Nawar A Alkhamesi1, Christopher M Schlachta. 1. Canadian Surgical Technologies and Advance Robotics (CSTAR), London Health Science Centre, University Hospital, 339 Windermere Road, P. O. Box 5339, London, ON, N6A 5A5, Canada, n.alkhamesi@imperial.ac.uk.
Abstract
INTRODUCTION: Intraperitoneal adhesions are a common and serious problem following abdominal surgery. Significant research has been performed to investigate the mechanisms involved; however, this has not influenced the incidence; it is still the leading cause of intestinal obstruction, pelvic pain, and infertility in women. The purpose of this study was to evaluate the ability of aerosolized heparin and hyaluronic acid for the prevention of postoperative adhesions. MATERIALS AND METHODS: A survival pig model was employed (N = 40). The pigs underwent laparoscopic insertion of polypropylene mesh to create intraperitoneal adhesions. The animals were randomized into four groups: control (n = 10), aerosolized heparin (n = 10), aerosolized hyaluronic acid (n = 10), and aerosolized mixture of both agents (n = 10). After a 2-week recovery period, the animals were killed and intraperitoneal adhesions were assessed. RESULTS: All of the animals in the control group suffered postoperative adhesions (10/10) compared with three in the heparin group, two in the hyaluronic group, and one in the mixed group. The number of adhesions per animal and the severity was higher in the control group compared with the therapeutic groups. The mean number of adhesions in the affected pigs also was higher in the control group compared with the therapeutic groups: 3.3 versus 0.4 in heparin group (range 0-2) versus 0.3 in hyaluronic acid group versus 0.1 in the mixed group (p = 0.002). CONCLUSIONS: This study has shown that aerosolised heparin and hyaluronic acid is an effective method to prevent postoperative adhesions whether they were used independently or in synergism. However, the best result was when both agents mixed together compared with the control. A human-based study will be the next step to confirm the success of these agents.
INTRODUCTION: Intraperitoneal adhesions are a common and serious problem following abdominal surgery. Significant research has been performed to investigate the mechanisms involved; however, this has not influenced the incidence; it is still the leading cause of intestinal obstruction, pelvic pain, and infertility in women. The purpose of this study was to evaluate the ability of aerosolized heparin and hyaluronic acid for the prevention of postoperative adhesions. MATERIALS AND METHODS: A survival pig model was employed (N = 40). The pigs underwent laparoscopic insertion of polypropylene mesh to create intraperitoneal adhesions. The animals were randomized into four groups: control (n = 10), aerosolized heparin (n = 10), aerosolized hyaluronic acid (n = 10), and aerosolized mixture of both agents (n = 10). After a 2-week recovery period, the animals were killed and intraperitoneal adhesions were assessed. RESULTS: All of the animals in the control group suffered postoperative adhesions (10/10) compared with three in the heparin group, two in the hyaluronic group, and one in the mixed group. The number of adhesions per animal and the severity was higher in the control group compared with the therapeutic groups. The mean number of adhesions in the affected pigs also was higher in the control group compared with the therapeutic groups: 3.3 versus 0.4 in heparin group (range 0-2) versus 0.3 in hyaluronic acid group versus 0.1 in the mixed group (p = 0.002). CONCLUSIONS: This study has shown that aerosolised heparin and hyaluronic acid is an effective method to prevent postoperative adhesions whether they were used independently or in synergism. However, the best result was when both agents mixed together compared with the control. A human-based study will be the next step to confirm the success of these agents.
Authors: Yavuz Yilmaz; Istemi H Celik; Arzu Pampal; Gamze Demirel; Ferda Topal; Serife S Oguz; Sibel S Kilicoglu; Ibrahim O Ozen; Ugur Dilmen Journal: J Pediatr Surg Date: 2012-08 Impact factor: 2.545
Authors: Zane Cohen; Anthony J Senagore; Merril T Dayton; Mark J Koruda; David E Beck; Bruce G Wolff; Phillip R Fleshner; Richard C Thirlby; Kirk A Ludwig; Sergio W Larach; Eric G Weiss; Joel J Bauer; Lena Holmdahl Journal: Dis Colon Rectum Date: 2005-06 Impact factor: 4.585