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Kobaylarda Postoperatif Adezyonların Önlenmesinde Hyaluronic Acid/Carboxymethylcellulose'un Etkisi

Year 2008, Volume: 41 Issue: 1, 33 - 37, 01.04.2008

Abstract

İt is well known that appropriate surgical techniçue alone will help decrease but not prevent intraabdominai adhesion for-mation. İt is necessary to use adjuvant therapy that falls into two main categories, drugs and barriers. This study was designed to determine the effectiveness of HA/CMC (Hyaluronic acid/Carboxymethylcellulose) as a barrier agent for preventing postoperative adhesions and also to determine whether it alters abdominal wound tensile strength. An adhesion forming State was created by traumatization of peritoneal and serozal surfaces and inocuiation of self biood on traumatized areas in 30 guinea pigs. HA/CMC was applied between the viscera and the abdominai wall before laparotomy clo-sure in the experimental group (n= 15). Three weeks after the operation the adhesion scores were obtained and the abdominai wall wound was evaiuated for tensile strength. Adhesion formation was significantly lower in the study group compared to the control group (U= 197, p< 0.05). There were no statistically significant difference for tensile strength betvveen the two groups (U=113, p> 0.05). HA/CMC has no adverse effect on wound tensile strength, while significantly lovvering adhesion formation. However, it does not totally prevent it. Future investigations on its insufficient States and causes will help in obtaining successfui results.

References

  • Oeutsch AA, Eviatar E, Gutman H. Small bowel obstruction: A review o f 264 cases and suggestions for management. Postgrad Med J 1989;65:463-7.
  • Holmdahl L, Risberg B, Beck DE. Aesions: Pathogenesis
  • and prevention-panel discussion and summary. E J Surg Suppl 1997;(577):56-62.
  • Risberg B. Adhesions: Preventive strategies. Eur J Surg
  • Suppl 1997;(577):32-9.
  • Sumbtiloglu K, Siimbilloglu V. Biyoistatistik. Ed 8, Hatipoğlu Yayınevi, Ankara 1998.
  • Moreira H, Wexner SD, Yamaguchi T. Use o f bioresorbabie
  • membrane (sodium hyaluronate + carboxymethylcellulose) after controlled bowel injuries in a rabbit model. Dis Colon Rectum 2000;43:182-7.
  • AlponatA ö Lakshminarasappa SR, Yavuz N. Prevention of adhesions by Seprafilm, an absorbabte adhesion barrier: An incisional hernia model in rats. Am Surg 1997;63:818-9.
  • Baptista ML, Bosnack ME, Delaney JP. Seprafilm reduces
  • adhesions to polypropylene mesh. Surgery 2000;128:86-92.
  • Binsmore RC; Calton WC, Harvey SB. Prevention o f adhe­
  • sions to polypropylene mesh in a traumatized bowel model. JA m Coll Surg 2000;191:131-6.
  • Szabo A, Haj M, Waxsman I. Evaluation o f Seprafilm and
  • amniotic membrane as adhesion prophylaxis in mesh repair o f abdominal. Wall hernia in rats. E ur Surg Res 2000;32:125-8.
  • Becker JM, Dayton MT, Fazio VW. Prevention o f postoper- ative abdominal adhesions by a sodium hyaluronate-based bioabsorbable membrane: A prospective, randomized, dou- ble-blind, multicenter study. J Am Coll Surg 1996;183:297- 306.
  • Diamond M P Reduction o f adhesions after uterine myomectomy by Seprafilm membrane (HAL-F): A blinded, prospective, randomized, m ulticenter clinical study. Seprafilm adhesion Study Group. Fertil Steril 1996;66:904- 10.
  • Alponat A, Lakshminarasappa SR, Teh M. Effects o f physi- cal barriers in prevention o f adhesions: An incisional hernia model in rats. J Surg Res 1997;68:126-32.
  • Buckenmaier CC, Pusateri AE, Harris RA. Comparison of antiadhesive treatments using objective rat model. Am Surg 1999;65:274-82.
  • Harris ES, Morgan RF, Rodeheaver GT. Analysis o f the kinetics of peritoneal adhesion formation in the rat and eval­ uation of potential antiadhesive agents. Surgery 1995; 117:663-9.
  • Heidrick GW, Pippitt CH Jr, Morgan MA. Efficacy of intraperitoneal sodium carboxymethylcellulose in preventing postoperative adhesion formation. J Reprod Med 1994;39: 575-8.
  • Hemadeh O, Chilukuri S, Bonet V. Prevention o f peritoneal adhesions b y administration o f sodium carboxymethylcellu- lose oraI vitamin E. Surgery 1993;114:907-10.
  • Gehlbach DL, O'HairKC, ParksAL. Combined effects oftis- sue plasminogen activator and carboxymethylcellulose on adhesion reformation in rabbits. Int J Fertil Menopausal Stud 1994;39:172-6.
  • Qrtega-Moreno J. Effects o f TC7 associated to 32% dextran 70, heparin and carboxymethylcellulose in adhesion pre­ vention in the rat. Arch Gynecol Obstet 1993;253:27-32.
  • Shushan A, Mor-Yosef S, Avgar A. Hyaluronic acid for pre­ venting experimental postoperative intraperitoneal adhe­ sions. J Reprod Med 1994;39:398-402.
  • Reijnen MM, Meis JF, Postma VA. Prevention of intraab- dominal abscesses and adhesions using a hyaluronic acid solution in a rat peritonitis model. Arch Surg g 1999;134: 997-1001.
  • Suzuki Y, Yamaguchi T. Effects o f hyaluronic acid on macrophage phagocytosis and active oxygen release. Agents Actions 1993;38:32-7.
  • YleigeIPH, Fuller GM, LeBoeuf RD. A model for the role of hyaluronic acid and fibrin in the early events during the inflammatory response and wound healing. J Theor Biol 1986;119:219-26.
  • Hau T, Payne WD, Simmons RL. Fibrinolytic activity o f the peritoneum during experimental peritonitis. Surg Gynecol Obstet 1979;148:415-8.
  • Van Goor H, Bom VJ, Van der Meer J. Coagulation and fib­ rinolytic responses o f human peritoneal fluid and plasma to bacterial peritonitis. Br J Surg 1996;83:1133-5.
  • Van Goor H, De GraafJ, GrondJ. Fibrinolytic activity in the abdominal cavity o f rats with faecal peritonitis. Br. J Surg 1994;81:1046-9.
  • McKee CM, Penno MB, Cowman M. Hyaluronan (HA) frag- ments induce chemokine gene expression in alveolar macrophages. The role o f HA size and CD44. J d in Invest 1996;98:2403-13.
  • Noble PW, Lake FR, Henson PM. Hyaluronate activation of CD44 induces insulinHike growth factor-1 expression by a tumor necrosis factor-alpha-dependent mechanism in murine macrophages. J CUn Invest 1993;91:2368-77.
  • Buckenmaier CC, Summers MA, Hetz SP. Effect o f the anti­ adhesive treatments, carboxymethylcellulose combined with recombinant tissue plasminogen activator and HA- CMC, on bowel anastomosis in the rat. Am Surg 2000;66: 1041-5.
  • Medina M, Paddock FİN, Connolly RJ. Novel antiadhesion barrier does not prevent anastomotic healing in a rabbit model. J Invest Surg 1995;8:179-86.
  • Van. Oosterom FJ,
  • van Lanschot JJ. Hyaluronic
  • acid/carboxymethylcellulose membrane surrounding an
  • intraperitoneal or subcutaneous jejunojejunostomy in rats.
  • Eur J Surg 2000;166:654-8.
  • Bothin C, Okada M, Midtvedt T. The intestinal flora influ- ences adhesion formation around surgical anastomoses. Br J Surg 2001;88:143-5.

