Intra-abdominal Adhesions Research Articles

Suprahepatic space as an alternative site for distal catheter insertion in pseudocyst-associated ventriculoperitoneal shunt malfunction.

Distal catheter malfunction due to pseudocyst formation or intraabdominal adhesion is a significant problem, especially in pediatric patients who have limited sites for distal catheter insertion. In this study, the authors present a series of 12 patients with intractable distal shunt malfunctions due to peritoneal pseudocyst formation who underwent distal catheter replacement in the suprahepatic space to reduce the risk of distal catheter malfunction. Twelve consecutive patients with shunt malfunction due to pseudocyst formation who had undergone ventriculosuprahepatic shunting from 2014 to 2019 were identified. According to medical records, after primary evaluations, shunt removal, and antibiotic therapy, they underwent revision surgeries with placement of a distal catheter into the suprahepatic space. Nine boys and 3 girls, ranging in age from 5 months to 14 years, with one or more episodes of pseudocyst formation, underwent shunt revision with placement of a distal catheter into the suprahepatic space. After a median follow-up of 31 months, none of the patients experienced further distal malfunction. The suprahepatic space appears to be a safe place to secure the distal end of a ventricular catheter following pseudocyst formation, with less risk of re-adhesion. This lower risk might be attributable to the lack of omentum in the suprahepatic space.

A LIP Abdominal Tuberculosis Classification System for Surgery

Tubercular infection can occur in various organs and tissues; however, abdominal tuberculosis is a common form of extrapulmonary tuberculosis after tubercular lymphadenitis. The treatment strategies and surgical indications for different types of abdominal tuberculosis are also not illustrated. This study aimed to create a classification scheme to guide the treatment strategy. The data of abdominal tuberculosis patients admitted to Shaanxi Tuberculosis Hospital from December 2012 to December 2016 were reviewed. All diagnosed abdominal tuberculosis cases were classified into the following 4 types, according to the LIP classification system: lymphatic type (type-L), intestinal type (type-I), peritoneum type (type-P), and mixed type. The differences in medical cure rate, surgical cure rate, postoperative complication rate, and mortality between the patients were compared. The medical cure rate of type-P was the highest of all 4 types (91.7%). The intra-abdominal adhesion of type-I abdominal tuberculosis was milder than those of the other types; hence, laparoscopic surgery can be considered. The incidence of postoperative complications of the mixed type was the highest of the 4 types at 22.7%. The mortality rate of type-L was the highest of the 4 types at 20%. In total, 3 of the 4 deceased mixed patients were found to have L-type abdominal tuberculosis. There were significant differences in the cure rate, complication rate, and mortality rate among the 4 types. The χ2 values were 38.895, 8.253, and 8.601, respectively. The P values were < 0.001, 0.023, and 0.013, respectively. The LIP classification can guide the treatment of abdominal tuberculosis.

ARE DRAIN FLUID AMYLASE LEVELS HELPFUL ON SECREENING PANCREATIC FISTULA SECONDARY TO PANCREATIC INJURY DURING EMERGENCY SPLENECTOMY?

Objective: Splenectomy is a major surgical intervention that brings several complications as well as saving life in the surgical treatment of blunt/penetrating spleen trauma. Although it is a highly standardized procedure in terms of the surgical technique used, pancreatic tail injuries can also be observed, especially during dissection and ligation of the splenic hilum. In this study, we investigated the possible helpful effects of the amylase levels of serum and drainage fluid when there was suspicion for pancreatic injury during splenic hilum dissection.Material and Methods: Forty-two patients who underwent splenectomy under emergency conditions for splenic injury secondary to acute trauma were included in the study. Nine of the patients developed pancreatic leakage/fistula (Group-1), while 33 did not in the control group (Group-2). Amylase levels measured in both the drain in the site of the surgery and in the serum at postoperative 8, 24, 48 and 72nd hours period were compared. Patients with severe systemic diseases and former hepatobiliary disease excluded.Results: There was no statistically significant difference in mean blood amylase levels between Group-1 and Group-2 (p&amp;gt;0.05), however, when it was examined with regard to the measured mean amylase levels, the measurement values of Group-1 were significantly higher than those of Group-2 (p&amp;lt;0.05).Conclusion: Considering tissue ischemia-necrosis, intraabdominal infection-abscesses, possible intraabdominal adhesions, and other serious complications occurred secondary to chemical trauma as a result of the dissemination of pancreatic secretions into the peritoneal cavity, it is very important to protect the peritoneal cavity from contact with these enzymes. For this purpose, we suggest that the use of early stage drainage fluid amylase measurement is very important.

