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PALA Ş, KULOĞLU T, ATILGAN R, ÖZKAN ZS, HANÇER S. What is the impact of intraperitoneal surfactant administration against postoperative intraabdominal adhesion formation? an experimental study. Turk J Med Sci 2023; 53:1817-1824. [PMID: 38813488 PMCID: PMC10760580 DOI: 10.55730/1300-0144.5752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 06/03/2023] [Accepted: 11/25/2023] [Indexed: 05/31/2024] Open
Abstract
Background/Aim Surfactant is a surface-active substance that, in addition to its detergent effect, also has effects that reduce inflammation and fibrosis. Because of these effects, it was aimed herein to investigate the effect of intraperitoneal surfactant application on preventing postoperative peritoneal adhesion formation in a uterine horn adhesion model. Materials and methods Twenty-one Wistar albino rats were randomly divided into 3 groups (G1-G3), as follows: G1 (n = 7): control group. The abdomen was opened and then closed; G2 (n = 7): adhesion group. The abdomen was opened. Then, a 2-cm linear incision was made over the right uterine horn, 2 mL of isotonic saline was administered intraperitoneally, and the abdomen was closed; and G3 (n = 7): treatment group. The abdomen was opened, a 2-cm linear incision was made over the right uterine horn, 2 mL (70 mg/kg) of surfactant was administered intraperitoneally, and the abdomen was closed. After 15 days, the rats were euthanized, the abdomens were reopened, and adhesion scoring was performed. After the right uterine horns were removed and fixed with 10% formalin, appropriate sections were taken from the traumatized tissue, stained with Masson's trichrome, and fibrosis and inflammation scoring were performed. Results The adhesion area and intensity were significantly higher in G2 than in G1 and G3 (p = 0.001) and were similar in G1 and G3 (p = 0.165). While fibrosis and inflammation were significantly higher in G2 than in G1 and G3 (p = 0.001), there was no difference between G1 and G3 (p = 0.5). Conclusion Intraperitoneal surfactant administration at a dose of 70 mg/kg was found to be effective in preventing intraabdominal adhesion formation in a rat uterine horn model.
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Affiliation(s)
- Şehmus PALA
- Department of Obstetrics and Gynecology, Fırat University School of Medicine, Elazığ,
Turkiye
| | - Tuncay KULOĞLU
- Department of Histology and Embryology, Fırat University School of Medicine, Elazığ,
Turkiye
| | - Remzi ATILGAN
- Department of Obstetrics and Gynecology, Fırat University School of Medicine, Elazığ,
Turkiye
| | - Zehra Sema ÖZKAN
- Department of Obstetrics and Gynecology, Kırıkkale University School of Medicine, Kırıkkale,
Turkiye
| | - Serhat HANÇER
- Department of Obstetrics and Gynecology, Fırat University School of Medicine, Elazığ,
Turkiye
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Lipid emulsions prevent postoperative abdominal adhesions. Asian J Surg 2023; 46:465-471. [PMID: 35688763 DOI: 10.1016/j.asjsur.2022.05.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/27/2022] [Accepted: 05/20/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Adhesions are the most common cause of long-term morbidity after abdominal surgery and most often cause various forms of intestinal passage disorders ranging from partial obstruction to complete, life-threatening intestinal obstruction. The aim of the present study was to evaluate the protective effect of intraperitoneally administered lipid emulsions on the formation of adhesions in larger animal model, as the lubricating effect of phospholipids and the mechanical barrier of the lipid component are combined with the anti-inflammatory effect of fish oil. METHODS Thirty-one female domestic pigs were randomly divided into three groups. At the end of the surgical procedure, a lipid emulsion or saline solution was applied intraperitoneally. After 14 days, an independent macroscopic, histological and immunohistochemical evaluation of the adhesions were performed. RESULTS Intraperitoneal administration of lipid emulsions significantly reduced the incidence of intra-abdominal adhesions. Microscopic examination demonstrated a significant reduction in the number of inflammatory elements and the amount of collagen in the adhesions, especially after administration of the fish oil-based emulsion. A simultaneous decrease in neovascularization was observed in the adhesions. Evaluation of the intestinal anastomosis did not reveal significant differences in healing between the groups. CONCLUSION Intraperitoneal administration of lipid emulsions can reduce the development of postoperative intra-abdominal adhesions by the combined action of phospholipids as important lubricants and lipids as a mechanical barrier. Their effect is caused by a reduction in proinflammatory and profibrotic mediators. At the same time, intraperitoneal administration of lipid emulsions does not impair healing of the anastomosis in larger animal model.
