Intra-abdominal Adhesions

Brüggmann, Dörthe; Tchartchian, Garri; Wallwiener, Markus; Münstedt, Karsten; Tinneberg, Hans‐Rudolf; Hackethal, Andreas

doi:10.3238/arztebl.2010.0769

Cited by 111 publications

(98 citation statements)

References 55 publications

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“…Our knowledge on the subject of adhesions forming after mesh implantation cannot, for obvious reasons, be based on direct assessment in patients. Indirect information obtained on the basis of analysis of viscera migrations and post-operative adhesions to the abdominal wall using ultrasonography (USG) or MRI examinations are imprecise and unsuitable for interpretation [1, 24]. As a result, the literature does not contain an official definition of adhesions or an objective system of classification of their extent and severity.…”

Section: Discussionmentioning

confidence: 99%

“…Variations in laboratory animal species, size, in the structure and type of materials used to synthesize prostheses, surgical techniques and criteria of evaluation can all influence the experimental consequences including inflammatory reactions, calcification, infection risk and finally adhesion formation [1, 13, 18, 23, 27]. …”

Section: Discussionmentioning

confidence: 99%

“…They attach normally separated organs to each other and cause small bowel obstruction, chronic pelvic pain, dyspareunia, infertility, and higher complication rates in subsequent operations [1]. …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Assessment of adhesion formation after laparoscopic intraperitoneal implantation of Dynamesh IPOM mesh

Jamry¹,

Jałyński²,

Piskorz³

et al. 2013

aoms

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IntroductionFormation of adhesions after laparoscopic hernia repair using the intra-peritoneal onlay mesh (IPOM) procedure can lead to intestinal obstruction or mesh erosion into intestinal lumen. The aims of this study included: measurement of adhesion formation with Dynamesh IPOM after laparoscopic intraperitoneal implantation, and assessment of the occurrence of isolated adhesions at the fastening sites of slowly absorbable sutures.Material and methodsTwelve healthy pigs underwent laparoscopic implantation of 2 Dynamesh IPOM mesh fragments each, one was fastened with PDSII, and the other with Maxon sutures. An assessment of adhesion formation was carried out after 6 weeks and included an evaluation of surface area, hardness according to the Zhulke scale, and index values. The occurrence of isolated adhesions at slowly absorbable suture fixation points was also analyzed.ResultsAdhesions were noted in 83.3% of Dynamesh IPOM meshes. Adhesions covered on average 37.7% of the mesh surface with mean hardness 1.46 and index value 78.8. In groups fixed with PDS in comparison to Maxon sutures adhesions covered mean 31.6% vs. 42.5% (p = 0.62) of the mesh surface, mean hardness was 1.67 vs.1.25 (p = 0.34) and index 85.42 vs. 72.02 (p = 0.95).ConclusionsThe Dynamesh IPOM mesh, in spite of its anti-adhesive layer of PVDF, does not prevent the formation of adhesions. Adhesion hardness, surface area, and index values of the Dynamesh IPOM mesh are close to the mean values of these parameters for other commercially available 2-layer meshes. Slowly absorbable sutures used for fastening did not increase the risk of adhesion formation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Assessment of adhesion formation after laparoscopic intraperitoneal implantation of Dynamesh IPOM mesh

Jamry¹,

Jałyński²,

Piskorz³

et al. 2013

aoms

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“…Clinically, the prevalence of postoperative, intra-abdominal adhesions is higher than 50% and could lead to complications in future interventions as well as to intestinal obstructions [38]. According to Brüggmann et al [39], the complexity of the surgical procedure, prolonged surgery time, management and production of iatrogenic injuries, peritoneal irritation, previous systemic diseases (such as diabetes), poor nutritional status, intra-abdominal placement of foreign bodies such as implants, sutures, meshes, or adhesives, an excessive use of electrocoagulation in tissue necrosis, bacterial infection, tissue dehydration during surgery, etc., are all factors predisposing to postoperative adhesions.…”

Section: Discussionmentioning

confidence: 99%

Behaviour of the Biological Adhesives TachoSil®, GelitaSpon®, and a New Elastic Cyanoacrylate (Adhflex®) in Experimental Renal Trauma and Wound Healing