Pure Robotic-assisted Level IV Inferior Vena Cava Thrombectomy for Angiomyolipoma Without Cardiopulmonary Bypass: A First Report

ObjectiveTo report the initial case of robotic-assisted level IV inferior vena cava (IVC) tumor thrombectomy, with the supra- and infradiaphragmatic caval segments managed purely by a robotic-assisted technique. MethodsA 67-year-old female presented with a 5.3 × 2.4 cm right renal tumor and a level IV IVC tumor thrombus, 16.5 cm in length, extending 1.5 cm into the right atrium. Through a robotic trans-abdominal approach, the infrarenal and retrohepatic IVC, left renal vein and right kidney were secured. Using a robotic transthoracic approach, the thrombus was milked out of the right atrium. The intrapericardial caval segment was secured and the right atrium was excluded. No cardiopulmonary bypass was used. A cavotomy was made at the right renal vein os and the tumor thrombus was extracted en bloc in a retrograde manner under transesophageal echocardiographic visualization. ResultsTotal operative time was 211 minutes, including robotic docking, with 90 minutes spent on taking down intraabdominal adhesions. Caval clamp time was 13 minutes. Estimated blood loss was 100 mL. Postoperatively, the patient developed atrial fibrillation with rapid ventricular rate (RVR) requiring diltiazem infusion (Clavien Grade II). Hospital stay was 5 days. There were no further complications. Pathology revealed an Angiomyolipoma and negative surgical margins. ConclusionThis is the initial report of a purely robotic-assisted level IV IVC tumor thrombectomy. We used this technique for an angiomyolipoma with tumor thrombus extending 1.5cm into the right atrium, managing both the supra- and infradiaphragmatic caval segments robotically. This report further extends the field of robotic surgery.

A fatal acute appendicitis with sepsis and pneumonia was caused by melioidosis: a case report

We report anunderdiagnosed fatal case of melioidosis that involved dygestion system which complicated with pneumonia, and sepsis. The case was initially diagnosed as acute appendicitis, and subsequently the patient underwent an exploratory laparatomy and appendectomy. He was discharged afer 3 days of hospitalization. Thirty days afterward, he was admitted to another private hospital to experience another exploratory laparatomy with indication of pancreatitis, intra-abdominal organs adhesions, and postoperative enterocutaneous fistula (ECF), and hospitalized there for 25 days. He eventually suffered from sepsis, pneumonia, unclosed ECF, anemia, hypoalbuminemia, and electrolyte imbalance. He then referred to a tertiary teaching hospital and hospitalized there for a total 134 days until he passed away. His clinical condition was declining, despite a long course of broad spectrum antibiotics. Treatment delay, prolong hospitalization, and complications were the inevitable, although Burkholderia pseudomallei was finally identified 2 weeks prior to his death. This case highlight that melioidosis canassociate with acute appendicitis, and that the delay on its diagnosis and treatment may trigger complications and death.

A Novel Rat Model to Test Intra-Abdominal Anti-adhesive Therapy.

Background: Adhesion formation after abdominal surgery is considered almost inevitable and a major cause of morbidity. Novel treatments have been proposed, however there is a lack of suitable small animal models for pre-clinical evaluation, mainly due to inconsistency in adhesion formation in positive control animals. Here, we propose a new rat model of abdominal adhesions using Kaolin as the adhesion-inducing agent at an optimized dosage for testing newer agents in respect to their anti-adhesive property.Materials and Methods: Twenty-five adult (8–10 week old) male Wistar albino rats underwent midline laparotomy and caecal abrasion and were randomized to receive topical applications of normal saline or different concentrations and volumes of a Kaolin-based formulation. At day 14 rats were humanely killed, and adhesions graded macroscopically by an investigator blinded to the treatment groups, using pre-determined adhesion scores and microscopically using histopathology.Results: Kaolin at 0.005 g/mL caused consistent adhesions without compromising rat viability. At higher doses significant morbidity and mortality was observed in the animals treated.Conclusions: Kaolin induced adhesion in a rat abdominal surgery model is reliable and can be safely used to test the efficacy of novel anti-adhesive formulations to prevent intra-abdominal adhesions.