The Effect of Hyaluronic Acid/Carboxymethylcellulose in the Prevention of Postoperative Adhesion in Guinea Pigs

Year 2008, Volume: 41 Issue: 1, 33 - 37, 01.04.2008

Abstract

Uygun cerrahi tekniğin tek başına adezyon oluşumunu azaltmaya yardımcı olabileceği fakat adezyon oluşumunu tümden engellemeye yetmeyeceği iyi bilinmektedir, ilaçlar ve bariyerler olmak üzere 2 ana grupta toplanan yardımcı yöntem kullanımı gereklidir. Bizim bu deneysel çalışmadaki amacımız, hem genel cerrahi hem de jinekoloji kliniklerinde giderek daha yaygın kullanılmaya başlanan, bariyer materyali HA-CMC'nin, adezyon oluşumunu engellemedeki etkinliğini, yara gerilim kuvveti üzerine olumsuz etkisinin olup olmadığını belirlemektir. Laparotomi sırasında peritoneal ve serozal hasar ile kan kullanılarak adezyojenik ortam oluşturulan 30 kobayın yarısına, batın kapatılmadan önce HA-CMC yerleştirildi. 3 haftanın sonunda yüksek doz eter anestezisi ile deneklerin hayatları sonlandı-rıldıktan sonra adezyon skorlaması ve yara gerilim kuvveti ölçümleri yapıldı. Adezyon oluşumu, çalışma grubunda kontrol grubuna göre anlamlı ölçüde daha azdı (U= 197, p< 0.05). Gruplar arasında, yara gerilim kuvvetlen yönünden istatistiksel anlamlı fark gözlenmedi (U= 113, p> 0.05). HA-CMC, yara gerilim kuvveti üzerine olumsuz etki yapmadan adezyon oluşumunu anlamlı derecede azaltmış fakat tamamen önleyememiştir. Yetersiz kaldığı durumların irdelenmesi, daha başarılı sonuçların alınmasına yardımcı olacaktır.

