Intraperitoneal Adhesions Research Articles

The Influence of Enzymes on Adhesive Processes in the Abdominal Cavity

Intraperitoneal adhesions remain a common problem after abdominal surgery. However, the advent of targeted, specific agents as a directed therapy against inflammatory and neoangiogenesis raises the prospect of a new approach for anti-adhesion strategies. 70 adult rats were divided into two groups: an enzyme group (35 rats) and a control group (35 rats). Following laparotomy the visceral peritoneum of the cecum and inner layer the abdominal cavity were abraded. In the enzyme group the preparation Wobenzym (a combination of animal and vegetable proteases plus rutoside) dissolved in 2 ml of sterile 0.9% NaCl was administered to the rats through a gastric probe over a period of 21 days. The control animals received the same quantity of saline without the preparation. On the 1st, 3rd, 7th and 21st postoperative days 8 animals from each group were sacrificed. VEGF, bFGF and laminin were detected in the visceral and parietal peritoneum by immunohistochemistry. The mean adhesion grades of the enzyme group were significantly lower than in the control group. A comparison of the two groups showed that the expression of VEGF, bFGF and laminin in the enzyme group was lower than in the control group. Moreover, in the enzyme group the concentration of bFGF and laminin peaked on the 7th day, while in the control group the maximum concentrations peaked on day 21. Our study found that oral poly-enzyme therapy following laparotomy and abrasion of the visceral and parietal peritoneum reduces the extent of postoperative intestinal adhesions. This favorable effect can be explained by the lower levels of angiogenic agents (VEGF, bFGF) and laminin after the administration of hydrolytic enzymes.

High resolution ultrasound for pre-operative detection of intraperitoneal adhesions: An invaluable diagnostic tool for the general and laparoscopic surgeon

Introduction The possibility of predicting the presence of intra-abdominal adhesions in post-surgical patients undergoing further laparotomy or laparoscopy is of great interest for the general and laparoscopic surgeon. Inadvertent enterotomy during re-laparotomy or trocar insertion is a feared complication with a significant associated morbidity and mortality occurring in 20% in open surgery and between 1% and 100% in laparoscopy. Materials and methods Sonographic study of the visceral slide (i.e. the “back and forth” movement of the peritoneal layer in rhythm with respiration in relation to the steady inner fascial layer) was the hallmark for free access to the peritoneal cavity. In 60 consecutive patients, aged 28–77, who had previously undergone open abdominal surgery, pre-operative ultrasound (US) was performed on Aloka 5.500 device (Aloka, Tokyo, Japan) using convex and linear multifrequency probes. Results The possibility of safely performing trans-umbilical open laparoscopy (TUOL) was US evaluated in 35 (58.3%) patients scheduled for various abdominal laparoscopic procedures. This approach was successfully performed in 26 patients (74.3%). In 2 (5.7%) it was attempted but had to be changed due to the presence of previously undetected adhesions. In 7 patients (20%) pneumoperitoneum was induced by means of a Veress needle positioned in the upper left quadrant due to the presence of midline adhesions, which were confirmed after trocar insertion. Among the remaining 25 patients who underwent re-laparotomy (41.6%), incision was performed outside the midline in 8 patients (32%) due to the presence of suspected midline adhesions, which were confirmed in 6 patients (24%). Conclusions In this study, pre-operative US evaluation showed a diagnostic accuracy of 93.3%.

Differential effects of rolipram on chronic subcutaneous inflammatory angiogenesis and on peritoneal adhesion in mice