Does applied ultrasound prior to laparoscopy predict the existence of intra-abdominal adhesions?

Background/aim The purpose of this study was to evaluate the efficacy of trans-abdominal ultrasonography (USG), a noninvasive diagnostic tool, in predicting the presence of intraabdominal adhesions, especially near the trocar entry area, to provide safe surgical access to the abdomen.Materials and methods Fifty-nine women with a previous history of open abdominal surgery (group A) and a group of 91 women with no previous history of surgery (group B) underwent dynamic ultrasound evaluation of the abdominal fields before laparoscopic operations. The anterior abdominal wall was divided into six quadrants: right upper, right lower, left upper, left lower, suprapubic, and umbilical. Adhesions were evaluated by surgeons during the operation and by radiologists using USG prior to the operation. Visceral organ movements greater than 1 cm was defined as normal visceral slide (positive test), with less than 1 cm of movement defined as abnormal visceral slide (negative test). Sliding test measures movements of omental echogenicity or a stable echogenic focus that corresponds to intestine peritoneal echogenicity that underlies abdominal wall during exaggerated inspiration and expiration. Adhesions observed during surgery were evaluated on a four-point scale, with 0 indicating no adhesions present, 1 indicating the presence of a thin, filmy avascular adhesion, 2 indicating the presence of a dense and vascular adhesion, and 3 indicating adhesions that connect surrounding organs with the overlying peritoneal surfaces. The McNemar test was used to compare the results of USG and laparoscopy for each measure. Results We found that preoperative USG was successful in identifying adhesions [sensitivity, 96.39% (95% CI 89.8–99.2); specificity, 97.43%]Conclusion Preoperative ultrasound examination of the abdominal wall may enhance the safety of abdominal entry during laparoscopic operations.

Evaluation of the efficacy of platelet-rich plasma in preventing postoperative intraabdominal adhesions.

Postoperative intraabdominal adhesions still maintain their currency as serious causes of morbidity and mortality. This study aimed at evaluating the role of platelet-rich plasma (PRP) in the prevention of intraabdominal adhesions. A total of 16 healthy rabbits were used within the scope of the study. The animals were allocated into two groups as Group 1 (control group) and Group 2 (study group). In all subjects, cecal abrasion was formed by laparotomy. In the study group, platelet rich plasma was administered intraabdominally. At the end of the study, the adhesions were evaluated by Nair's Score. Total adhesion score in Group 1 was 8, while the mean score was 1. On the other hand, total adhesion score in Group 2 was 12, while the mean score was 1.5. There was no statistical difference between both groups by total adhesion score and mean fibrosis score. However, mean scores for inflammatory cell infiltration and angiogenesis were higher in Group 2 and the differences were statistically significant (p= 0.021). We were not able to report the positive results of PRP; however, we believe that we shed an important light for future studies which might be conducted using the combination of different methods.

A facile strategy for fabricating composite patch scaffold by using porcine acellular dermal matrix and gelatin for the reconstruction of abdominal wall defects.

Defects of the abdominal wall continue to be a significant issue in regenerative medicine and tissue engineering. Porcine acellular dermal matrix (P-ADM) and gelatin have been widely used for fabricating engineered abdominal wall due to their good biocompatibility and integration with host tissues. In this study, we demonstrate a novel and reproducible approach of using gelatin and P-ADM powder to fabricate composite patch scaffolds by combining solvent casting and enzymatic cross-linking for the abdominal wall regeneration in rats. Different concentration ratios of gelatin and P-ADM and different shapes of engineered scaffolds are studied for various abdominal wall defects. Skeletal muscle cells and human umbilical vein endothelial cells can successfully attach to the surface of the scaffolds and maintain high viability after culturing for five days. In vivo experiments demonstrate that there are no signs of infection, intra-abdominal adhesion, and severe inflammation after two weeks, which indicate good repairability of the scaffolds. In conclusion, we propose a novel method that holds great potential for building engineered scaffolds to meet the different requirements of abdominal wall regeneration.

