Changed inflammatory markers after application of 4DryField PH for adhesion prevention in gynecological surgery (2025)

Pathophysiology and prevention of postoperative peritoneal adhesions

World Journal of Gastroenterology

Peritoneal adhesions represent an important clinical challenge in gastrointestinal surgery. Peritoneal adhesions are a consequence of peritoneal irritation by infection or surgical trauma, and may be considered as the pathological part of healing following any peritoneal injury, particularly due to abdominal surgery. The balance between fibrin deposition and degradation is critical in determining normal peritoneal healing or adhesion formation. Postoperative peritoneal adhesions are a major cause of morbidity resulting in multiple complications, many of which may manifest several years after the initial surgical procedure. In addition to acute small bowel obstruction, peritoneal adhesions may cause pelvic or abdominal pain, and infertility. In this paper, the authors reviewed the epidemiology, pathogenesis and various prevention strategies of adhesion formation, using Medline and PubMed search. Several preventive agents against postoperative peritoneal adhesions have been investigated. Their role aims in activating fibrinolysis, hampering coagulation, diminishing the inflammatory response, inhibiting collagen synthesis or creating a barrier between adjacent wound surfaces. Their results are encouraging but most of them are contradictory and achieved mostly in animal model. Until additional findings from future clinical researches, only a meticulous surgery can be recommended to reduce unnecessary morbidity and mortality rates from these untoward effects of surgery. In the current state of knowledge, pre-clinical or clinical studies are still necessary to evaluate the effectiveness of the several proposed prevention strategies of postoperative peritoneal adhesions.

Efficacy of polyethylene glycol adhesion barrier after gynecological laparoscopic surgery

Gynecological Surgery, 2011

Postoperative adhesions are the most frequent complication of peritoneal surgery, causing small bowel obstruction, female infertility and chronic pain. This pilot study assessed the efficacy of a sprayable polyethylene glycol (PEG) barrier in the prevention of de novo adhesions. 16 patients undergoing laparoscopic gynecological surgery were randomly assigned by shuffled sealed envelopes to receive either the adhesion barrier or no adhesion prevention. Incidence and severity of adhesions were scored at eight sites in the pelvis and reassessed by second look laparoscopy. Adhesion prevention was considered successful if no de novo adhesion were found at second look laparoscopy. One patient was excluded before randomization. Nine patients were randomized to treatment and six patients to control group. De novo adhesions were found in 0/9 patients who received the PEG barrier compared to 4/6 without adhesion prevention (0% vs. 67%, P = 0.01). Reduction in adhesion score was significantly ...

[Prevention of postoperative peritoneal adhesions using reodextran and dextran]

Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti, 1970

Post-surgial adhesion formation can result in significant morbidity and mortality. N,O-carboxymethyl chitosan (N,O-CMC) has been previously shown to be effective in the prevention of postsurgical adhesion formation. In this study, we evaluated the ability of O-carboxymethyl chitosan (O-CMC), another chitosan derivative generated by carboxymethylation of chitosan's oxygen centers, to reduce postsurgical adhesion development. Methods: Twenty male Sprague-Dawley rats (250 ± 20 g) were divided into two equal groups: O-CMC group and saline (control) group. All rats underwent a midline laparotomy and the cecum was abraded to cause petechial hemorrhages. Following peritoneal injections of either saline or O-CMC, the incisions were closed. Seven days after surgery, the animals were killed and adhesion formation was scored. Tissue samples from the adhesions were examined histochemically. Results: Adhesion formation was significantly decreased in the O-CMC group (P<.001) in comparison with the control group. Furthermore, significantly less collagen (P<.001) and fewer inflammatory cells and fibroblasts were detected in the O-CMC-treated animals. Additionally, a significantly (P<.05) lower level of TGF-β1 expression was found in the O-CMC group. Conclusion: O-CMC appears to be effective in the prevention of postoperative peritoneal adhesion formation, which may be attributed to decreased accumulation of inflammatory cells and fibroblasts and reduced collagen synthesis. Adhesion formation is a very common complication of surgery. Several studies have documented that 68-100% of patients undergoing laparotomies have postsurgical adhesions. 1,2 The formation of adhesions, probably resulting from mechanical damage, ischemia, and infection by microorganisms, 1-3 can increase the morbidity and mortality following surgery. 4-6 There are two major strategies for adhesion prevention or reduction: improvement of surgical technique and application of adjuvants. 7 Modifications in technique alone will decrease but not prevent adhesion formation; thus, adjuvant therapy is essential. 7 Among ORIGINAL RESEARCH