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Tsaousi G, Stavrou G, Fotiadis K, Kotzampassi K, Kolios G. Implementation of phospholipids as pharmacological modalities for postoperative adhesions prevention. Eur J Pharmacol 2018; 842:189-196. [PMID: 30391744 DOI: 10.1016/j.ejphar.2018.10.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/25/2018] [Accepted: 10/31/2018] [Indexed: 01/23/2023]
Abstract
Adhesions formation is considered a significant clinical entity implicating the healing process following major abdominal surgery, with serious clinical consequences and need for substantial health care expenditures. Several agents and substances applied either locally or systematically could potentially function as inhibitors of the formation of peritoneal adhesions endowed by limiting tissue apposition during the critical stages of mesothelial repair. Phospholipids are identified as surfactant-like substances, acting as a temporary membrane-like coverage of serosal defects. The experimental use of phospholipids for adhesions formation totals 24 publications. All retrieved studies, out of two, demonstrated the efficacy of phospholipids use in adhesions prevention. A single intraperitoneal dose of approximately 75 mg/kg of phosphatidylcholine, for a 30-min exposure time, emerges as the standard practice in terms of efficacy in both surgical alone or combined to peritonitis settings. The findings revealing an unimpeded healing of anastomoses and laparotomy wounds support the safety of this agent. The two additional properties of intraperitoneal use of phospholipids involve the inhibition of bacterial adherence/growth following impregnation of intra-abdominal drainages with phospholipids, without influencing bacterial translocation and the elimination of peritoneal carcinosis, through inhibition of intraperitoneal adhesion of tumor cells. The latter effect is achieved by a dose of phospholipids equal to 150 mg/kg. These experimental data, support that the intraperitoneal phospholipids administration can forestall adhesions formation following intra-abdominal surgical trauma, with no considerable overdosing-related adverse effects. Furthermore, these substances could possibly attenuate posttraumatic inflammation, and inhibit intraperitoneal tumor cell adhesion.
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Affiliation(s)
- Georgia Tsaousi
- Department of Anesthesiology and ICU, Faculty of Medicine, Aristotle University of Thessaloniki, University Campus, P.O. 54006, Thessaloniki, Greece.
| | - George Stavrou
- Department of Surgery, Faculty of Medicine, Faculty of Medicine, Aristotle University of Thessaloniki, University Campus, P.O. 54006, Thessaloniki, Greece; Department of General Surgery, York Teaching Hospital, NHS Foundation Trust, Wigginton Road, York, North Yorkshire YO31 8HE, UK.
| | - Kyriakos Fotiadis
- Department of Surgery, Faculty of Medicine, Faculty of Medicine, Aristotle University of Thessaloniki, University Campus, P.O. 54006, Thessaloniki, Greece.
| | - Katerina Kotzampassi
- Department of Surgery, Faculty of Medicine, Faculty of Medicine, Aristotle University of Thessaloniki, University Campus, P.O. 54006, Thessaloniki, Greece.
| | - George Kolios
- Laboratory of Pharmacology, Faculty of Medicine, Democritus University of Thrace, Dragana, Alexandroupolis 68100, Greece.
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Shimi SM, Loudon MA. Pumactant in the prevention of postoperative adhesions: A randomized trial. J Surg Res 2012; 178:677-84. [DOI: 10.1016/j.jss.2012.06.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 06/14/2012] [Accepted: 06/22/2012] [Indexed: 12/22/2022]
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Yilmaz Y, Celik IH, Pampal A, Demirel G, Topal F, Oguz SS, Kilicoglu SS, Ozen IO, Dilmen U. Effects of different pulmonary surfactants in the prevention of postoperative intraabdominal adhesion formation. J Pediatr Surg 2012; 47:1560-5. [PMID: 22901917 DOI: 10.1016/j.jpedsurg.2012.01.080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 01/20/2012] [Accepted: 01/22/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND After abdominal surgery, the formation of postoperative adhesion is a serious problem. The aim of the study is to evaluate the efficacy of 2 different pulmonary surfactants, poractant and beractant, on adhesion prevention in an experimental model. MATERIALS AND METHODS An experimental intraabdominal adhesion model was created in 18 adult female rats by cecal abrasion. The rats were randomly assigned to 3 groups. Group I received no further treatment, whereas groups II and III received intraperitoneal poractant and beractant, respectively, before closing the incision. On the 15th postoperative day, all rats underwent relaparotomy, intraabdominal adhesions were scored macroscopically according to Canbaz scoring system, and the cecum in each animal was evaluated microscopically. RESULTS The median adhesion scores of group II and III rats were significantly lower when compared with group I (P = .02). Group III had a lower median adhesion score than did group II, but this did not reach significance (P > .05). CONCLUSION These observations suggest that intraperitoneal instillation of both pulmonary surfactants is associated with lower adhesion scores, higher adhesion-free cases, and improved histologic findings.
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Affiliation(s)
- Yavuz Yilmaz
- Department of Pediatric Surgery, Neonatal Intensive Care Unit, Zekai Tahir Burak Maternity Teaching Hospital 06230 Cebeci, Ankara, Turkey.