The specific PDE4 inhibitor (rolipram) has been shown to attenuate excessive accumulation/activation of inflammatory cells and fibroblasts and cytokine production in several pathological conditions through cyclic nucleotide modulation. Here, using the murine sponge model to induce chronic subcutaneous inflammatory response and to elicit the formation of intraperitoneal adhesions we explored the hypothesis that rolipram would exert beneficial effects on decreasing key components of both processes (inflammatory cell recruitment, angiogenesis, and deposition of extracellular matrix component). Two doses of rolipram (0.2 or 2 mg/kg/day) were administered orally for 7 days in groups of mice bearing either subcutaneous or intraperitoneal polyether–polyurethane implants. Rolipram was effective in inhibiting angiogenesis as assessed by hemoglobin content and VEGF levels in subcutaneous implants (about 40% with both doses) but failed to exert this activity in intraperitoneal implants. Conversely, accumulation of neutrophils and macrophages determined by measuring myeloperoxidase (MPO) and N-acetylglucosaminidase (NAG) activities intraimplant, respectively, was attenuated only in intraperitoneal implants by the treatment. Levels of TNF-α and MCP-1 were also determined and rolipram at both doses decreased the production of both cytokines in intraperitoneal implants. The levels of MCP-1 in the subcutaneous implants were not affected by the treatment. Fibrosis was evaluated by determining the amount of collagen and production of TGF-β1 intraimplant. Both parameters were attenuated by rolipram. These results have shown differential sensitivity of proliferating tissues to PDE4 inhibitor indicating that this agent may be used to target inflammatory angiogenesis selectively.

Peritoneal Dialysis Catheter Insertion by Interventional Nephrologists

Peritoneal dialysis (PD) catheter placement is performed by surgeons, interventional radiologists, and interventional nephrologists. Catheter insertion is accomplished through various methods including open surgical technique and laparoscopic, peritoneoscopic, and fluoroscopic guidance. Complication rates and catheter survival can vary based on the insertion technique used. Recently, nephrologists have made significant advances in the area of peritoneal dialysis catheter design and placement. Current data suggest that nephrologists are increasingly placing PD catheters using peritoneoscopic and fluoroscopic technique. This review focuses on peritoneoscopic and fluoroscopic insertion and highlights the advantages of catheter insertion by nephrologists.

Laparoscopy Assisted Versus Open Ileocystoplasty in Pigs

We compared laparoscopy assisted and open ileocystoplasty in an experimental model in pigs. We evaluated intraoperative aspects, postoperative recovery, peritoneal adhesions and functional results. The study included 30 male pigs divided into 4 groups, including 10 with laparoscopy assisted ileocystoplasty, 10 with open surgery, 5 with sham laparoscopy and 5 with sham open surgery. Variables studied were total operative time, ileovesical anastomosis time, postoperative urodynamic findings (bladder capacity and compliance), daily and weekly weight gain, and intraperitoneal adhesions (incidence, type and score). Mean operative time in the laparoscopic and open groups was 179.4 and 69.6 minutes, respectively, which was significantly different (p <0.05). Mean ileovesical anastomosis time was also significantly different for laparoscopic vs open surgery (74.8 vs 31.8 minutes, p <0.05). Significant differences were observed in mean weekly weight gain during the first 4 weeks after surgery. Postoperatively bladder capacity and compliance differences among the groups were not significantly different (p >0.05). The overall incidence of intraperitoneal adhesions was not significantly different in all groups (p >0.05). However, in the open vs laparoscopy, sham laparoscopy and sham open surgery groups adhesion complexity was greater and mean score was higher (4.2 vs 2.8, 2.0 and 2.0, respectively), which was statistically significantly different (p <0.05). Laparoscopy assisted ileocystoplasty requires more operative time than open surgery. However, postoperative recovery is more rapid and intraperitoneal adhesions are less complex in pigs with laparoscopy assisted ileocystoplasty vs conventional surgery. Functional results are comparable for open and laparoscopy assisted ileocystoplasty.

1063: High Resolution Ultrasound for Pre-Operative Detection of Intra-Peritoneal Adhesions: An Invaluable Instrument for the General and Laparoscopic Surgeon

The possibility to predict the existence of intra-abdominal adhesions in post-surgical patients undergoing further laparotomy or laparoscopy is of great interest for both the general and the laparoscopic surgeon. Inadvertent enterotomy during re-laparotomy or trocar insertion is a feared complication, with significant associated morbidity and mortality, occurring in 20% in open surgery and between 1% and 100% in laparoscopy.

