Metabolic Syndrome is a Risk Factor for Post-Operative Adhesions: Need for Novel Treatment Strategies

Pilpel, Yair; Pines, Guy; Birkenfeld, Andreas L.; Bornstein, Stefan R.; Miller, Rafael

doi:10.1055/a-0798-3931

Cited by 11 publications

(6 citation statements)

References 54 publications

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“…Metabolic syndrome (METs) is characterized by a cluster of risk components, including abdominal obesity, hyperglycemia, dyslipidemia and hypertension [ 9 ]. In general, METs affect post-operative care in nearly all other surgery, which was closely associated with the incidence of wound infections and surgical adhesions [ 10 , 11 ] 30497091/26109210. For cardiovascular system, METs seems to be an independent predisposing factor for mortality after coronary artery bypass grafting surgery [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Metabolic syndrome and its components are associated with hypoxemia after surgery for acute type A aortic dissection: an observational study

Zhang

Zhao

et al. 2022

J Cardiothorac Surg

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Background The aim of this study was to explore whether or to what extent metabolic syndrome (METs) and its components were associated with hypoxemia in acute type A aortic dissection (ATAAD) patients after surgery. Methods This study involved 271 inpatients who underwent surgery. Demographic and clinical data were collected. Subgroup analysis, mixed model regression analysis, and receiver operating characteristic (ROC) curve analysis were performed, and a scoring system was evaluated. Results The 271 inpatients were assigned to the hypoxemia group (n = 48) or no hypoxemia group (n = 223) regardless of METs status. Compared to the no hypoxemia group, the hypoxemia group had a higher incidence of METs. Hypoxemia was present in 0%, 3.7%, 19.8%, 51.5%, 90.0% and 100% in the groups of individuals who met the diagnostic criteria of MetS 0, 1, 2, 3, 4 and 5 times, respectively. In the multivariable logistic regression analysis, BMI quartile was still a risk factor for hypoxemia after adjustment for other risk factors. After adjustment for potential confounding factors, METs was an independent risk factor for hypoxemia in several models. After assigning a score for each METs component present, the AUCs were 0.852 (95% CI 0.789–0.914) in all patients, 0.728 (95% CI 0.573–0.882) in patients with METs and 0.744 (95% CI 0.636–0.853) in patients without METs according to receiver operating characteristic analysis. Conclusions METs, especially body mass index, confers a greater risk of hypoxemia in ATAAD after surgery.

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Section: Introductionmentioning

confidence: 99%

Metabolic syndrome and its components are associated with hypoxemia after surgery for acute type A aortic dissection: an observational study

Zhang

Zhao

et al. 2022

J Cardiothorac Surg

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“…Surgery on pelvic organs such as the uterus, adnexa, and the colon or rectum is more likely to generate adhesions [ 13 ]. PAAs are also more likely in obese, diabetic, hypertensive patients and patients with lipid metabolism disorders [ 14 ]. During the repair of the peritoneum by its mesothelial cells, the activation of vasoactive substances comes into play, as do cytokines that promote the processes of inflammation and coagulation, the activation of fibrinogenesis, the limitation of fibrinolysis, and the anti-inflammatory process in a hypoxic environment where adhesion fibroblasts are activated, causing excessive deposition of fibrin and mature collagen as well as supporting connective tissue [ [6] , [7] , [8] ].…”

Section: Discussionmentioning

confidence: 99%

Different doses of enoxaparin in the prevention of postoperative abdominal adhesions. Experimental study