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Ward BC, Panitch A. Abdominal Adhesions: Current and Novel Therapies. J Surg Res 2011; 165:91-111. [DOI: 10.1016/j.jss.2009.09.015] [Citation(s) in RCA: 153] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 08/17/2009] [Accepted: 09/04/2009] [Indexed: 12/20/2022]
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Peritoneal damage: the inflammatory response and clinical implications of the neuro-immuno-humoral axis. World J Surg 2010; 34:704-20. [PMID: 20049432 DOI: 10.1007/s00268-009-0382-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The peritoneum is a bilayer serous membrane that lines the abdominal cavity. We present a review of peritoneal structure and physiology, with a focus on the peritoneal inflammatory response to surgical injury and its clinical implications. METHODS We conducted a nonsystematic clinical review. A search of the Ovid MEDLINE database from 1950 through January 2009 was performed using the following search terms: peritoneum, adhesions, cytokine, inflammation, and surgery. RESULTS The peritoneum is a metabolically active organ, responding to insult through a complex array of immunologic and inflammatory cascades. This response increases with the duration and extent of injury and is central to the concept of surgical stress, manifesting via a combination of systemic effects, and local neural pathways via the neuro-immuno-humoral axis. There may be a decreased systemic inflammatory response after minimally invasive surgery; however, it is unclear whether this is due to a reduced local peritoneal reaction. CONCLUSIONS Interventions that dampen the peritoneal response and/or block the neuro-immuno-humoral pathway should be further investigated as possible avenues of enhancing recovery after surgery, and reducing postoperative complications.
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Domnina YA, Yeo Y, Tse JY, Bellas E, Kohane DS. Spray-dried lipid-hyaluronan-polymethacrylate microparticles for drug delivery in the peritoneum. J Biomed Mater Res A 2009; 87:825-31. [PMID: 18257078 DOI: 10.1002/jbm.a.31741] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Application of controlled release technology to the peritoneum would allow for sustained drug levels. However, some polymeric systems either create adhesions, or rapidly exit the peritoneum; neither result is desirable. Here we have produced particles based on sphyngomyelin, a phospholipid that occurs naturally in the peritoneum, along with hyaluronic acid and the polymethacrylate Eudragit E100 (to modulate drug release). Particles with a low proportion of E100 (5% (w/w); "high SPM") release albumin rapidly over 2 days, then more slowly; increasing the E100 to 20% (w/w; high "E100") slowed drug release markedly. When injected in the murine peritoneum, high SPM particles were disseminated as free particles, without forming collections. There was a mild inflammatory response but no formation of adhesions. High E100 particles formed collections in all animals, with an intense inflammatory response. Even so, there were very few adhesions. These results suggest that microparticulate formulations can be produced that have acceptable drug-releasing properties and are suitable for use in the peritoneum from the standpoint of biocompatibility.
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Affiliation(s)
- Yuliya A Domnina
- Division of Pediatric Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
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Butz N, Müller SA, Treutner KH, Anurov M, Titkova S, Oettinger AP, Schumpelick V. The influence of blood on the efficacy of intraperitoneally applied phospholipids for prevention of adhesions. BMC Surg 2007; 7:14. [PMID: 17651501 PMCID: PMC1945018 DOI: 10.1186/1471-2482-7-14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2007] [Accepted: 07/25/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The formation of adhesions following abdominal surgery is a well known problem. In previous studies we demonstrated the efficacy and safety of intraperitoneally applied phospholipids in order to prevent adhesion formation. This study evaluates the influence of blood on the efficacy of intraperitoneally applied phospholipids for prevention of adhesions. METHODS In 40 Chinchilla rabbits adhesions were induced by median laparotomy, standardized abrasion of the visceral and parietal peritoneum in defined areas of the ventral abdominal wall and the caecum. The animals were randomly divided into four groups. They received either phospholipids 3.0% or normal saline (NaCl 0.9%) (5 ml/kg body weight). In 50% of the rabbits we simulated intraperitoneal bleeding by administration of blood (1.5 ml/kg body weight). The other half served as control group. Ten days following the operation the animals were sacrificed and adhesion formation was assessed by computer aided planimetry and histopathologic examination. RESULTS The median adhesion surface area in the NaCl-group (n = 9) amounted to 68.72 mm2, in the NaCl+Blood-group (n = 10) 147.68 mm2. In the Phospholipid (PhL)-group (n = 9) the median adhesion surface area measured 9.35 mm2, in the PhL+Blood-group (n = 9) 11.95 mm2. The phospholipid groups had a significantly smaller adhesion surface area (p < 0.05). CONCLUSION Again these results confirm the efficacy of phospholipids in the prevention of adhesions in comparison to NaCl (p = 0.04). We also demonstrated the adhesion preventing effect of phospholipids in the presence of intraperitoneal blood.