The correlation of adhesions and peritoneal fluid cytokine concentrations: a pilot study

Human Reproduction, 2002

BACKGROUND: Intra-abdominal adhesion formation and reformation after surgery is a significant cause of morbidity. The greatest problem after the surgical removal of adhesions is their reformation. We examined the concentrations of interleukin (IL)-1, IL-6 and tumour necrosis factor (TNF)-α in the peritoneal fluid throughout the 48 h post-operative period following adhesiolysis, and correlated the results to the extent of adhesion reformation. METHODS: Peritoneal fluid, collected from eight patients following laparoscopy and again at 12, 36 and 48 h after surgery, was analysed using enzyme-linked immunosorbent assay (IL-1 and IL-6) and bioassay (TNF-α). At 48 h, a second look laparoscopy was performed to inspect the pelvis for adhesion formation/reformation. RESULTS: Three patients had adhesion reformation >10% at 48 h after surgery. The mean adhesion score 48 h after adhesiolysis was 5 (range 0-17). The mean reduction in adhesion score was 88% (range 83-100%). Newly formed adhesions were filmy, relatively soft and avascular in nature. Adhesion reformation of >10% was associated with (i) high concentrations of IL-6 at 12 h (P < 0.01) and (ii) high concentrations of IL-1 at 48 h (P < 0.001). CONCLUSIONS: Results from this preliminary study suggest that future treatment strategies for adhesion prevention could be aimed at the control of cellular mediators in the peritoneal fluid during the initial adhesion formation period.

Comparative study of intraperitoneal prophylactic agents in preventing postoperative adhesions

Journal of the American College of Surgeons, 2014

Preventing intraperitoneal adhesions with ethyl pyruvate and hyaluronic acid/carboxymethylcellulose: a comparative study in an experimental model

European Journal of Obstetrics &amp; Gynecology and Reproductive Biology, 2014

To compare the effectiveness of ethyl pyruvate (EP) with that of hyaluronic acid + carboxymethyl cellulose (Seprafilm) for the prevention of intraperitoneal adhesions. Seprafilm has been shown to be effective in many experimental and clinical studies. Study design: Thirty rats were divided into three groups at random, and uterine horn abrasion was performed by laparotomy. One group received no treatment (control group), one group received a single intraperitoneal dose of EP 50 mg/kg (EP group), and a 2 Â 1-cm patch of Seprafilm was applied in the third group (Seprafilm group). All rats were killed 14 days after surgery. Macroscopic and histopathological evaluation were performed by a surgeon and a pathologist who were blinded to group allocation. Histopathologically, inflammation, fibroblastic activity, foreign body reaction, collagen proliferation, vascular proliferation, Masson-Trichrome score, matrix metalloproteinase-2 score and vascular endothelial growth factor score were studied. Results: Median macroscopic intraperitoneal adhesion scores for the control, EP and Seprafilm groups were 2.8, 1.2 and 1.1, respectively. Multiple comparisons between groups showed a significant difference (p < 0.05). In binary comparisons, significant differences were found between the control group and the EP group, and between the control group and the Seprafilm group (p < 0.05). No significant difference was found between the adhesion scores for the EP group and the Seprafilm group (p > 0.05). After histopathological evaluation, significant differences in all parameters were found between the groups (p < 0.05). In the paired comparison, significant differences were found between the control group and the EP group, and between the control group and the Seprafilm group (p < 0.0167), but no significant difference was found between the EP group and the Seprafilm group (p > 0.0167). Conclusions: In comparison with the untreated control group, EP and Seprafilm were found to reduce the formation of intraperitoneal adhesions. No significant difference was found between EP and Seprafilm.

Adhesion prevention in operative laparoscopy

Majalah obstetri dan ginekologi Indonesia

Post-operative adhesion formation is still a major complication of open laparotomy surgery or operative laparoscopy and a contributing factor that cause infertility, small bowel obstruction, ectopic pregnancy, abdominal or pelvic pain and increasing difficulty when reoperation is performed. 1 Adhesion actually results as a natural consequence of surgical trauma and healing. Operative injury will cascade several reactions that trigger adhesion formation through inflammation process, reactive oxygen species (ROS) which results in formation of fibrinous exudate. 2-4 The use of laparoscopy is less adhesiogenic than laparotomy, this was demonstrated by Dwight Chen 5 when compared laparoscopy vs laparotomy in the porcine model to evaluate the adhesion formation. The result were significantly higher adhesion formation was observed in the laparotomy group than in the laparoscopic group. But a study done by Binda 4 demonstrated the use of CO2 gas for the pneumoperitoneum during laparoscopy was cofactor in adhesion formation itself. Based on these studies, whether the surgical procedures are, it is important to consider the prevention of adhesion. Nowadays, there are many methods that can be used, which are: modification of surgical technique, anti-inflammatory agents, peritoneal instillates, and surgical adhesion barriers. This article shows the review of methods mentioned above.