Gómez

Tena-Betancourt

Trejo

2022

Annals of Medicine &Amp; Surgery

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Background Postoperative abdominal adhesions (PAAs) are present in more than 90% of patients undergoing abdominal surgery. They are a cause of chronic pain, hospitalizations, multiple surgeries, and infertility in women of reproductive age. The participation of three processes have been recognized: coagulation, fibrinolysis, and inflammation. The usefulness of subcutaneous enoxaparin in their prevention has been established. The objective is to establish the safest and most efficient dose for PAA prevention by testing five different doses of subcutaneous enoxaparin (0.25, 0.5, 1, 1.5, and 2 mg/kg/day) given in one dose/day for seven days. Material and methods Fifty Sprague-Dawley rats were studied, 10 in each group. Adhesions were induced through controlled rubbing of the cecum and suturing of an incision in the terminal ileum. Two independent observers recorded the degree of adhesion formation at 14 days and histologically studied the adhesions. Statistical analysis ANOVA compared group averages. The nonparametric Kruskal-Wallis test was used to identify group differences. Results The 0.5 mg/kg/day group had greater formation of adhesions (p < 0.001). There was no significant difference between the 1.5 and 2 mg/kg/day groups, though the latter group had an incidence of 27.2% of bleeding in the abdominal cavity. The degree of adhesions in the histological sections coincided with the macroscopic findings. The interobserver agreement was kappa = 0.88 (very good). Conclusion The safe and effective dose of subcutaneous enoxaparin to prevent PAA formation was 0.5–1.5 mg/kg/day for seven days.

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“…In a prospective study of 210 patients undergoing a laparotomy who had previously undergone abdominal surgery, 93% reportedly had intra-abdominal adhesions (Menzies and Ellis, 1990). Metabolic disorders associated with aging are thought to increase the likelihood of postoperative adhesion development (Pilpel et al, 2019), so the rate and cumulative societal burden of adhesions will probably increase as the world population gets older. Unlike temporary postoperative complications such as infection and bleeding, adhesions can increase long-term risk of serious health conditions.…”

Section: Discussionmentioning

confidence: 99%

PuraStat RADA16 Self-Assembling Peptide Reduces Postoperative Abdominal Adhesion Formation in a Rabbit Cecal Sidewall Injury Model

Gil

Aleksi

Spirio

2021

Front. Bioeng. Biotechnol.

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Objective: To evaluate the effect of PuraStat (2.5% RADA16) administration on postoperative abdominal adhesion formation in an in vivo model.Methods: Anesthetized New Zealand white rabbits underwent cecal sidewall abrasion surgery in which the cecal serosa and juxtaposed parietal peritoneum were abraded after access through an abdominal midline incision. Eight animals were randomized to receive PuraStat administration at the interface of the injured tissues before incision closure, and five animals served as untreated controls. Treated animals received 3–12 ml PuraStat solution per lesion. Animals were sacrificed 14 days after surgery and examined for adhesion formation at the wound site.Results: At study terminus, adhesions were identified in 90% (9/10) of abraded cecum/peritoneal wound sites in untreated controls versus 25% (4/16) of PuraStat-treated sites (p = 0.004). Mean ± SD Total Adhesion Score (average of the values for extent + strength of the adhesion in both defects per animal; maximum score = 14 points) was significantly 76% lower in PuraStat-treated animals (2.0 ± 3.0 points) compared to untreated controls (8.2 ± 1.9 points) (p = 0.029). Mean adhesion coverage area of wound sites was 79% lower in PuraStat-treated animals than controls (p < 0.001), and mean adhesion durability was 72% lower in PuraStat-treated animals versus controls (p = 0.005). Remnant hydrogel was observed at the wound sites of 75% of treated animals at postoperative Day 14.Conclusion: PuraStat treatment has a positive protective effect in the cecal sidewall injury model, and significantly reduces abdominal adhesion formation at the interface of the injured cecum and overlying peritoneal sidewall defect.

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Metabolic Syndrome is a Risk Factor for Post-Operative Adhesions: Need for Novel Treatment Strategies

Cited by 11 publications

References 54 publications

Metabolic syndrome and its components are associated with hypoxemia after surgery for acute type A aortic dissection: an observational study

Metabolic syndrome and its components are associated with hypoxemia after surgery for acute type A aortic dissection: an observational study

Different doses of enoxaparin in the prevention of postoperative abdominal adhesions. Experimental study

PuraStat RADA16 Self-Assembling Peptide Reduces Postoperative Abdominal Adhesion Formation in a Rabbit Cecal Sidewall Injury Model

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