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Affiliation(s)
- Nick Butz
- Department of Surgery, Medical Faculty Rhenish-Westphalian Technical University, Aachen, Germany
| | - Stefan A Müller
- Department of Surgery I, Klinikum Mutterhaus der Borromäerinnen, Trier, Germany
| | | | - Michail Anurov
- Joint Institute for Surgical Research Russian Medical State University, Moscow, Russia
| | - Svetlana Titkova
- Joint Institute for Surgical Research Russian Medical State University, Moscow, Russia
| | - Alexander P Oettinger
- Joint Institute for Surgical Research Russian Medical State University, Moscow, Russia
| | - Volker Schumpelick
- Department of Surgery, Medical Faculty Rhenish-Westphalian Technical University, Aachen, Germany
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Binnebösel M, Klinge U, Rosch R, Junge K, Lynen-Jansen P, Schumpelick V. Morphology, quality, and composition in mature human peritoneal adhesions. Langenbecks Arch Surg 2007; 393:59-66. [PMID: 17605037 DOI: 10.1007/s00423-007-0198-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Accepted: 05/04/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIM Peritoneal adhesions are caused by intra-abdominal surgery and can lead to relevant complications. Adhesions are supposed to consist of avascular scar tissue. The aim of the present study was to analyze whether mature postsurgical adhesions even after years still reveal a dynamic remodeling process. MATERIALS AND METHODS In a prospective analysis, we investigated tissue specimen of peritoneal adhesions in 40 patients after abdominal surgery. Expression of five parameters representing wound healing and remodeling were examined (MMP-2, Ki-67, apoptosis, collagen/protein ratio, and collagen type I/III ratio). RESULTS Gender, age, and the number of previous operations had no impact on the parameters measured. Adhesion specimens were cell rich, containing mononuclear round cells, fibroblasts, adipose cells, and vascular endothelial cells. There was a positive expression of MMP-2 and apoptosis, whereas Ki-67 was marginal irrespective of adhesion maturity or quality. Adhesions classified as dense showed a significant increase in total collagen (118.2 +/- 4.9 microg/mg) and collagen type I/III ratios (3.9 +/- 0.2), whereas there were no significant differences regarding the adhesion maturity. CONCLUSION The distinct composition of cellular components as well as of extracellular matrix proteins may reflect an interactive cross-talk between adhesion- and stroma-derived cells even in mature adhesions. Our findings support the hypothesis that the disabilities of appropriate repair of the peritoneal surface leading to persistent adhesions are a consequence of a permanent process of disturbed remodeling.
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Affiliation(s)
- Marcel Binnebösel
- Department of Surgery, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074 Aachen, Germany.
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Otto J, Jansen PL, Lucas S, Schumpelick V, Jansen M. Reduction of peritoneal carcinomatosis by intraperitoneal administration of phospholipids in rats. BMC Cancer 2007; 7:104. [PMID: 17584925 PMCID: PMC1913062 DOI: 10.1186/1471-2407-7-104] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Accepted: 06/21/2007] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Intraperitoneal tumor cell attachment after resection of gastrointestinal cancer may lead to a developing of peritoneal carcinosis. Intraabdominal application of phospholipids shows a significant decrease of adhesion formation even in case of rising tumor cell concentration. METHODS In experiment A 2*106 colonic tumor cells (DHD/K12/Trb) were injected intraperitonely in female BD-IX-rats. A total of 30 rats were divided into three groups with treatments of phospholipids at 6% or 9% and the control group. In experiment B a total of 100 rats were divided into ten groups with treatments of phospholipids at 9% and the control group. A rising concentration of tumor cells (10,000, 50,000, 100,000, 250,000 and 500,000) were injected intraperitonely in female BD-IX-rats of the different groups. After 30 days, the extent of peritoneal carcinosis was determined by measuring the tumor volume, the area of attachment and the Peritoneal Cancer Index (PCI). RESULTS In experiment A, we found a significant reduction (control group: tumor volume: 12.0 +/- 4.9 ml; area of tumor adhesion: 2434.4 +/- 766 mm2; PCI 28.5 +/- 10.0) of peritoneal dissemination according to all evaluation methods after treatment with phospholipids 6% (tumor volume: 5.2 +/- 2.2 ml; area of tumor adhesion: 1106.8 +/- 689 mm2; PCI 19.0 +/- 5.0) and phospholipids 9% (tumor volume: 4.0 +/- 3.5 ml; area of tumor adhesion: 362.7 +/- 339 mm2; PCI 13.8 +/- 5.1). In experiment B we found a significant reduction of tumor volume in all different groups of rising tumor cell concentration compared to the control. As detected by the area of attachment we found a significant reduction in the subgroups 1*104, 25*104 and 50*104. The reduction in the other subgroups shows no significance. The PCI could be reduced significantly in all subgroups apart from 5*104. CONCLUSION In this animal study intraperitoneal application of phospholipids resulted in reduction of the extent of peritoneal carcinomatosis after intraperitoneal administration of free tumor cells. This effect was exceptionally noticed when the amount of intraperitoneal tumor cells was limited. Consequently, intraperitoneal administration of phospholipids might be effective in reducing peritoneal carcinomatosis after surgery of gastrointestinal tumors in humans.
