Use of Fibrin Sealant for Reproductive Surgery: A Randomized Study in the Rabbit Model

Marana, Riccardo; Muzii, Ludovico; Catalano, Giovan Fiore; Caruana, Paul; Mancuso, Salvatore

doi:10.1159/000292268

Cited by 11 publications

(4 citation statements)

References 12 publications

(21 reference statements)

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“…25 Many experimental studies have shown that fibrin glue cannot prevent abdominal adhesions sufficiently. [26][27][28] However, some authors have described its efficacy in preventing adhesion. 29-31 These discrepancies may be due to the use of different experimental conditions, such as fibrinogen concentration (gel mechanics and hydration), as well as fibrin gel barrier thickness.…”

Section: Discussionmentioning

confidence: 99%

Mesothelial Cell Sheets Cultured on Fibrin Gel Prevent Adhesion Formation in an Intestinal Hernia Model

et al. 2005

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In the present study, we examined a novel technique to prevent adhesion formation in a rat intestinal hernia model with mesothelial cell sheets cultured on fibrin gel. Mesothelial cells were obtained from isologous rats by enzymatic disaggregation of mesentery and cultured on fibrin gel. Electron microscopy revealed that these cultured cells form contiguous monolayer cell sheets with well-developed microvilli. These tissue-engineered constructs were grafted in vivo to an intestinal hernia model that results in regular surgical adhesions without treatment. Five days postgrafting, rats were sacrificed. Adhesion formation was not observed in rats grafted with the constructs, whereas severe adhesions were observed in all control rats. Constructs seeded with mesothelial cells isolated from EGFP-transgenic rats clearly revealed that grafted mesothelial cells remained at the host tissue site even after fibrin scaffold degradation. These cells developed more abundant microvilli in vivo than those in vitro. These results show that cultured mesothelial cell sheets are effective in preventing adhesion formation and should reduce postoperative complications caused by adhesion formation.

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Section: Discussionmentioning

confidence: 99%

Mesothelial Cell Sheets Cultured on Fibrin Gel Prevent Adhesion Formation in an Intestinal Hernia Model

et al. 2005

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“…Using in vivo systems, these biologic effects of Tisseel and derivative fibrin sealant formulations of these experiments would be complemented by its ability to achieve hemostasis, thereby limiting collection of blood clots, which have been implicated in adhesion development. Consistent with the hypothesis that Tisseel would be expected to reduce adhesions are extensive studies in multiple animal species and in humans, utilizing a diverse variety of surgical models including cardiac, bowel, reproductive tract, and tendons 15–33 . However, whether removal of aprotinin from Tisseel would further improve its in vivo efficacy to reduce adhesions remains to be established.…”

Section: Discussionmentioning

confidence: 93%

“…Consistent with the hypothesis that Tisseel would be expected to reduce adhesions are extensive studies in multiple animal species and in humans, utilizing a diverse variety of surgical models including cardiac, bowel, reproductive tract, and tendons. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] However, whether removal of aprotinin from Tisseel would further improve its in vivo efficacy to reduce adhesions remains to be established.…”

Section: Discussionmentioning

confidence: 99%

Expression of transforming growth factor‐β and extracellular matrix by human peritoneal mesothelial cells and by fibroblasts from normal peritoneum and adhesions: Effect of Tisseel

