Chinese expert consensus on the prevention of abdominal pelvic adhesions after gynecological tumor surgeries

Nanofiber Hydrogel Drug Delivery System for Prevention of Postsurgical Intestinal Adhesion

Intestinal adhesion is one of the complications that occurs more frequently after abdominal surgery. Postsurgical intestinal adhesion (PIA) can lead to a series of health problems, including abdominal pain, intestinal obstruction, and female infertility. Currently, hydrogels and nanofibrous films as barriers are often used for preventing PIA formation; however, these kinds of materials have their intrinsic disadvantages. Herein, we developed a dual-structure drug delivery patch consisting of poly lactic-co-glycolic acid (PLGA) nanofibers and a chitosan hydrogel (NHP). PLGA nanofibers loaded with deferoxamine mesylate (DFO) were incorporated into the hydrogel; meanwhile, the hydrogel was loaded with anti-inflammatory drug dexamethasone (DXMS). The rapid degradation of the hydrogel facilitated the release of DXMS at the acute inflammatory stage of the early injury and provided effective anti-inflammatory effects for wound sites. Moreover, PLGA composite nanofibers could provide sustained and stable release of DFO for promoting the peritoneal repair by the angiogenesis effects of DFO. The in vivo results indicated that NHP can effectively prevent PIA formation by restraining inflammation and vascularization, promoting peritoneal repair. Therefore, we believe that our NHP has a great potential application in inhibition of PIA.

Anti-infective therapy durations predict psychological stress and laparoscopic surgery quality in pelvic abscess patients

BACKGROUND

The degree of psychological stress and the difficulty and efficacy of laparoscopic surgery differ in patients with pelvic abscesses after different durations of anti-infection treatment.

AIM

To compare and analyse the effects of different durations of anti-infective therapy on patients’ preoperative psychological stress level and the clinical efficacy of laparoscopic surgery in patients with pelvic abscesses to offer a reference for the selection of therapy plans.

METHODS

A total of 100 patients with pelvic abscesses who were admitted to the Department of Gynecology of Suzhou Ninth Hospital affiliated to Soochow University (Suzhou Ninth People's Hospital) from January 2018 to December 2022 were retrospectively enrolled. According to the different durations of anti-infective therapy, they were divided into Group S (50 patients, received anti-infective therapy for 24-48 h) and Group L (50 patients, received anti-infective therapy for 48-96 h). Baseline data, state-trait anxiety score at admission and before surgery, self-rating anxiety scale (SAS) + self-rating depression scale (SDS) score, surgery time, adhesion grading score, intraoperative blood loss, presence or absence of intraoperative intestinal injury, ureteral injury or bladder injury, postoperative body temperature, length of hospital stay, and presence or absence of recurrence within 3 mo after surgery, chronic pelvic pain, incision infection, dysmenorrhea, menstrual disorder or intestinal obstruction were compared between the S group and the L group.

RESULTS

There was no significant difference in the background data between the S group and the L group (P < 0.05). There was no significant difference in the state-trait anxiety score or SAS + SDS score between the S group and the L group on admission (P < 0.05). The state-trait anxiety score and SAS + SDS score of the S group were lower than those of Group L after receiving different durations of anti-infective therapy (P < 0.05). There was no significant difference in the incidence of intestinal, ureteral or bladder injury between the S group and the L group (P < 0.05). The surgery time of Group S was shorter than that of Group L, and the adhesion score and intraoperative blood loss volume were lower than those of Group L (P < 0.05). There was no significant difference in the incidence of incision infection, dysmenorrhea, menstrual disorder or intestinal obstruction between the S group and the L group (P < 0.05). The postoperative body temperature of Group S was lower than that of Group L (P < 0.05), and the hospital stay was shorter than that of Group L (P < 0.05). The incidences of recurrence and chronic pelvic pain within 3 mo after surgery were lower than that of Group L (P < 0.05).

CONCLUSION

Twenty-four to forty-eight hours of anti-infective therapy is better than 48-96 h of anti-infective therapy for patients with pelvic abscesses because the degree of psychological stress is lower, which is more conducive to achieving better outcomes after laparoscopic surgery.

Transumbilical single-site laparoscopic parallel mattress suturing prevents bleeding and chronic pelvic pain in myomectomy: a retrospective cohort study of 124 cases with intramural fibroids

Background

The most common complications of myomectomy are intraoperative hemorrhage and postoperative adhesion. The key point to overcome this problem is to improve suture quality. However, to date, there is still no consensus on the optimal method of uterine repair. In this study, we explored the effectiveness and feasibility of single-site laparoscopic parallel mattress sutures to reduce intraoperative bleeding and postoperative adhesion.

