Ultrapure alginate gel reduces adhesion reformation after adhesiolysis

Chaturvedi, Ankit; Lomme, Roger M. L. M.; Hendriks, T.; Goor, Harry van

doi:10.1007/s00384-014-2009-5

Cited by 10 publications

(4 citation statements)

References 32 publications

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“…Ratings of the necropsies showed no difference between groups, and were almost identical to the ratings of the 7-day rats as reported earlier (Fig 7). This similarity is consistent with other reports of adhesiolysis in rats where there was no difference between the severities at initial versus post-adhesiolysis ratings [39–41]. …”

Section: Resultssupporting

confidence: 92%

Attenuation of postoperative adhesions using a modeled manual therapy

Bove

Chapelle²,

Hanlon

et al. 2017

PLoS ONE

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Postoperative adhesions are pathological attachments that develop between abdominopelvic structures following surgery. Considered unavoidable and ubiquitous, postoperative adhesions lead to bowel obstructions, infertility, pain, and reoperations. As such, they represent a substantial health care challenge. Despite over a century of research, no preventive treatment exists. We hypothesized that postoperative adhesions develop from a lack of movement of the abdominopelvic organs in the immediate postoperative period while rendered immobile by surgery and opiates, and tested whether manual therapy would prevent their development. In a modified rat cecal abrasion model, rats were allocated to receive treatment with manual therapy or not, and their resulting adhesions were quantified. We also characterized macrophage phenotype. In separate experiments we tested the safety of the treatment on a strictureplasty model, and also the efficacy of the treatment following adhesiolysis. We show that the treatment led to reduced frequency and size of cohesive adhesions, but not other types of adhesions, such as those involving intraperitoneal fatty structures. This effect was associated with a delay in the appearance of trophic macrophages. The treatment did not inhibit healing or induce undesirable complications following strictureplasty. Our results support that that maintained movements of damaged structures in the immediate postoperative period has potential to act as an effective preventive for attenuating cohesive postoperative adhesion development. Our findings lay the groundwork for further research, including mechanical and pharmacologic approaches to maintain movements during healing.

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Section: Resultssupporting

confidence: 92%

Attenuation of postoperative adhesions using a modeled manual therapy

Bove

Chapelle²,

Hanlon

et al. 2017

PLoS ONE

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“…It has been recommended to excise adhesions instead of simply dividing them, because fibroblast cultured from adhesions are different from fibroblasts from a normal peritoneum (16,57,(132)(133)(134)(135). Specific products to prevent adhesion reformation are being explored but are not yet clinically available (136).…”

Section: Prevention Of Adhesion Reformation After Adhesiolysismentioning

confidence: 99%

Role of the peritoneal cavity in the prevention of postoperative adhesions, pain, and fatigue

Koninckx¹,

Gomel

Ussia³

et al. 2016

Fertility and Sterility

109

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A surgical trauma results within minutes in exudation, platelets, and fibrin deposition. Within hours, the denuded area is covered by tissue repair cells/macrophages, starting a cascade of events. Epithelial repair starts on day 1 and is terminated by day 3. If repair is delayed by decreased fibrinolysis, local inflammation, or factors in peritoneal fluid, fibroblast growth starting on day 3 and angiogenesis starting on day 5 results in adhesion formation. For adhesion formation, quantitatively more important are factors released into the peritoneal fluid after retraction of the fragile mesothelial cells and acute inflammation of the entire peritoneal cavity. This is caused by mechanical trauma, hypoxia (e.g., CO pneumoperitoneum), reactive oxygen species (ROS; e.g., open surgery), desiccation, or presence of blood, and this is more severe at higher temperatures. The inflammation at trauma sites is delayed by necrotic tissue, resorbable sutures, vascularization damage, and oxidative stress. Prevention of adhesion formation therefore consists of the prevention of acute inflammation in the peritoneal cavity by means of gentle tissue handling, the addition of more than 5% NO to the CO pneumoperitoneum, cooling the abdomen to 30°C, prevention of desiccation, a short duration of surgery, and, at the end of surgery, meticulous hemostasis, thorough lavage, application of a barrier to injury sites, and administration of dexamethasone. With this combined therapy, nearly adhesion-free surgery can be performed today. Conditioning alone results in some 85% adhesion prevention, barriers alone in 40%-50%.

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“…26 Several strategies for the prevention of adhesions have been proposed, including inhibition of inflammation, prevention of fibrin formation, promotion of fibrinolysis, and antiangiogenesis and tissue engineering. 6,[27][28][29] We assumed that the HAM`s anti-inflammatory properties would reduce the formation of adhesions. For this purpose, we decided to use the epithelial side of the HAM facing the abdominal cavity.…”

Section: Discussionmentioning

confidence: 99%