Topical Application of High-Dose Mesna Prevents Adhesion Formation: An Experimental Animal Study

BackgroundAdhesion formation is a common complication of abdominal surgeries. Mesna is a drug with fibrinolytic properties which has been used in surgical field to facilitate tissue dissection. The aim of this experimental animal study was to investigate the effect of mesna on prevention of intra-abdominal adhesion in rats. Materials and methodsTwenty-eight Wistar albino rats were used in the study. To create abdominal adhesion, cecum was abraded in all rats. No additional surgical procedure was performed other than adhesion in group 1 (only adhesion). In the other groups, rats were treated topically by administering 0.9% saline (group 2), 40 mg/kg mesna (group 3), and 400 mg/kg mesna (group 4). All rats were sacrificed on postoperative 21st day. Histopathological and macroscopic evaluations of adhesion formation were performed. ResultsQuantity of adhesion scores (P = 0.022), severity of adhesion scores (P = 0.041), total adhesion scores (P = 0.023), and histopathological adhesion grading scores (P < 0.001) were reduced by 400 mg/kg mesna. ConclusionsThis is the first study for mesna on prevention of abdominal adhesion formation in rats. We concluded that dose-dependent reduction of adhesion was achieved by mesna. With future studies, topical administration of mesna during open abdominal surgeries may be used to prevent adhesion formation.

Assessment of the diagnostic efficacy of abdominal ultrasonography and cine magnetic resonance imaging in detecting abdominal adhesions: A double-blind research study

PurposeThis cohort aimed to determine the efficacy and safety of abdominal ulrasonography and cine-MRI by a double-blind study in the diagnosis of intraabdominal organs and abdominal wall adhesions in patients with previous abdominal operations. MethodsBetween 2017 and 2019, 108 consecutive patients were prospectively included in the study. Visceral slide and induced visceral slide were measured during AU and cine-MRI. An abdominal map consisting of nine segments was created to document the location and extent of the adhesion. The degree and severity of the adhesions detected by the radiologist preoperatively and detected in surgery as the gold standard was recorded in the same abdominal zones. AU, c-MRI and intraoperative findings were correlated. ResultsThe mean age was 53.0 ± 10.3 years, body mass index was 30.4 ± 3.4, male (52.8 %) and female (47.2 %). According to the total nine zones, the sensitivity of AU was 91.4 %, specificity was 100 %, positive predictive value was 90.7 %, negative predictive value was 100 % and diagnostic accuracy was 87.9 %. Considering the total zones, the sensitivity of c-MRI was 90.8 %, specificity was 100 %, PPV was 90.7 %, NPV was 100 % and diagnostic accuracy was 91.7 %. A comparison of AU and c-MRI showed no significant difference in the detection of adhesions to the abdominal wall; however, c-MRI was superior in detecting intraabdominal organs adhesion. ConclusionWe have demonstrated that AU and c-MRI are accurate for diagnosing adhesions in patients undergoing repeated surgery and may have a place on planning elective laparoscopic or open surgery to avoid bowel injury.

The effects of ozone therapy on postoperative adhesions and ovarian functions: An experimental study

Aim: Numerous methods are used to prevent the development of postoperative adhesion formation. There are few studies on the effects of ozone therapy on postoperative intraabdominal adhesions and ovarian functions. This study aimed to investigate the effects of ozone treatment on postoperative intraabdominal adhesions and ovarian roles in rats.Methods: Twenty female Wistar albino rats were randomly allocated into two groups as laparotomy (Group 1, n: 10) and laparotomy + intraperitoneal ozone (Group 2, n: 10). After laparotomy, parietal peritoneum, uterus and adnexal surfaces were scraped in both groups. Follicle-stimulating hormone (FSH), Estradiol (E2), Lactate Dehydrogenase (LDH), Urea, and Creatinine levels were measured, and histopathological evaluation was performed. Both groups were compared concerning histopathological and biochemical findings.Results: In the ozone-treated group, antioxidant levels (P=0.012) were significantly higher, and E2 levels (P=0.005) were substantially lower than the control group. There was no statistically significant difference between the two groups regarding FSH, Urea, Creatinine, and LDH (P=0.12, P=0.72, P=0.45, and P=0.79, respectively). Histopathologically, postoperative intraabdominal adhesion rates between the two groups were statistically similar.Conclusion: Although there was no statistically significant difference, ozone therapy had a decreasing effect on severe fibrosis and congestion rates. Although there was no difference in FSH, low levels of E2 in Group 2 suggest that ozone treatment may have a protective effect on the ovaries. However, further studies are needed concerning adhesion formation and the impact on ovarian functions.