Lloris‐Carsí

García-Cerdá²,

Prieto‐Moure³

et al. 2016

Eur Surg Res

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Background: Renal injuries are relatively frequent in abdominal trauma. In some cases, adhesives and sealants can be used to repair and preserve injured organs. This paper describes the behaviour of three biomaterials - TachoSil®, GelitaSpon®, and a new elastic cyanoacrylate (CyA), Adhflex® - in standardized experimental renal injuries. Methods: Ninety male Wistar rats (300-350 g) were used. A Stiefel Biopsy Punch (8 mm diameter, 3 mm depth) was used to create injuries to the anterior kidney to evaluate wound healing. The animals were divided into five groups: (1) sham (n = 3); (2) control (n = 6), untreated, standard punch injury created on the anterior left kidney; (3) TachoSil® (n = 27), punch injury treated with TachoSil®; (4) GelitaSpon® (n = 27), punch injury treated with GelitaSpon®, and (5) Adhflex® (n = 27), punch injury treated with the new elastic CyA adhesive. The parameters studied were bleeding time, peritoneal adhesions, and histopathological evaluation of wound healing on days 2, 6, and 18, including measurements of the gap between wound edges, inflammatory reaction (CD68), and vascular neoformation (CD31). Results: The bleeding time was significantly shorter (27.7 ± 12.9 s) in the Adhflex® group than in the control (135.8 ± 11.6 s; p < 0.01), TachoSil® (77.5 ± 7.4 s; p < 0.05), and GelitaSpon® (82.5 ± 14.4 s; p < 0.05) groups. The incidence of intraperitoneal adhesions in the animals treated with Adhflex® was 3.6 times higher than in the non-treated group. It was also higher (p < 0.04) than in the groups treated with TachoSil® and GelitaSpon®. The time point with the largest gap between the wound edges and most abundant granulation tissue was at day 6. The largest gap after 18 days was reported for the Adhflex® adhesive. With regard to the markers CD31 and CD68, Adhflex® showed the largest areas 2 days after surgery, but no differences were found after 6 and 18 days versus the other treatments. The expression of the immunomarkers on the renal samples treated with Adhflex® was consistent with a normal healing process. Conclusions: In this experimental model of renal injuries, the new elastic CyA (Adhflex®) resulted in the shortest bleeding time. It offers rapid sealing of the bleeding produced by renal injuries, fixation to adjacent tissues, and reduced occurrences of relapse. The evolution of the scarring is similar to other procedures. Given that traumatic renal injuries are always an emergency due to haemorrhage, Adhflex® might offer additional benefits over conventional treatment methods in human clinical practice.

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“…It is also a cause of morbidity and problems during a second laparotomy [27]. Some hemostatic agents such as cyanoacrylate [28] and albumin-glutaraldehyde adhesives [29] have been reported to cause foreign body reaction and inflammation and promote adhesion formation.…”

Section: Discussionmentioning

confidence: 99%

Hemostatic Efficacy and Safety of the Novel Medical Adhesive, MAR VIVO-107, in a Rabbit Liver Resection Model

et al. 2018

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Background: Topical hemostatic agents are useful when hepatic hemorrhage is difficult to control. The aim of this study was to evaluate the hemostatic efficacy and safety of a biodegradable polyurethane-based adhesive, MAR VIVO-107 (MAR), in comparison with a clinically used fibrin glue. Methods: Thirty female New Zealand white rabbits were randomly assigned to 3 study groups as follows: MAR (n = 10), fibrin glue (n = 10), and saline groups (n = 10). After standardized partial liver resection was performed, each agent was immediately applied to the wound area. Bleeding time until hemostasis and blood loss were recorded. After 7 days, body weight, hematology parameters, and serum levels of aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase were measured. Simultaneously, the severity of intra-abdominal adhesion was evaluated. Results: The mean bleeding time in the MAR (38 ± 10 s) and fibrin glue groups (65 ± 17 s) was significantly shorter than that in the saline group (186 ± 12 s). Similarly, the mean blood loss in the MAR (9 ± 3 g) and fibrin glue groups (9 ± 3 g) was significantly less than that in the saline group (23 ± 4 g). No significant differences in bleeding time and blood loss were found between the MAR and fibrin glue groups. The postoperative survival rate was 100% in all the groups. Body weight as well as hematological and serum biochemical values on day 7 were within the small and physiological range when compared with the preoperative baseline values, and significant differences were not detected among the MAR, fibrin glue, and saline groups. The severities of adhesion were similar between the 3 groups. Conclusion: Our data demonstrated that MAR was not inferior to fibrin glue in terms of hemostatic efficacy and safety.

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Intra-abdominal Adhesions

Cited by 111 publications

References 55 publications

Assessment of adhesion formation after laparoscopic intraperitoneal implantation of Dynamesh IPOM mesh

Assessment of adhesion formation after laparoscopic intraperitoneal implantation of Dynamesh IPOM mesh

Behaviour of the Biological Adhesives TachoSil®, GelitaSpon®, and a New Elastic Cyanoacrylate (Adhflex®) in Experimental Renal Trauma and Wound Healing

Hemostatic Efficacy and Safety of the Novel Medical Adhesive, MAR VIVO-107, in a Rabbit Liver Resection Model

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