References

  • Oeutsch AA, Eviatar E, Gutman H. Small bowel obstruction: A review o f 264 cases and suggestions for management. Postgrad Med J 1989;65:463-7.
  • Holmdahl L, Risberg B, Beck DE. Aesions: Pathogenesis
  • and prevention-panel discussion and summary. E J Surg Suppl 1997;(577):56-62.
  • Risberg B. Adhesions: Preventive strategies. Eur J Surg
  • Suppl 1997;(577):32-9.
  • Sumbtiloglu K, Siimbilloglu V. Biyoistatistik. Ed 8, Hatipoğlu Yayınevi, Ankara 1998.
  • Moreira H, Wexner SD, Yamaguchi T. Use o f bioresorbabie
  • membrane (sodium hyaluronate + carboxymethylcellulose) after controlled bowel injuries in a rabbit model. Dis Colon Rectum 2000;43:182-7.
  • AlponatA ö Lakshminarasappa SR, Yavuz N. Prevention of adhesions by Seprafilm, an absorbabte adhesion barrier: An incisional hernia model in rats. Am Surg 1997;63:818-9.
  • Baptista ML, Bosnack ME, Delaney JP. Seprafilm reduces
  • adhesions to polypropylene mesh. Surgery 2000;128:86-92.
  • Binsmore RC; Calton WC, Harvey SB. Prevention o f adhe­
  • sions to polypropylene mesh in a traumatized bowel model. JA m Coll Surg 2000;191:131-6.
  • Szabo A, Haj M, Waxsman I. Evaluation o f Seprafilm and
  • amniotic membrane as adhesion prophylaxis in mesh repair o f abdominal. Wall hernia in rats. E ur Surg Res 2000;32:125-8.
  • Becker JM, Dayton MT, Fazio VW. Prevention o f postoper- ative abdominal adhesions by a sodium hyaluronate-based bioabsorbable membrane: A prospective, randomized, dou- ble-blind, multicenter study. J Am Coll Surg 1996;183:297- 306.
  • Diamond M P Reduction o f adhesions after uterine myomectomy by Seprafilm membrane (HAL-F): A blinded, prospective, randomized, m ulticenter clinical study. Seprafilm adhesion Study Group. Fertil Steril 1996;66:904- 10.
  • Alponat A, Lakshminarasappa SR, Teh M. Effects o f physi- cal barriers in prevention o f adhesions: An incisional hernia model in rats. J Surg Res 1997;68:126-32.
  • Buckenmaier CC, Pusateri AE, Harris RA. Comparison of antiadhesive treatments using objective rat model. Am Surg 1999;65:274-82.
  • Harris ES, Morgan RF, Rodeheaver GT. Analysis o f the kinetics of peritoneal adhesion formation in the rat and eval­ uation of potential antiadhesive agents. Surgery 1995; 117:663-9.
  • Heidrick GW, Pippitt CH Jr, Morgan MA. Efficacy of intraperitoneal sodium carboxymethylcellulose in preventing postoperative adhesion formation. J Reprod Med 1994;39: 575-8.
  • Hemadeh O, Chilukuri S, Bonet V. Prevention o f peritoneal adhesions b y administration o f sodium carboxymethylcellu- lose oraI vitamin E. Surgery 1993;114:907-10.
  • Gehlbach DL, O'HairKC, ParksAL. Combined effects oftis- sue plasminogen activator and carboxymethylcellulose on adhesion reformation in rabbits. Int J Fertil Menopausal Stud 1994;39:172-6.
  • Qrtega-Moreno J. Effects o f TC7 associated to 32% dextran 70, heparin and carboxymethylcellulose in adhesion pre­ vention in the rat. Arch Gynecol Obstet 1993;253:27-32.
  • Shushan A, Mor-Yosef S, Avgar A. Hyaluronic acid for pre­ venting experimental postoperative intraperitoneal adhe­ sions. J Reprod Med 1994;39:398-402.
  • Reijnen MM, Meis JF, Postma VA. Prevention of intraab- dominal abscesses and adhesions using a hyaluronic acid solution in a rat peritonitis model. Arch Surg g 1999;134: 997-1001.
  • Suzuki Y, Yamaguchi T. Effects o f hyaluronic acid on macrophage phagocytosis and active oxygen release. Agents Actions 1993;38:32-7.
  • YleigeIPH, Fuller GM, LeBoeuf RD. A model for the role of hyaluronic acid and fibrin in the early events during the inflammatory response and wound healing. J Theor Biol 1986;119:219-26.
  • Hau T, Payne WD, Simmons RL. Fibrinolytic activity o f the peritoneum during experimental peritonitis. Surg Gynecol Obstet 1979;148:415-8.
  • Van Goor H, Bom VJ, Van der Meer J. Coagulation and fib­ rinolytic responses o f human peritoneal fluid and plasma to bacterial peritonitis. Br J Surg 1996;83:1133-5.
  • Van Goor H, De GraafJ, GrondJ. Fibrinolytic activity in the abdominal cavity o f rats with faecal peritonitis. Br. J Surg 1994;81:1046-9.
  • McKee CM, Penno MB, Cowman M. Hyaluronan (HA) frag- ments induce chemokine gene expression in alveolar macrophages. The role o f HA size and CD44. J d in Invest 1996;98:2403-13.
  • Noble PW, Lake FR, Henson PM. Hyaluronate activation of CD44 induces insulinHike growth factor-1 expression by a tumor necrosis factor-alpha-dependent mechanism in murine macrophages. J CUn Invest 1993;91:2368-77.
  • Buckenmaier CC, Summers MA, Hetz SP. Effect o f the anti­ adhesive treatments, carboxymethylcellulose combined with recombinant tissue plasminogen activator and HA- CMC, on bowel anastomosis in the rat. Am Surg 2000;66: 1041-5.
  • Medina M, Paddock FİN, Connolly RJ. Novel antiadhesion barrier does not prevent anastomotic healing in a rabbit model. J Invest Surg 1995;8:179-86.
  • Van. Oosterom FJ,
  • van Lanschot JJ. Hyaluronic
  • acid/carboxymethylcellulose membrane surrounding an
  • intraperitoneal or subcutaneous jejunojejunostomy in rats.
  • Eur J Surg 2000;166:654-8.
  • Bothin C, Okada M, Midtvedt T. The intestinal flora influ- ences adhesion formation around surgical anastomoses. Br J Surg 2001;88:143-5.
There are 41 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Savaş Tezel This is me