A randomized controlled study of the efficacy of misoprostol and hyaluronic acid in preventing adhesion formation after gynecological surgery: a rat uterine horn model

European Journal of Obstetrics &amp; Gynecology and Reproductive Biology, 2014

Postoperative intra-abdominal adhesions occur in 50-95% of women who undergo gynecological surgery [1]. The development of peritoneal adhesions following abdominal and pelvic surgery leads to clinical problems, including intestinal obstruction, infertility, and chronic pelvic pain [2]. Adhesions remain a potential problem for future surgical procedures, increasing health expenses and hospital readmission rates, and reducing the quality of life of the patient [3]. There are several described causes of adhesions, such as mechanical trauma, ischemia caused by sutures or electrocautery, presence of foreign bodies, tissue desiccation, and infection [4]. Furthermore, during peritoneal healing following surgery, the increase in peritoneal fluid, cytokines, proteins and fibrin formation can promote adhesion formation [5,6]. Currently, there are various methods of preventing adhesion formation such as the use of barrier materials, non-steroid antiinflammatory drugs, calcium channel blockers, corticosteroids, vitamin E, antihistamines, metformin, melatonin, progesterone, estrogen, gonadotrophin-releasing hormone (GnRH)-agonists and antagonists, anticoagulants, fibrinolytic agents, and antibiotics [7-10]. Hyalobarrier 1 gel is a highly viscous gel derived from hyaluronan, obtained through an auto-crosslinking process, and used as an adhesion prevention agent in a variety of surgical procedures [11-13]. Hyalobarrier 1 gel can reduce the incidence and severity of postoperative adhesions in cases of severe uterine damage caused by laparotomy or laparoscopic myomectomies [14,15]. The gel can also be easily applied during laparoscopic and hysteroscopic procedures.

Severe inflammatory reaction induced by peritoneal trauma is the key driving mechanism of postoperative adhesion formation

BMC surgery, 2011

Background: Many factors have been put forward as a driving mechanism of surgery-triggered adhesion formation (AF). In this study, we underline the key role of specific surgical trauma related with open surgery (OS) and laparoscopic (LS) conditions in postoperative AF and we aimed to study peritoneal tissue inflammatory reaction (TIR), remodelling specific complications of open surgery (OS) versus LS and subsequently evaluating AF induced by these conditions. Methods: A prospective randomized study was done in 80 anaesthetised female Wistar rats divided equally into 2 groups. Specific traumatic OS conditions were induced by midline incision line (MIL) extension and tissue drying and specific LS conditions were remodelled by intraperitoneal CO 2 insufflation at the 10 cm of water. TIR was evaluated at the 24 th , 72 nd , 120 th and 168 th hour by scoring scale. Statistical analysis was performed by the nonparametric t test and two-way ANOVA using Bonferroni post-tests.

The effect of Suprogel - macromolecule polysaccharide - on the formation of postoperative abdominal adhesions

Balkan Military Medical Review, 2007

Abdominal adhesion is one of the major causes of intestinal obstruction, primary and secondary female infertility, chronic pelvic pain, and inconveniences in the future operations. Postoperative adhesions develop after 90% of all laparotomies and they become mostly the reason for 54% to 74% of small bowel obstructions, which need additional surgical correction by the rate of 41% to 44%. The aim of this study is to evaluate the efficacy of Suprogel ®-macromolecule polysaccharide-in the protection against formation of postsurgical adhesion in a standardized rat experimentally pathological model. Twenty rats with induced peritoneal adhesion were randomly divided into two groups. Rats in group 1 received no medication, while ingroup 2 rats Suprogel ® was applied. Adhesions were evaluated blindly 21 days following the surgical operation. Adhesion tissue samples were microscopically evaluated. Tissue hydroxyproline and collagen concentrations were measured. The adhesion grading and histopathological adhesion score were significantly lower in Suprogel group, but peritoneal hydroxyproline levels did not differ significantly between the groups. Consequently, the present study suggested that intraperitoneal administration of Suprogel ® might be effective to reduce the incidence of postoperative adhesions in this experimental model.