The significance of starch powder contamination in the aetiology of peritoneal adhesions

Cooke, S. A. R.; Hamilton, D.

doi:10.1002/bjs.1800640610

Cited by 40 publications

(16 citation statements)

References 8 publications

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“…24 In the current study, starch granulomas were found mostly up to 48 months. However, in four patients, starch granulomas were found much later-up to 32 years after the last operation.…”

Section: Discussionsupporting

confidence: 49%

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Foreign Material in Postoperative Adhesions

Luijendijk¹,

Lange²,

et al. 1996

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Objective: The authors determined the prevalence of foreign body granulomas in intra-abdominal adhesions in patients with a history of abdominal surgery.Patients and Methods: In a cross-sectional, multicenter, multinational study, adult patients with a history of one or more previous abdominal operations and scheduled for laparotomy between 1991 and 1993 were examined during surgery.Patients in whom adhesions were present were selected for study. Quantity, distribution, and quality of adhesions were scored, and adhesion samples were taken for histologic examination.Results: In 448 studied patients, the adhesions were most frequently attached to the omentum (68%) and the small bowel (67%). The amount of adhesions was significantly smaller in patients with a history of only one minor operation or one major operation, compared with those with multiple laparotomies (p < 0.001).Significantly more adhesions were found in patients with a history of adhesions at previous laparotomy (p < 0.001), with presence of abdominal abscess, hematoma, and intestinal leakage as complications after former surgery (p = 0.01, p = 0.002, and p < 0.001, respectively), and with a history of an unoperated inflammatory process (p = 0.04).Granulomas were found in 26% of all patients. Suture granulomas were found in 25% of the patients. Starch granulomas were present in 5% of the operated patients whose surgeons wore starch-containing gloves. When suture granulomas were present, the median interval between the present and the most recent previous laparotomy was 13 months. When suture granulomas were absent, this interval was significantly longer-i.e., 30 months (p = 0.002). The percentage of patients with suture granulomas decreased gradually from 37% if the previous laparotomy had occurred up to 6 months before the present operation, to 18% if the previous laparotomy had occurred more than 2 years ago (p < 0.001).Conclusions: The number of adhesions found at laparotomy was significantly larger in patients with a history of multiple laparotomies, unoperated intraabdominal inflammatory disease, and previous postoperative intra-abdominal complications, and when adhesions were already present at previous laparotomy. In recent adhesions, suture granulomas occurred in a large percentage. This suggests that the intra-abdominal presence of foreign material is an important cause of adhesion formation. Therefore intra-abdominal contamination with foreign material should be minimized.

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“…24 In the current study, starch granulomas were found mostly up to 48 months. However, in four patients, starch granulomas were found much later-up to 32 years after the last operation.…”

Section: Discussionsupporting

confidence: 49%

“…Therefore intra-abdominal contamination with foreign material should be minimized. [24][25][26] In the current series, the presence of foreign body granulomas and adhesions after laparotomy was studied in humans.…”

mentioning

confidence: 99%

Foreign Material in Postoperative Adhesions

Luijendijk¹,

Lange²,

et al. 1996

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“…Sheikh et al 32 showed that most of the starch powder granules had been disappeared by the fourth week in rats undergoing a laparotomy. Cade and Ellis, however, found that, in rats undergoing laparotomy, 34 excised peritoneal nodules and band adhesions for pathological examination from patients undergoing re-laparotomy for several reasons. It was found that, in the vast majority of patients who had undergone the first laparotomy within the previous 2 years, starch granulomas could be detected and they were responsible for the development of intestinal obstruction.…”

Section: Use Of Starch-free Glovesmentioning

confidence: 95%

The Incidence and Risk Factors of Post-Laparotomy Adhesive Small Bowel Obstruction

Barmparas

Branco

Schnüriger

et al. 2010

Journal of Gastrointestinal Surgery

138

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“…From a historical perspective, it is also important to note that the use of starch gloves has also been associated with the development of adhesive SBO after laparotomy, as noted by Cooke and colleagues [20]. The use of laparoscopy has had a profound impact on adhesive SBO but outcomes are mixed.…”

Section: Discussionmentioning

confidence: 98%

“…Additionally, Duron and colleagues demonstrated an age less than 40 as an independent risk factor for development of recurrent adhesive small bowel obstruction [19]. The role of gender in development of adhesive small bowel obstruction appears unclear, as several studies have had conflicting results [20].…”

Section: Discussionmentioning

confidence: 99%