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Affiliation(s)
- Jens Otto
- Department of Surgery, University Clinic RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany
| | - Petra Lynen Jansen
- Department of Surgery, University Clinic RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany
| | - Stefan Lucas
- Department of Surgery, University Clinic RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany
| | - Volker Schumpelick
- Department of Surgery, University Clinic RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany
| | - Marc Jansen
- Department of Surgery, University Clinic RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany
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Davey AK, Maher PJ. Surgical adhesions: a timely update, a great challenge for the future. J Minim Invasive Gynecol 2007; 14:15-22. [PMID: 17218224 DOI: 10.1016/j.jmig.2006.07.013] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Revised: 07/27/2006] [Accepted: 07/29/2006] [Indexed: 02/06/2023]
Abstract
Damage to the peritoneum during abdominal surgery triggers a cascade of events aimed at repairing the damage. As part of this process, fibrin is deposited, which is the precursor to the formation of an adhesion between 2 damaged peritoneal surfaces. This can have a significant impact on morbidity and even mortality as well as large cost implications. Strategies to reduce adhesion formation include improving surgical techniques, optimizing laparoscopy conditions, using pharmacologic interventions targeted at the inflammatory response and/or fibrin deposition, and using agents that provide a physical barrier to adhesion formation. While these strategies have provided some success, none have yet proved totally successful in abolishing adhesions. Further research to ensure that adhesion prevention is optimal is therefore essential.
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Affiliation(s)
- Andrew K Davey
- Sansom Institute, University of South Australia, Adelaide, South Australia.
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Yiyang Z, Qunxi C, Weiling W. Closure vs. nonclosure of the peritoneum at cesarean delivery. Int J Gynaecol Obstet 2006; 94:103-7. [PMID: 16784747 DOI: 10.1016/j.ijgo.2006.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2006] [Revised: 04/16/2006] [Accepted: 05/03/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare the frequency and severity of celiac adhesions following cesarean sections performed with and without closure of the parietal and visceral peritoneum. METHODS A retrospective cohort study involved 612 women who underwent their second lower-segment transverse cesarean section. RESULTS Nonclosure of the parietal peritoneum at the time of the first cesarean section was associated with significantly more visceral adhesions than closure (16.2% vs. 8.1%; P=0.003), and closure of the visceral peritoneum had a similar effect (16.1% vs. 6.7%; P=0.02). However, the difference in rates of severe adhesions was not statistically significant (12.9% vs. 17.6%; P=0.12). After controlling for confounding variables, it was found that closure of the parietal peritoneum reduced the rate of visceral adhesions 2.7-fold. Trial of labor before and fever after surgery increased the risk of severe adhesions 6.1-fold and 5.6-fold, respectively. CONCLUSION Nonclosure of the peritoneum at primary cesarean section is associated with a significantly increased risk of visceral adhesions.
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Affiliation(s)
- Zhu Yiyang
- Department of Obstetrics and Gynecology, Taizhou Hospital, Wenzhou Medical College, Lin Hai City, Zhejiang Province, China.
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Jansen M, Jansen PL, Otto J, Kirtil T, Neuss S, Treutner KH, Schumpelick V. The inhibition of tumor cell adhesion on human mesothelial cells (HOMC) by phospholipids in vitro. Langenbecks Arch Surg 2006; 391:96-101. [PMID: 16534652 DOI: 10.1007/s00423-006-0025-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Accepted: 12/21/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIMS Intraperitoneal tumor cell adhesion to extracellular matrix and to mesothelial cells mediated by integrins is an important step in developing peritoneal carcinosis. In former animal studies, we could demonstrate that intraperitoneal treatment with a new phospholipid (PL) emulsion significantly reduces the amount of peritoneal carcinosis by adhesion prevention. This in vitro study tries to elucidate the influence of phospholipids on cells of the human gastric cancer cell line (NUGC-4) and the human rectal cancer cell line (HRT-18) adhering to mesothelial cells (HOMC) in a monolayer culture in vitro. MATERIALS AND METHODS HOMC cells were derived from omentum majus from patients undergoing elective abdominal surgery. Three passages of both cancer cell lines (NUGC-4 and HRT-18) were used. 1x10(5)/100 microl (HRT-18) or 1.2x10(5)/100 microl (NUGC-4) cells, according to forgoing dilution series, were pretreated with different concentrations of phospholipid emulsion (0.05, 0.1, 0.5, 0.75, 1% PL) stained with cell tracker chloromethyl-benzamidodialkylcarbocyanine (CM-DIL) and seeded into each well on the mesothelial monolayer. After 90 min, the number of adherent cells was counted by fluorescence microscopy at 530 and 620 nm. Additionally, flow cytometric analysis of integrin alpha3 and beta1 expression on the tumor cell surface after treatment with phospholipids was completed. RESULTS We found a dose dependent effect of phospholipids on both tumor cell lines causing a reduction of cell-cell adhesion. Already low concentrations of phospholipids (PL 0.5) had a significant influence. The mean cell count could be reduced from 234+/-12/mm2 in controls to 124+/-41/mm2 (PL 0.5; NUG-4) and from 295+/-49/mm2 to 169+/-29/mm2 (PL 0.5; HRT-18), respectively. Additionally, the integrin alpha3 and beta1 expression on both cell lines could be reduced. CONCLUSION Our results within the scope of published data indicate that adhesion prevention is capable to reduce peritoneal carcinosis.
