Reduction of postoperative adhesions with an auto-crosslinked hyaluronan gel in gynaecological laparoscopic surgery: a blinded, controlled, randomized, multicentre study

Mais, Valerio; Bracco, Gian Luca; Litta, Pietro; Gargiulo, T; Melis, Gian Benedetto

doi:10.1093/humrep/dei488

Cited by 97 publications

(75 citation statements)

References 31 publications

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“…The same authors also demonstrated that the application of ACP in infertile patients undergoing a laparoscopic myomectomy was associated with an increased pregnancy rate [63]. The favorable safety profile and the efficacious antiadhesive action of the adjunct following laparoscopic myomectomy have been confirmed in a blinded, controlled, randomized, multicenter study [64]. Hyalobarrier is fairly easy to use in laparoscopic surgery and should be used at the end of surgery, as further rinsing can remove the gel.…”

Section: Gel Barriersmentioning

confidence: 89%

Belgian consensus on adhesion prevention in hysteroscopy and laparoscopy

Verguts

Bosteels

Roberta³

et al. 2015

Gynecol Surg

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Intrauterine and intraabdominal adhesions are a major cause for infertility. The most recent investigations have demonstrated the potential of intraperitoneal adhesion barriers combined with good surgical technique to reduce adhesion formation. For intrauterine adhesions we suggest to minimize unipolar and bipolar instrumentation whenever possible. We advocate the use of estrogens for 10 days after adhesiolysis: 2dd two tablets of estradiol 2 mg. Instillation of Hyalobarrier Gel Endo actually is not reimbursed but may have a beneficial effect after myomectomy or adhesiolysis. Concerning laparoscopic and laparotomic prevention of adhesion also, meticulous surgical technique is of the utmost importance. Residual blood should be avoided by careful hemostasis and rinsing with Ringer's lactate with heparin. Preferably braided sutures are not to be left in the abdominal cavity. We advise to avoid unipolar and bipolar cauterization when possible and to replace with ultrasonic or laser energy. The use of floatation barriers does not seem to add substantial benefit in the prevention of adhesions. Gel barriers (Hyalobarrier Gel Endo® or Intercoat®) are proven to have a significant effect on adhesion prevention. As for sheets, there is enough evidence that they prevent adhesions. The use of NSAID in the prevention of pain and/or corticosteroids in the prevention of postoperative nausea is already mainstay after surgery and can be further endorsed in the prevention of adhesions.

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Section: Gel Barriersmentioning

confidence: 89%

Belgian consensus on adhesion prevention in hysteroscopy and laparoscopy

Verguts

Bosteels

Roberta³

et al. 2015

Gynecol Surg

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“…11,18,19,[23][24][25][26][27][28][29] Daha önceki çalışmalarda PEO+CMS'nin bağır-saklar üzerinde irritan olmadığı ve kuvvetli adezyon önleyici etkiye sahip olduğu gösteril-miştir. 3,11,18,24,26,27 Bizim çalışmamızda da bu maddelerin kuvvetli adezyon önleyici etkisinin olduğu görüldü. Kullanılan maddeler içinde adezyon skoru en az bulunan, hidroksiprolin düzeyini en fazla düşüren, fibroblastik aktiviteyi azaltan ve periserozal irritasyon yapmayan en kuvvetli adezyon önleyici etkinin PEO+CMS'de olduğu tespit edildi.…”

Section: Discussionunclassified

Comparison of Substances Used for Prevention of Intra-Abdominal Adhesions: An Experimental Study in Rats