Reha Özgüven This is me

Selma Tunçol This is me

Publication Date April 1, 2008
Published in Issue Year 2008 Volume: 41 Issue: 1

Cite

APA Tezel, S. ., Özgüven, R. ., & Tunçol, S. . (2008). The Effect of Hyaluronic Acid/Carboxymethylcellulose in the Prevention of Postoperative Adhesion in Guinea Pigs. Acta Oncologica Turcica, 41(1), 33-37.
AMA Tezel S, Özgüven R, Tunçol S. The Effect of Hyaluronic Acid/Carboxymethylcellulose in the Prevention of Postoperative Adhesion in Guinea Pigs. Acta Oncologica Turcica. April 2008;41(1):33-37.
Chicago Tezel, Savaş, Reha Özgüven, and Selma Tunçol. “The Effect of Hyaluronic Acid/Carboxymethylcellulose in the Prevention of Postoperative Adhesion in Guinea Pigs”. Acta Oncologica Turcica 41, no. 1 (April 2008): 33-37.
EndNote Tezel S, Özgüven R, Tunçol S (April 1, 2008) The Effect of Hyaluronic Acid/Carboxymethylcellulose in the Prevention of Postoperative Adhesion in Guinea Pigs. Acta Oncologica Turcica 41 1 33–37.
IEEE S. . Tezel, R. . Özgüven, and S. . Tunçol, “The Effect of Hyaluronic Acid/Carboxymethylcellulose in the Prevention of Postoperative Adhesion in Guinea Pigs”, Acta Oncologica Turcica, vol. 41, no. 1, pp. 33–37, 2008.
ISNAD Tezel, Savaş et al. “The Effect of Hyaluronic Acid/Carboxymethylcellulose in the Prevention of Postoperative Adhesion in Guinea Pigs”. Acta Oncologica Turcica 41/1 (April 2008), 33-37.
JAMA Tezel S, Özgüven R, Tunçol S. The Effect of Hyaluronic Acid/Carboxymethylcellulose in the Prevention of Postoperative Adhesion in Guinea Pigs. Acta Oncologica Turcica. 2008;41:33–37.
MLA Tezel, Savaş et al. “The Effect of Hyaluronic Acid/Carboxymethylcellulose in the Prevention of Postoperative Adhesion in Guinea Pigs”. Acta Oncologica Turcica, vol. 41, no. 1, 2008, pp. 33-37.
Vancouver Tezel S, Özgüven R, Tunçol S. The Effect of Hyaluronic Acid/Carboxymethylcellulose in the Prevention of Postoperative Adhesion in Guinea Pigs. Acta Oncologica Turcica. 2008;41(1):33-7.