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Affiliation(s)
- M Jansen
- Department of Surgery, University Clinic, RWTH Aachen, Pauwelsstr. 30, 52057, Aachen, Germany.
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Jansen M, Treutner KH, Jansen PL, Zuber S, Otto J, Tietze L, Schumpelick V. Inhibition of gastric cancer cell adhesion in nude mice by inraperitoneal phospholipids. World J Surg 2005; 29:708-14. [PMID: 15895297 DOI: 10.1007/s00268-005-7583-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Adhesion of tumor cells to mesothelial cells or extracellular matrix components is a pivotal step in developing peritoneal dissemination after gastric cancer. As phospholipids were found to reduce adhesion formation, especially at sites of peritoneal lesions, we assessed the inhibition of attachment of NUGC-4 gastric cancer cells by local treatment with phospholipids to the peritoneum in nude mice. Gastric cancer cells (1xl0(6)) suspended in either normal saline (controls) or phospholipid suspension 75 mg/kg body weight (PL75) or 150 mg/kg (PL150) were injected intraperitoneally into 90 female BALB/c nu/nu mice. The treatment groups were subdivided into animals with defined peritoneal lesions and animals without lesions. After 30 days the extent of peritoneal carcinosis and the Peritoneal Cancer Index were evaluated. Statistical analysis was performed with two factorial ANOVAs. The level of significance was adjusted according to Bonferrorni (alpha = 0.00278). During a 90-day observation period the survival rate was determined using the log rank test. After 30 days the intraperitoneal tumor volume was reduced by PL150 up to 0.6 ml (SEM 0.16) and 0.48 ml (SEM 0.09) in mice with peritoneal lesions compared to 0.9 ml (SEM 0.2) and 0.9 ml (SEM 0.1) in the control group (P = 0.04). The mean area of tumor adhesion amounted to 145 mm(2) (SEM 17) (P = 0.08) and 164 mm(2) (SEM 32.8) (P = 0.049) with peritoneal lesions after treatment with PL150 [controls: 216 mm(2) (SEM 28.5) and 245 mm(2) (SEM 29.3)]. The peritoneal cancer index was 16.4 (SEM 1.7) in the control group and 9 (SEM 1.68) with PL150 (P = 0.0002). In the subgroup with peritoneal lesions, the respective values were as follows: controls: 20.8 (SEM 0.85); PL 150:14.3 (SEM 1.07) (P = 0.0001). We found a prolonged survival rate after treatment with PL150. However, this effect was not significantly different to that seen in the control group. Treatment with PL75 had no significant influence. Phospholipids may be an efficacious and economic tool for reducing peritoneal tumor cell adhesion and consequently the development of peritoneal carcinosis after resection of gastric cancer.
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Affiliation(s)
- Marc Jansen
- Department of Surgery, University Clinic, RWTH Aachen Pauwelsstrasse 30, Aachen, 52057, Germany.
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Jansen M, Treutner KH, Schmitz B, Otto J, Jansen PL, Neuss S, Schumpelick V. Phospholipids reduce gastric cancer cell adhesion to extracellular matrix in vitro. BMC Gastroenterol 2004; 4:33. [PMID: 15625005 PMCID: PMC544579 DOI: 10.1186/1471-230x-4-33] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2004] [Accepted: 12/29/2004] [Indexed: 12/04/2022] Open
Abstract
Background Nidation of floating tumour cells initiates peritoneal carcinosis and limits prognosis of gastro-intestinal tumours. Adhesion of tumour cells to extracellular matrix components is a pivotal step in developing peritoneal dissemination of intraabdominal malignancies. Since phospholipids efficaciously prevented peritoneal adhesion formation in numerous animal studies we investigated their capacity to reduce adhesions of gastric cancer cells to extracellular matrix components (ECM). Methods Human gastric cancer cells (NUGC-4, Japanese Cancer Research Resources Bank, Tokyo, Japan) were used in this study. Microtiter plates were coated with collagen IV (coll), laminin (ln) and fibronectin (fn). Non-specific protein binding of the coated wells was blocked by adding 1% (w/v) BSA (4°C, 12 h) and rinsing the wells with Hepes buffer. 50.000 tumour cells in 100 μl medium were seeded into each well. Beside the controls, phospholipids were added in concentrations of 0.05, 0.1, 0.5, 0.75 and 1.0/100 μl medium. After an incubation interval of 30 min, attached cells were fixed and stained with 0.1% (w/v) crystal violet. The dye was resuspended with 50 μl of 0.2% (v/v) Triton X-100 per well and colour yields were then measured by an ELISA reader at 590 nm. Optical density (OD) showed a linear relationship to the amount of cells and was corrected for dying of BSA/polystyrene without cells. Results The attachment of gastric cancer cells to collagen IV, laminin, and fibronectin could be significantly reduced up to 53% by phospholipid concentrations of 0.5 mg/100 μl and higher. Conclusion These results, within the scope of additional experimental studies on mice and rats which showed a significant reduction of peritoneal carcinosis, demonstrated the capacity of phospholipids in controlling abdominal nidation of tumour cells to ECM components. Lipid emulsions may be a beneficial adjunct in surgery of gastrointestinal malignancies.