P105 PREDICTIVE FACTORS FOR DEVELOPING SMALL BOWEL OBSTRUCTIONS AFTER ILEAL RESECTION IN PATIENTS WITH CROHN’S DISEASE

Abstract Background and Aims Patients with Crohn’s disease (CD) may require small bowel resections. Unfortunately, some of these patients may develop post-operative small bowel obstructions (SBO). Many clinicians perceive ileal resections dramatically increase the risk of developing SBO in the future, but the incidence and risk factors to developing SBO are poorly described. The primary aim of this study is to document the incidence and factors associated with the development of SBO not related to recurrence of disease in CD patients that undergo ileal resection. We also sought to assess long-term outcomes of this complication. Methods We performed a retrospective cohort study including patients aged 18 years or older with CD, who have had ileocecal resection with ileocolonic anastomosis or segmental small bowel resection. Data abstracted included demographics, phenotype and therapies of CD, disease recurrence post-ileal resection and multiple surgical variables. The primary outcome was the development of SBO within 5 years post-surgery not including obstructions secondary to recurrence of CD. Results 92 total patients were included in the analysis. All had a colonoscopy within a year of the surgery. The mean Rutgeerts score was 0 (interquartile range [IQR] 0 to 2) and the mean short endoscopic score was 0 (IQR 0 to 4). The remainder of baseline characteristics are shown in Table 1. At 6 months, 1 year, and 5 years, the rate of SBO was 4/92 (4%), 6/92 (6.5%), and 15/92 (16%), respectively. Throughout follow-up, only 5 patients had an SBO attributed to intra-abdominal adhesions and only 2 patients required surgical lysis of adhesions. Patients that were found to have histologic inflammation in the margins of the resected bowel specimen had a significantly higher chance of developing an SBO within 5 years of the initial surgery (OR: 4.5 [95%CI: 1.3–15.3], p=0.02 - Table 2). Conversely, patients with either active endoscopic and/or radiologic inflammation on post surgical surveillance colonoscopy did not have a higher risk of developing an SBO within 5 years of the initial surgery (p=0.37). Finally the length of bowel resected at the index surgery was not associated with the development of an SBO (AUC: 0.62, p=0.18). Conclusions The incidence of SBO after ileal resection in CD is low and resolves with medical management on most cases. Inflammation in the margins of the resected bowel and previous bowel resections were associated with new SBO within 5 years. These results must take into account the study population were monitored and cannot be extrapolated to those patients that lost follow-up.

The Effectiveness of Laparoscopic-assisted Percutaneous Endoscopic Gastrostomy in Patients with Unfavorable Anatomy: A Single-center Retrospective Cohort Study.

Percutaneous endoscopic gastrostomy (PEG) is an easy means to provide enteral access in patients unable to maintain adequate nutrition via the oral route. In patients with morbid obesity, altered intra-abdominal anatomy due to prior abdominal surgery, the interposition of the colon or other factors precluding endoscopy, feeding tube placement by laparoscopic means (LAPEG) can provide a potentially safe alternative. The objective of this study was to examine the efficacy and outcomes of laparoscopic-assisted placement of PEG in adult patients. This is a retrospective cohort analysis of adult patients, who underwent PEG and/or laparoscopic-assisted percutaneous endoscopic gastrostomy placement (LAPEG) by two surgeons at a single institution. A total of 36 patients underwent PEG and/or LAPEG. No significant differences were found in the total and postoperative length of stay and mortality. There were no procedure-related complications in the LAPEG group versus two in the PEG group (8.7%), but this did not reach statistical significance. LAPEG was 100% successful in gaining enteral feeding access in patients that had failed PEG. The most common reason for PEG placement failure was colonic interposition (39%), followed by intra-abdominal adhesions and gastric displacement by hiatal hernia (each 23%). 38.5% of LAPG procedures could be done via 5-mm single port access, 38.5% required two-port and 23% required three-port access. In conclusion, LAPEG is a feasible minimally invasive alternative to gain enteral feeding access in patients that have failed PEG that does not increase the length of stay, morbidity or mortality.

