Adherencias abdominales postquirúrgicas en equinos: patofisiología, prevención y tratamiento

Abstract

SUMMARYDespite the great number of human and veterinary medicine research, abdominal adhesions are still a big concern and a frequent complication for surgeons. The development of abdominal adhesions is a complex and dynamic process that involves a series of different mechanisms that start with an inflammatory process and tissue damage, followed by a fibrinogenic and fibrinolytic unbalance and ends with a change from fibrin deposit to fibrous tissue. In horses, after small intestine surgeries, adhesion incidence ranges from 14 to 22%. It is the most frequent cause of recurrent abdominal pain and the second cause for repeat celiotomy. Nevertheless, when all equine abdominal surgeries are included, the incidence of postoperative adhesions approximates 5%. A better understanding of the cellular mechanisms of adhesion formation and reformation should help to develop better prevention methods. Currently, a variety of prevention measures and treatments, most of them aiming to reduce or avoid adhesions formation, are used in veterinary medicine. The aim of this review is to gather most of the available information and the latest research explaining the pathophysiology, prevention and treatment of abdominal adhesions in horses.Palabras clave: equinos, adherencias abdominales, postquirúrgicas.Key words: equine, abdominal adhesions, post-surgical. INTRODUCCIÓNLas enfermedades gastrointestinales continúan siendo una de las mayores preocupaciones en la industria de los equinos y una gran proporción de caballos son derivados a centros quirúrgicos debido a desórdenes abdominales (Smith y col 2005). Estas patologías incluyen desórdenes de la motilidad y obstructivos, siendo comunes tanto en medicina humana como en medicina veterinaria. Estas alteraciones tienden a ser clínicamente importantes en ambas disciplinas, con un extensivo impacto en la práctica veterinaria así como también en la salud pública humana (Hudson y Dunlop 2005). Se ha descrito que la formación de adherencias es la causa más común de episodios repetidos de cólico luego de cirugías de intestino delgado en caballos y es la segunda causa más común de celiotomías repetidas en equinos después de cirugías de cólico por otras causas (Baxter y col 1989, Parker y col 1989, Baxter 1991, Mair y Edwards 2003). Estos estudios contrastan con Gorvy y col (2008), quienes no encontraron evidencia que sugiriera a partir del hecho de que las lesiones de intestino delgado o grueso en una primera cirugía lleven a la formación de adherencias. Adicionalmente, se detalla que posterior a cirugías de intestino grueso el 36% de las adherencias produjeron obstrucción de intestino delgado. Varios estudios realizados en los últimos diez años describen que las adherencias postquirúrgicas se presentan entre un 6% y un 27% en equinos con obstrucción de intestino delgado o como un hallazgo de una segunda cirugía de abdomen (Freeman y col 2000, Mair y Smith 2005, Gorvy y col 2008).En este sentido, estudios realizados previamente indican un 14% de adherencias postquirúrgicas (Phillips y Walmsl...

Cloreto de sódio a 0,9%, adicionado ou não de dexametasona, intrapleural, na prevenção de aderências pulmonares após toracotomia intercostal em cães

“…Nos animais da presente pesquisa, em que se infundiu no espaço pleural, apenas na solução de NaCl 0,9% (grupo C) não foi encontrada nenhuma aderência, resultado que se credita à ação mecânica pela interposição de líquido entre a parede costal e a pleura visceral e ao efeito diluente das substâncias pró-infl amatórias na superfície pleural da ferida cirúrgica. Essa afi rmação apoia-se em WERNER et al (2009), os quais citam que aparentemente o lavado pós-cirúrgico cria um efeito de hidrofl otação, que no abdome separa a superfície da serosa intestinal e remove fi brina peritoneal e mediadores infl amatórios.…”

Prevention of postoperative abdominal adhesions using systemic enoxaparin and local diclofenac. An experimental study

“…The surgical injury of the peritoneum may be incisional, by cauterization or caused by the presence of foreign matter such as sutures and the abrasion of the mesothelial cells, activating the process of inflammation and the release of vasoactive substances and kinins that increase the vascular permeability and the formation of a rich‐fibrin exudate, called extracellular matrix …”

“…1,2 The surgical injury of the peritoneum may be incisional, by cauterization or caused by the presence of foreign matter such as sutures and the abrasion of the mesothelial cells, activating the process of inflammation and the release of vasoactive substances and kinins that increase the vascular permeability and the formation of a rich-fibrin exudate, called extracellular matrix. [3][4][5][6] Fibrin is the result of the coagulation cascade leading to the progressive formation of dense deposits, amid the proliferation of adhesion fibroblasts, which through the activators of collagen and the inhibition of fibrin and collagen lysis favours the formation of adhesions.…”