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Affiliation(s)
- Marc Jansen
- Department of Surgery, University Clinic, Pauwelsstr. 30, 52057 Aachen, Germany
| | - Karl-Heinz Treutner
- Department of Surgery, University Clinic, Pauwelsstr. 30, 52057 Aachen, Germany
| | - Britta Schmitz
- Department of Surgery, University Clinic, Pauwelsstr. 30, 52057 Aachen, Germany
| | - Jens Otto
- Department of Surgery, University Clinic, Pauwelsstr. 30, 52057 Aachen, Germany
| | - Petra Lynen Jansen
- Interdisciplinary Centre of Clinical Research (IZKF) Biomat; University Clinic, Pauwelsstr. 30, 52057 Aachen, Germany
| | - S Neuss
- Institute of Pathology, University Clinic, Pauwelsstr. 30, 52057 Aachen, Germany
| | - Volker Schumpelick
- Department of Surgery, University Clinic, Pauwelsstr. 30, 52057 Aachen, Germany
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Jansen M, Treutner KH, Jansen PL, Otto J, Schmitz B, Mueller S, Weiss C, Tietze L, Schumpelick V. Phospholipids reduce the intraperitoneal adhesion of colonic tumor cells in rats and adhesion on extracellular matrix in vitro. Int J Colorectal Dis 2004; 19:525-32. [PMID: 15309464 DOI: 10.1007/s00384-004-0611-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2004] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the influence of intraperitoneal treatment with phospholipids on the formation of peritoneal carcinosis after inoculation of colonic tumor cells in rats. The presence of tumor cells in the peritoneal cavity serves as a prognostic marker for postoperative survival after resection of gastrointestinal cancer. Intraperitoneal tumor cell attachment is a pivotal step in developing peritoneal carcinosis. Intraabdominal application of phospholipids resulted in a significant decrease of adhesion formation, especially at sites of peritoneal lesions. METHODS 2x10(6) colonic tumor cells (DHD/K12/TRb) were injected intraperitonely in female BD-IX rats. A total of 90 rats were divided into three groups with treatments of phospholipids at 75 mg/kg or 150 mg/kg bodyweight or sodium chloride at 0.9% in the control group. The treatment groups were subdivided into animals with defined peritoneal lesions and animals without lesions. After 30 days, the extent of peritoneal carcinosis was determined by measuring the tumor volume, the area of tumor attachment and the Peritoneal Cancer Index. Over a 90-day observation period, the survival rate was analyzed. In vitro, we examined the reduction of tumor cell adhesion on extracellular matrix components after treatment with phospholipids. Microtiter plates were coated with laminin, fibronectin or collagen IV for adhesion experiments. RESULTS In our study, we found a significant reduction of peritoneal dissemination with respect to all evaluation methods after treatment with phospholipids at 150 mg/kg in animals without peritoneal lesions. This could not be achieved using the lower concentration of phospholipids (75 mg/kg). In vitro, the maximum reductions of tumor cell adhesion by phospholipids compared with the control values for laminin and fibronectin were 46% and 37%, respectively, whereas for collagen IV the reduction was only 24% ( p<0.0001). CONCLUSIONS A new method of prevention of intraperitoneal tumor cell adhesion, possibly leading to a reduced incidence of peritoneal carcinosis after surgery of gastrointestinal tumors, is introduced.
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Affiliation(s)
- Marc Jansen
- Department of Surgery, University Clinic Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany.
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Müller SA, Treutner KH, Anurov M, Titkova S, Oettinger AP, Schumpelick V. Experimental evaluation of phospholipids and icodextrin in re-formation of peritoneal adhesions. Br J Surg 2003; 90:1604-7. [PMID: 14648743 DOI: 10.1002/bjs.4316] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Abstract
Background
The formation of further adhesions after adhesiolysis is a major problem. Not all agents that are supposed to reduce de novo adhesions can reduce further adhesion formation. The efficacy and safety of intraperitoneally applied phospholipids has been shown previously. This study evaluated the influence of phospholipids and icodextrin on adhesion re-formation.
Methods
In an experimental study on 60 Chinchilla rabbits adhesions were induced by standardized abrasion of defined areas of the ventral abdominal wall, the caecum and the ileum. Open adhesiolysis was performed 10 days later. The animals randomly received either 1·5 per cent phospholipids, 4 per cent icodextrin or Ringer's lactate intraperitoneally. Half of the animals in each group were killed after a further 10 days and the remainder at 20 days. Adhesion formation was assessed by computer-aided planimetry and histopathological examination.