Effects of vitamin E, methylprednisolone and nedocromil sodium on healing of rats with experimentally created intraabdominal adhesions

IntroductionIntraabdominal adhesions are a condition that can occur after many surgical procedures and may cause complications in a spectrum ranging from simple abdominal pain to ileus. For years, efforts have been made to prevent this complication. In this experimental study, the effects of methylprednisolone, vitamin E and nedocromil sodium on the improvement of intraabdominal adhesions in rats were investigated.Material and methodsTwenty Wistar Albino rats weighing 280 to 330 g were divided into four equal groups. 5 ml of 0.9% NaCl was given to the control group, 5 ml of methylprednisolone was given to group 2, 5 ml of vitamin E to group 3 and 5 ml of nedocromil sodium to group 4 were given intraabdominally. On the 14th postoperative day, all rats were sacrificed and re-laparotomy was performed. Intraabdominal adhesions were scored according to the Nair classification.ResultsWhen the groups were compared dyadically, the difference between group 1 and group 2 was found to be statistically significant (p = 0.011). The difference between group 1 and group 3 was statistically significant (p = 0.011). The difference between group 1 and group 4 was statistically significant (p = 0.007). There was no statistically significant difference between group 2 and group 3, and group 2 and group 4, and group 3 and group 4 (p &lt; 0.05).ConclusionsAs a result, methylprednisolone, vitamin E and nedocromil sodium have been shown to have a healing effect on adhesions.

Effects of polyurethane membrane on septic colon anastomosis and intra-abdominal adhesions.

Anastomotic leakages and adhesions after gastrointestinal tract surgery are still a significant cause of morbidity and mortality. The rate of anastomotic leakage is 3%-8%, whereas the mortality from leakage is over 30%. Intra-abdominal sepsis is a well-known cause of anastomotic leakage. In addition, intra-abdominal adhesion is a major cause of hospital admissions and reoperations and is associated with morbidity and mortality. In this study, we aimed to investigate the effects of a polyurethane membrane on anastomotic healing and intra-abdominal adhesions. This study used 32 Wistar albino rats divided into four groups. Standard resection of left colon 2 cm above the peritoneal reflection and colonic anastomosis were performed after causing abdominal sepsis through caecal ligation and perforation. The control groups (1 and 3) received no further treatment. The experimental groups (2 and 4) received the polyurethane membrane around the colonic anastomosis. Burst pressure, hydroxyproline, interleukin-6 (IL-6), nitric oxide (NO), tissue plasminogen activator (tPA), and tumor necrosis factor-alpha (TNF-α) levels were measured, and histopathological characteristics of the anastomosis were analyzed after re-laparotomy. Moreover, adhesion scores were measured. No statistically significant differences were found in the mean burst pressure levels between sacrificed animals on days three and five (p=0.259, p=0.177). When all the groups were compared, no significant difference was observed in the hydroxyproline, NO, and IL-6 levels (p=0.916, p=0.429, p=0.793, p=0.332, p=0.400, p=0.317). However, in groups 2 and 4, the tPA levels were significantly increased by Opsite therapy (p=0.001, p=0.003), and a statistically significant difference was observed in the adhesion scores (p<0.035). Groups 2 and 4 had significantly lower adhesion scores than groups 1 and 3. We found that Opsite therapy had no positive or negative effects on histopathological and biochemical healing in the experimental septic colon anastomosis model. However, the perianastomotic application of polyurethane membrane effectively decreased the intra-abdominal adhesions.

Cesarean bladder injury - obstetrician's nightmare.

Urinary bladder is an adjacent viscus susceptible for intraoperative injury during cesarean section (CS). Prolonged labor, scarred uterus, intraabdominal adhesion, emergency CS, advanced labor, cesarean hysterectomy etc., are the predisposing factors for bladder injury during CS. While operating on such conditions, one should be meticulous to explore the possibility of bladder injury. Family physician practicing community obstetrics should be aware of this and know how to tackle this. Usually the dome of the bladder is injured and the trigonal area remains away from the injury field by 6–10 cm. Bladder rent is repaired in two layers either by continuous simple or interrupted suture with 3-0 & 2-0 polyglycolic acid suture. Suprapubic cystostomy and transurethral catheter are kept for 10–14 days. While postoperative adhesion, CS during full dilatation of cervix, abnormal anatomy etc., may not proceed for negligence, bladder injury in normal patients and unrecognized intraoperative bladder injury may attract penalty from the consumer court.