Günaydın¹,

Güvenç²,

Yıldız³

et al. 2012

Turkiye Klinikleri J Med Sci

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Ö ÖZ ZE ET T A Am ma aç ç: : Cerrahi sonrası karın içi yapışıklığı önlemek için şimdiye kadar birçok madde denenmiştir. Bu sorun araştırmacıların önünde bir 'bulmaca' olarak halen durmaktadır. Deneysel ameliyat sonrası yapışıklık modelinde çeşitli yapışıklık önleyici maddeleri karşılaştırmayı amaçladık. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Otuz beş dişi Sprague-Dawley sıçan beş eşit gruba ayrıldı. Laparatomi sonrası, periton ve çekum, nokta nokta kanama görülene kadar diş fırçası ile fırçalandı. Kontrol grubunda (grup 1) ek cerrahi uygulanmadı. Diğer gruplarda, karın içi yapışıklığı önlemek için kanamalı alana sırasıyla polietilenoksid+sodyum-karboksimetilselluloz (PEO+CMS) (grup 2), hyaluronan (HA) (grup 3), oktenidin dihidroklorid+%2 fenoksietanol (ODH+FE) (grup 4) ve surfaktan (SFT) (grup 5) uygulandı. Sıçanlar onuncu günde öldürüldü. Adezyon skorları, fibroblastik akivite ve periserozal inflamasyon skorları ve yüksek performanslı likit kromatografi (HPLC) yöntemiyle hidroksiprolin (HP) düzeyleri belirlendi. B Bu ul lg gu ul la ar r: : Grup 1'in (kontrol) adezyon ve fibroblastik aktivite skorları diğer gruplardan anlamlı ölçüde daha yüksek bulundu (ODH+FE grubu dışında). En düşük adezyon skoru ve hidroksiprolin düzeyi PEO+CMS grubundaydı (p<0,05). En düşük fibroblastik aktivite ve periserozal inflamasyon SFT grubundaydı ve grup 1'den (kontrol) anlamlı derecede farklıydı. ODH grubunda, periserozal inflamasyon diğer gruplardan anlamlı derecede yüksekti (p<0,05). PEO+CMS grubunun adezyon skoru diğer gruplardan anlamlı derecede düşüktü. S So on nu uç ç: : Bu maddelerin hepsinin bir dereceye kadar yapışıklık önleyici etkileri vardır. ODH+FE bağırsak serozasına irritasyon ve zayıf yapışıklık önleyici etkiye sahiptir. SFT bu maddeler arasında en az irritatifti. PEO+CMS en güçlü yapışıklık önleyici madde gibi görülmektedir. Bu çalışma PME+CMS ve HA'nın klinikte kullanımıyla ilgili olumlu raporları desteklemektedir. Özellikle, SFT'nin karın içi yapışıklara karşı etkili olduğu bulundu. Ancak, ODH+FE seyreltilmiş konsantrasyonlarda daha fazla araştırılmalıdır.A An na ah ht ta ar r K Ke el li im me el le er r: : Karın boşluğu; karın ağrısı; doku yapışıklıkları A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Many substances have been used up to date in order to prevent postoperative adhesions. This problem is still a 'puzzle' for researchers. We aimed to compare various substances preventing adhesions in an experimental postoperative adhesion model. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : A total of 35 female Sprague-Dawley rats were divided into five groups containing equal number of animals. After laparatomy, peritoneum and ceacum were brushed using a tooth brush until punctate hemorrhage was seen. Additional surgery was not applied in control group (group 1). In the other groups, polyethylene dioxide+sodium carboxymethyl cellulose (PEO+CMC) (group 2), hyaluronan (HA) (group 3), octenidine dihydrochloride+fenoxyethanol 2% (ODH+FE) (group 4) and surfactant (SFT) (group 5) were...

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“…Several studies have shown that laparoscopic myomectomy may be comparable or even superior to the traditional abdominal myomectomy [7] . It is associated with less postoperative pain, a shorter hospital stay, less blood loss, fewer postoperative complications and a lower frequency of adhesion [2,8] . Along with the improvement in laparoscopic techniques, there has been an increase in the number of women with fibroids who wish to preserve their uterus regardless of their fertility status.…”

Section: Discussionmentioning

confidence: 99%

“…The use of adhesive barriers such as sodium hyaluronate after myomectomy in order to reduce postoperative adhesion has been widely accepted. Despite numerous studies attesting to the safety of the hyaluronate-based adhesion barrier [1][2][3][4] , the use of hyaluronan gel is not without potential complications [5] . Here we report a case with a hyaluronate-based absorbable membrane prepared in a slurry that may have induced pelvic peritonitis and abscess formation following laparoscopy-assisted myomectomy (LAM).…”

mentioning

confidence: 99%

An Adhesion Barrier May Induce Peritonitis and Abscess after Laparoscopy-Assisted Myomectomy with Vaginal Extraction: Report of a Case

Huang

Chang

et al. 2009

Gynecol Obstet Invest

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Following a myomectomy, postoperative adhesions occur in many patients. Although laparoscopy has been shown to decrease the development of adhesions compared to laparotomy, adhesions still occur. There are several commercially available adhesion barriers but these are not designed to be easily applied during laparoscopic surgery. In this study, we report a case involving a 34-year-old patient who developed pelvic peritonitis and abscess without an obvious etiology; this might have been related to the off-label use of a bioabsorbable membrane converted into a slurry during recent surgery. Surgeons should be aware of such complications, which might be attributed to this product.

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Reduction of postoperative adhesions with an auto-crosslinked hyaluronan gel in gynaecological laparoscopic surgery: a blinded, controlled, randomized, multicentre study

Abstract: Our results suggest that the auto-crosslinked hyaluronan gel may have a favourable safety profile and efficacious antiadhesive action following laparoscopic myomectomy.

Cited by 97 publications

References 31 publications

Belgian consensus on adhesion prevention in hysteroscopy and laparoscopy

Belgian consensus on adhesion prevention in hysteroscopy and laparoscopy

Comparison of Substances Used for Prevention of Intra-Abdominal Adhesions: An Experimental Study in Rats

An Adhesion Barrier May Induce Peritonitis and Abscess after Laparoscopy-Assisted Myomectomy with Vaginal Extraction: Report of a Case

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