Results
Phospholipids (10 days: P = 0·001; 20 days: P = 0·012) and icodextrin (10 days: P = 0·006; 20 days: P = 0·055) reduced adhesion re-formation after both intervals compared with Ringer's lactate controls.
Conclusion
Phospholipids and icodextrin were effective in preventing re-formation of adhesions.
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Affiliation(s)
- S A Müller
- Department of Surgery, Medical Faculty, Rhenish-Westphalian Technical University, Aachen, Germany.
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Bertram P, Treutner KH, Tietze L, Vicas M, Weiss C, Anurov M, Titkova S, Polivoda M, Oettinger AP, Schumpelick V. Effects of intra-abdominal drainages on adhesion formation and prevention by phospholipids in a rat model. Drainages and adhesion formation. Eur Surg Res 2003; 35:92-7. [PMID: 12679618 DOI: 10.1159/000069400] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2002] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS The study was designed to asses the adhesiogenic capacity of silicone drainages and the protective effect of phospholipids (PL). MATERIALS AND METHODS A total of 75 Wistar rats were randomly assigned to the different groups. In a preliminary trial (pt; n = 15), all rats underwent midline laparotomy. The control group (C(pt); n = 5) received no further treatment. In the other animals, either an 'easy flow' drainage (EF(pt); n = 5) or an 'Aachen' drainage (AC(pt); n = 5) was placed into the abdominal cavity. In the final study (fs; n = 60), rats underwent laparotomy and colonic anastomosis. The control groups (C(fs)) received no drainages. In the other groups either one of the two types of drainages (EF(fs), AC(fs)) were introduced. In 50% of the rats, 75 mg/kg of PL were administered intraperitoneally (C(fs)+PL, EF(fs)+PL, AC(fs)+PL). The other rats received no additional treatment (C(fs)ØPL, EF(fs)ØPL, AC(fs)ØPL). All animals were sacrificed 10 days after surgery. Areas of adhesions and anastomotic bursting pressures were measured (mean +/- SD). RESULTS In the preliminary trial, analysis of variance (ANOVA) revealed no differences between the groups after application of drainages (values are given in mean +/- SD): C(pt) mean 23.3 +/- 29.4 mm(2), EF(pt) 829.7 +/- 679.3 mm(2), AC(pt) 609.9 +/- 219.4 mm(2). In the final study, 2-factorial ANOVA showed a significant effect (p < 0.001) for the use of drainages but not for the application of PL (C(fs)ØPL 140.6 +/- 124.2 mm(2), C(fs)+PL 67.7 +/- 60.4 mm(2), EF(fs)ØPL 1,217.0 +/- 458.3 mm(2), EF(fs)+PL 1,266.8 +/- 368.3 mm(2), AC(fs)ØPL 861.7 +/- 274.8 mm(2), AC(fs)+PL 544.2 +/- 193.8 mm(2)). Post hoc test for pairwise comparisons adjusted to Bonferroni showed significant differences (p < 0.001) between all of the three pairs (C(fs) 104.1 +/- 92.3 mm(2) vs. EF(fs) 1,241.9 mm(2) +/- 413.3 mm(2); C(fs) vs. AC(fs) 702.9 mm +/- 234.3 mm(2); EF(fs) vs. AC(fs)). DISCUSSION The final study demonstrates the adhesiogenic capacity of silicone drainage tubes in combination with anastomoses. Any protective effect of PL alone or in combination with drainages could not be shown. CONCLUSIONS Indication for the use of drainages in standard surgical procedures should be reconsidered within the scope of their potential to cause adhesions and subsequent complications.
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Affiliation(s)
- P Bertram
- Department of Surgery, Rheinish-Westphalian Technical University, Aachen, Germany.
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Müller SA, Treutner KH, Jörn H, Anurov M, Oettinger AP, Schumpelick V. Phospholipids reduce adhesion formation in the rabbit uterine horn model. Fertil Steril 2002; 77:1269-73. [PMID: 12057739 DOI: 10.1016/s0015-0282(02)03094-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To access the ability of intraperitoneal phospholipids to reduce adhesions in a standardized model for gynecologic operations. DESIGN A randomized, experimental, blinded study using the double uterine horn model. SETTING Academic animal research laboratory. ANIMAL(S) Thirty-three Chinchilla rabbits. INTERVENTION(S) Phospholipids or Ringer's lactate were intraperitoneally administered after bilateral uterine horn injury. MAIN OUTCOME MEASURE(S) After 10 days, adhesions were evaluated concerning area and strength as well as scores describing tenacity and degree. RESULT(S) Phospholipids (median 102.1 mm2) significantly reduce adhesion areas in comparison to surgical controls (median 392.2 mm2) and Ringer group (median 323.8 mm2). Scores reflecting severity and degree of adhesions support this finding. CONCLUSION(S) These results prove the efficacy of phospholipids in the double uterine horn model. Future clinical studies are recommended.
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Affiliation(s)
- Stefan A Müller
- Department of Surgery, Medical Faculty, Rhenish-Westphalian Technical University, Aachen, Germany.
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