting of the pericardial adhesions and bleeding or not as well as dissection time (Table 1). 18 The surgeon who graded the adhesions was…”