Methods

A retrospective cohort analysis was performed, according to the STROBE guidelines, on 124 patients with intramural fibroids admitted between May 2020 and April 2021. The cases were divided into two groups based on the description of the uterine incision suture in the surgical records, including 68 cases in the parallel mattress suture (PMS) group and 56 cases in the simple continuous suture (SCS) group. Operation-related indicators, bleeding indicators, surgical complications, scar reduction index 1 month after surgery, and the incidence of chronic pelvic pain 6 months after the surgery were observed. Independent sample t-tests and Mann–Whitney U tests were performed for the measurement data, and Pearson Chi-square tests were performed for count data. Statistical significance was set at P < 0.05.

Results

There was no significant difference in the baseline characteristics between the two groups. All operations were performed under transumbilical single-site laparoscopy without conversion. Compared to the SCS group, the PMS group had earlier postoperative anal exhaust (14.3 ± 6.7 h vs. 19.2 ± 9.6 h, P = 0.002), fewer postoperative hemoglobin drops (7.6 ± 3.7 g/L vs. 11.6 ± 4.3 g/L, P = 0.000), smaller uterine scars (3.7 ± 1.9 cm vs. 5.2 ± 1.8 cm, P = 0.000), and a larger uterine scar reduction index (50.2% vs. 31.0%, P = 0.000) one month after surgery and less chronic pelvic pain 6 months after surgery (2.9% vs. 12.5%, P = 0.016). No difference was found in auxiliary trocar usage, transfusion rate, operation time, hospital stay, or perioperative complications between the two groups.

Conclusion

Seromuscular parallel mattress sutures during myomectomy can prevent pinhole errhysis of the uterine incision, achieve complete serosal and aesthetic incisions, and reduce postoperative chronic pelvic pain. It is effective and feasible to complete a parallel mattress suture during myomectomy via single-site laparoscopy. Further prospective studies are required to determine its efficacy as well as pregnancy outcomes.

The Future of Adhesion Prophylaxis Trials in Abdominal Surgery: An Expert Global Consensus

Postoperative adhesions represent a frequent complication of abdominal surgery. Adhesions can result from infection, ischemia, and foreign body reaction, but commonly develop after any surgical procedure. The morbidity caused by adhesions affects quality of life and, therefore, it is paramount to continue to raise awareness and scientific recognition of the burden of adhesions in healthcare and clinical research. This 2021 Global Expert Consensus Group worked together to produce consented statements to guide future clinical research trials and advise regulatory authorities. It is critical to harmonize the expectations of research, to both develop and bring to market improved anti-adhesion therapies, with the ultimate, shared goal of improved patient outcomes.

The Inhibitory Effects of Naringin in a Rat Model of Postoperative Intraperitoneal Adhesion Formation

Background

Many attempts have been made to inhibit the formation of postoperative intraperitoneal adhesions, but the results have been discouraging. Therefore, the identification of effective preventative measures or treatments is of great importance. In this study, the substantial potential of naringin (NG) to reduce peritoneal adhesions was validated in a rat model.

Materials and Methods

A rat peritoneal adhesion model was established by abrasion of the cecum and its opposite intraperitoneal region under aseptic surgical conditions. After the operation, three groups of NG-treated rats were given 2 mL of NG by gavage at different concentrations (40, 60, or 80 mg/kg/d). The sham, control, and hyaluronan (HA) groups were given equal volumes of normal saline daily. On the 8th day, all rats were sacrificed 30 min after the administration of an activated carbon solution (10 mL/kg) by oral gavage. Intraperitoneal adhesion formation was adequately evaluated by necropsy, hematoxylin and eosin (HE) staining, Sirius red staining, immunofluorescence staining, enzyme-linked immunosorbent assays, and reactive oxygen species (ROS) probes. The gastrointestinal dynamics of the rats were assessed on the basis of a small intestinal charcoal powder propulsion test and the detection of motilin and gastrin levels in serum.

Results

Intraperitoneal adhesions were markedly reduced in the group of rats receiving high-dose NG. Compared with the control group, the high-dose NG group showed clear reductions in inflammatory reactions, oxidative stress, collagen deposition, and fibroblast formation in the adhesion tissue and enhanced gastrointestinal dynamics (P < 0.05).

Conclusion

NG alleviated the severity of intraperitoneal adhesions in a rat model by reducing inflammation, oxidative stress, collagen deposition, and fibroblast formation, highlighting the potential of NG as a drug candidate to prevent postoperative peritoneal adhesion formation.