Boric acid is as effective as hyaluronic acid-based agent in preventing intra-abdominal adhesions in a rat model.

In this experimental rat model, we aimed to investigate boric acid's possible protective effect against the formation of post-operative abdominal adhesions through its anti-inflammatory and antioxidant properties. Forty healthy male albino rats were randomly and evenly allocated to vehicle, hyaluronic acid-based (HA-b) material, boric acid 50 (BA50), boric acid 100 (BA100), and sham groups. Intra-abdominal adhesions were induced by mechanical cecal abrasion. Macroscopic and pathologic assessments of the adhesions were done and tissue tumor necrosis factor-α (TNF-α) and transforming growth factor-β1 (TGF-β1) levels were measured. Total abdominal adhesion scores were 129.7, 91.07, 53.77, 90.07, and 140.5 for the vehicle, HA-b, BA50, BA100, and sham groups, respectively, with the highest score indicating more severe adhesions. A significant difference in fibrosis scores was noted between both BA50 and BA100, and the sham group (p=0.018). When objective parameters were analyzed, TNF-α levels were significantly lower in the BA50 group than the sham, BA100, and vehicle groups (p=0.01, 0.019, and 0.03, respectively). TGF-β1 levels were also significantly lower in BA50 group than the sham, BA100, and the vehicle groups (p=0.013, 0.016, and 0.05, respectively). No difference was observed for any parameter between BA50 group and HA-b group. Topical boric acid at a dose of 50 mg/kg is found safe and as effective as the hyaluronic acid-based agent in preventing postoperative abdominal adhesions in our rat model.

The effectiveness of Teucrium chamaedrys L. extracts on endometriotic implant regression in rat endometriosis model.

The aim of the present study was to investigate the therapeutic effects of Teucrium chamaedrys L. (Lamiaceae) in the experimentally induced endometriosis in rats. Endometrial tissue was implanted into the abdominal wall of thirty Sprague Dawley rats; the rats with endometriosis were randomized into five groups and treatment procedure was performed for three weeks. The treatment groups were orally treated with three different extracts of Teucrium chamaedrys. Buserelin acetate (20.00 mg) was given as a reference drug. Vehicle was administered alone to the control group. All rats were sacrified at the end of the experiment. The endometriotic implants were measured, intra-abdominal adhesions were scored and the tissue samples were histopathologically investigated. After the treatment procedure, the volumes of endometrial implant and adhesions were detected to be significantly decreased in the T. chamaedrys extracts treated groups compared to the control group. Therapeutic effect of the T. chamaedrys extracts could be attributed to the both nonpolar and polar secondary metabolites. The study conceived that the different polarity extracts of T. chamaedrys could be beneficial in the treatment of endometriosis.

Experimental evaluation of intra-abdominal adhesions comparing two different intraperitoneal meshes and the effect of a natural anti-inflammatory product on their formation.

Purpose:In laparoscopic incisional hernia repair, meshes with a tissue-separating barrier are positioned intraperitoneally. Despite this property, the close contact between mesh and viscera involves a risk of adhesion formation. Some natural products, such as red propolis (RP), could reduce these adhesions owing to their anti-inflammatory properties. This study aimed to compare two different intraperitoneal meshes with respect to their characteristics of adhesion formation, histological findings and evaluate the role of RP in the development of these adhesions.Methods:40 Wistar rats received placement of two different meshes (Symbotex and Dynamesh IPOM) on peritoneum. The animals were divided into two groups: control group (mesh) and treatment group (mesh and RP). After 7 and 14 days, 20 animals of each group underwent midline laparotomy to determine the adhesions and histological characteristics.Results:Out of the 40 animals, there were two deaths in the test group and two in the control group. All animals in both groups developed adherence to the mesh. At postoperative day (POD) 7, two Symbotex meshes presented firm adhesions and at POD 14, two Dynamesh meshes had firm adhesions as well. The comparison between the meshes under the effect of RP in relation to the control group showed no statistical difference.Conclusions:Both meshes showed intraperitoneal adhesions in all evaluated samples with similar results on the characteristics of adhesions. RP showed no effect on the incidence or gradation of intraperitoneal adhesions with the mesh.