Saed

Krüger

Diamond

2004

Wound Repair Regeneration

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We have previously shown that fibroblasts obtained from adhesions produce greater amounts of transforming growth factor-beta 1 (TGF-beta1) and extracellular matrix (ECM) molecules than normal fibroblasts isolated from normal peritoneum. The purpose of the current studies was to examine the effect of Tisseel (Baxter Healthcare Corporation, Glendale, CA), a fibrin sealant containing fibrinogen, aprotinin (a protease inhibitor), thrombin, and CaC1(2), on TGF-beta1 and ECM production by human peritoneal mesothelial cells, normal peritoneal fibroblasts, and adhesion fibroblasts. Multiplex reverse transcription-polymerase chain reaction using beta-actin as a housekeeping gene was used to determine mRNA levels of TGF-beta1 and ECM in these cells at 6, 12, 24, and 48 hours under normoxic conditions in the following treatment groups : fibrin sealant (Tisseel) alone; fibrin sealant with the two components diluted 1 : 2; fibrin sealant with the sealer protein component reconstituted without aprotinin (a protease inhibitor); fibrin sealant with the sealer protein component reconstituted without aprotinin (and both components diluted 1 : 2); fibrin sealant components diluted to physiologic concentrations; and control (culture media). The test compositions had little effect on TGF-beta1 mRNA expression in mesothelial cells and normal peritoneal fibroblasts, but resulted in a marked reduction of TGF-beta1 from adhesion fibroblasts. Expression of type I collagen by human peritoneal mesothelial cells was not detected; the compositions reduced type I collagen mRNA expression by both types of fibroblasts. Type III collagen was detected at six hours, and increased approximately 50 percent by culturing for 48 hours. Tisseel at full strength and with both components diluted 1 : 2 initially increased type III collagen mRNA levels; in contrast, type III collagen mRNA levels were reduced in mesothelial cells by the fibrin sealant without aprotinin at both concentrations and at physiologic concentrations. In both types of fibroblasts, the Tisseel compositions reduced type III collagen mRNA expression. Fibronectin mRNA were transiently reduced at six hours by approximately 50 percent in the presence of the Tisseel components, but then returned to control levels. Fibronectin mRNA levels were not altered in normal peritoneal fibroblasts, but were reduced by all but the physiologic concentration in adhesion fibroblasts. Tisseel may modulate human peritoneal mesothelial cell, normal peritoneal fibroblast, and adhesion fibroblast function. These results suggest that fibrin sealant prepared from the Tisseel kit without aprotinin has the ability to reduce ECM and TGF-beta1 mRNA levels, especially from adhesion fibroblasts, which may indicate a role in reduction of postoperative adhesion development.

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“…Controversy remains on the effect of thrombin and fibrin sealant on adhesion formation. While some studies report more extensive adhesion formation with the use of fibrin sealant (Gauwerky et al, 1990), others demonstrate no increase (McGaw et al, 1988;Bruel et al, 1993;Bilgin et al, 1995;Evrard et al, 1996;Marana et al, 1996) and even a reduction (Lindenberg et al, 1985;de Virgilio et al, 1990;Tulandi, 1991;Caballero and Tulandi, 1992;Sheppard et al, 1993;De Iaco et al, 1994;Takeuchi et al, 1996). The diversity of results may be due to differences in study design, injury model, control group, chemical composition and mode of application of the fibrin sealant and evaluation of adhesions.…”

mentioning

confidence: 99%

A comparative study of the effects of thrombin and electrodesiccation used for haemostasis on inflammation and adhesion formation

Yaralı́¹,

Gomel²,

Uygur³

et al. 1998

Human Reproduction

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Electrodesiccation or chemical agents, such as thrombin and fibrin sealant, may be used to control oozing in the peritoneal cavity. Electrodesiccation is time consuming and associated with adjacent thermal damage. Adhesion formation remains a concern with the use of thrombin and fibrin sealant. In this study, adhesion formation and various histological parameters of inflammation were evaluated following haemostasis with electromicrodesiccation or thrombin in the rabbit model (n = 36). Following laparotomy, the right uterine horn was subjected to a measured injury producing sufficient oozing. After the injury was effected, the animals were randomized to haemostasis with electromicrodesiccation (n = 18) or thrombin (n = 18). In the first phase of the study, the histological parameters of acute injury and haemostasis with either modality were evaluated in two animals in each group. In the second phase, one, two and 10 animals, in each group, were submitted to second-look laparotomy on post-operative days 2, 7, and 15, respectively and the type and extent of adhesions were quantified. Histological parameters of inflammation as well as the type and extent of adhesions were comparable between the two groups. We conclude that local application of thrombin is not associated with a statistically greater degree of post-operative adhesions when compared to electromicrodesiccation.

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Use of Fibrin Sealant for Reproductive Surgery: A Randomized Study in the Rabbit Model

Cited by 11 publications

References 12 publications

Mesothelial Cell Sheets Cultured on Fibrin Gel Prevent Adhesion Formation in an Intestinal Hernia Model

Mesothelial Cell Sheets Cultured on Fibrin Gel Prevent Adhesion Formation in an Intestinal Hernia Model

Expression of transforming growth factor‐β and extracellular matrix by human peritoneal mesothelial cells and by fibroblasts from normal peritoneum and adhesions: Effect of Tisseel

A comparative study of the effects of thrombin and electrodesiccation used for haemostasis on inflammation and adhesion formation

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