Intérêt des produits antiadhérentiels en chirurgie gynécologique

Investigation of the Effects of Boric Acid against Post Operative Testicular Adhesion Caused by Experimental Laporotomy in Rats

Post-operative intra-abdominal adhesions, significantly affecting testicular tissue, are a prevalent and serious complication following laparoscopic surgery. This study investigated the efficacy of boric acid, known for its antioxidant, anti-inflammatory, and anti-apoptotic properties, in preventing post-operative testicular adhesions. Forty rats, were divided into four groups: control, laparoscopy (LA), boric acid (BA), and LA + BA. Following laparoscopic surgery, BA treatment was administered for seven days. While the adhesion score was around 3 in the LA group, it was 1 or below in the LA + BA group. Testicular tissues were examined by histopathological and biochemical methods. In testis tissues, in the LA group, malondialdehyde (MDA) levels increased while superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) levels decreased; these parameters normalized with BA treatment. Additionally, the LA group exhibited reduced levels of IL-10, Bcl-2, Kisspeptin-1, and GnRH, alongside elevated levels of inflammatory markers IL-1β, IL-6, TNF-α, JNK, BAX, and Caspase 3. BA treatment significantly restored these levels to normal. In conclusion, oxidative stress, inflammation, and apoptosis in testicular tissues were associated with post-operative testicular adhesions. BA demonstrated potential as an anti-adhesive agent, reducing testicular adhesions and normalizing biochemical and histological parameters following laparoscopic surgery.

Chemically Modified Hyaluronic Acid for Prevention of Post-Surgical Adhesions: New Aspects of Gel Barriers Physical Profiles

This study was conducted to provide information regarding the chemistry—including structure, synthesis, formulation, and mechanical properties—of two types of chemically modified anti-adhesion gels made of hyaluronic acid. Gel A (Hyalobarrier®) and gels B and C (HyaRegen® and MetaRegen®) that are used in postsurgical adhesion prevention. To date, little information is available on their physicochemical attributes. This information is necessary in order to understand the differences in their in vivo behavior. Methods: Comparative analyses were conducted under laboratory-controlled conditions, including measuring the shear viscosity, storage modulus G’, peel strength, and extrusion forces. Results: All polymers exhibited viscoelastic behavior. Polymer A showed a shear viscosity approximately three times larger than both polymers B and C (114 Pa.s−1 vs. 36–38 Pa.s−1) over the shear-rate range measured, indicating a possible better ability to resist flows and potentially remain in place at the site of application in vivo. The results of storage modulus (G’) measurements showed 100 Pa for polymer A and 16 Pa and 20 Pa for polymers B and C, respectively. This translated into a weaker elastic behavior for gels B and C, and a lower ability to resist sudden deformation. The peel test results showed a rupture strength of 72 mN (0.016 lbf) for polymer A, 39.6 mN (0.0089 lbf) for polymer B, and 38.3 mN (0.0086 lbf) for polymers C, indicating possible higher adhesive properties for polymer A. Tests measuring the extrudability of the hyaluronic acid gels in their commercial syringes showed an average extrusion force of 20 N (4.5 lbf) for polymer A, 28 N (6.33 lbf) for polymer B, and 17 N (3.79 lbf) for polymer C. Conclusions: Modified anti-adhesion gels made of hyaluronic acid differed in mechanical properties and concentration. Further clinical studies are needed to confirm whether these differences make one polymer easier to apply during surgery and more likely to stay in place longer after in vivo application, and to determine which is potentially superior in terms of preventing adhesions.

The preventive effect of Met-RANTES on postoperative intraperitoneal adhesion formation in the rat model

BACKGROUND

Chemokines are proinflammatory proteins that participate in immune and inflammatory responses through chemoattraction and leukocyte activation. The chemokine antagonist Met-RANTES (Regulated upon Activation Normal T cell Expressed and Secreted) has been shown to be efficacious in decreasing inflammation in several animal disease models. The purpose of this study was to investigate the effects of administration of Met-RANTES on intra-abdominal adhesion formation after abdominal operation.

MATERIALS AND METHODS

A 42 and 4-month-old female Wistar-Albino rats were subjected to standardized lesions by cauterization of the cecum and uterine horn. They were divided randomly into 3 groups containing 14 rats each: group 1 (control), operative procedure without further treatment; group 2 (Seprafilm), operative procedure with an antiadhesive membrane; 2 x 1 cm of Seprafilm was interposed beneath the peritoneal incision, and group 3 (Met-RANTES), operative procedure with the chemokine antagonist Met-RANTES. The extent and severity of adhesions at the operative site were evaluated. Light microscopic examination was performed to determine semiquantitative scores of VEGF expression.

RESULTS

Rats in the control group formed extensive adhesions. In comparison with the control group, the adhesion scores were significantly lower in the 2 other groups. The immunohistochemical grading scores of vascular endothelial growth factor correlated closely with the total adhesion scores and were less in groups 2 and 3 (P < .005).

CONCLUSIONS

Selective chemokine suppression with Met-RANTES seems to decrease rates, extent, and severity of postoperative intraperitoneal adhesions.