Reparo intraperitoneal de defeitos da parede ventral do abdome com telas de poliéster com colágeno e polipropileno com ácido poliglicólico

To compare the clinical and histological outcomes of the repair of induced abdominal wall defects with Parietex and Optilene Mesh Elastic + Safil in direct contact with abdominal viscera (intraperitoneal position, IPOM). Sixteen rabbits were allocated into two groups with 8 animals each, corresponding to evaluation on the 30th and 60th postoperative days. All animals were submitted to two standardized symmetric abdominal wall defects, comprising all muscular layers and the peritoneum, followed by repair through the intraperitoneal placement of two different meshes. The experimental design allowed each animal to be its own control. Macroscopic aspects evaluated were: surgical site infection, mesh erosion, suture insufficiency, fistulae, intra-abdominal infection and adhesion formation. Microscopic parameters analyzed consisted of collagen deposition and the immunohistochemical healing process. The formation of intraperitoneal adhesions and the other macroscopic outcome measures evaluated did not present significant statistical differences between the two meshes, neither did type I and III collagen deposition and MMP-1 and MMP-8 antibody expression. MMP-13 antibody exhibited significantly higher expression on the 30th postoperative day with Optilene+Safil and on the 60th day with Parietex. Due to the similar results obtained, both macroscopically and microscopically, the meshes can be considered equivalent with respect to the healing of surgical wounds in abdominal wall defects in rabbits.

A novel antibiotic, linezolid, reduces intraperitoneal adhesion formation in the rat uterine horn model

To examine the effects of linezolid in prevention of adhesion formation in a rat uterine horn model. Prospective randomized study. University Experimental Animal Research Laboratory Center. Ninety female Wistar albino rats. A dose response study was first conducted with 60 Wistar albino rats that were randomly assigned to six equal groups by administering vehicle (control), 5 mg/kg (Group 1), 15 mg/kg (Group 2), 50 mg/kg (Group 3), 100 mg/kg (Group 4), and 150 mg/kg (Group 5) linezolid starting three days before the adhesion inducing operation and continuing for 14 days postoperatively. Adhesion was scored clinically with a scoring system. The minimum effective dose was found to be 100 mg/kg/day. With this dose time response (starting three days before the operation and continuing for seven days), only preoperative and postoperative administration studies were conducted. Extent and severity of adhesions. Total adhesion scores in the control and Groups 1 and 2 were significantly higher when compared with Groups 4 and 5, but not with Group 3. There were no significant differences in the adhesion scores between Groups 3, 4, and 5. In time response arm a total of 10 days treatment was not as effective as 17 days treatment. In postoperative and preoperative arms of the study, it was found that administration of linezolid only postoperatively or preoperatively did not affect adhesion formation significantly when compared with the control group. Linezolid was found to reduce intraperitoneal adhesion formation.

Laparoscopic Resection of Colorectal Cancer in a Regional Hospital

Background: Laparoscopic colectomy is a safe and effective alternative to open colectomy for colorectal cancer. It is not widely adopted because of its complex procedures and estimated higher morbidity and mortality in the early period of the learning curve. In this paper, we report on the short-term results of our first 14 consecutive laparoscopic colectomies performed in 2006. Methods: Laparoscopic colectomy was offered as an alternative to elective open colectomy for colorectal cancer, except for T4 tumors. Fourteen patients underwent laparoscopic resection of colorectal cancer in 2006. In this paper the characteristics of patients and tumors are reported as well as the short-term outcomes, including the length of operation time, conversion rate, recovery course, morbidity and mortality. Data were prospectively recorded. Results: Laparoscopic procedures were completed in 13 of the 14 patients. The average operation time was 238 minutes and the average postoperative hospital stay was 17.8 days. The postoperative staging was stage I in 2 patients, stage IIA in 2, stage IIIB in 4, and stage IV in 6, according to the American Joint Committee on Cancer (AJCC). One of the 14 patients experienced ureter injury and conversion of the procedure to open colectomy. Postoperative complications occurred in 3 patients, including respiratory failure in one, anastomosis leak in another one, and wound infection with dehiscence in the remaining one. The only patient whose body-mass index (BMI) was ＞30 kg/m^2 experienced conversion due to intraoperative ureter injury and died of postoperative respiratory failure. The patient with anastomosis leak had severe intraperitoneal adhesion due to 3 previous major intraabdominal operations. No positive margin was detected in the specimens and the average number of harvested lymph nodes was 16. These results closely follow the guidelines of colorectal cancer surgery in Taiwan. Conclusion: Our report indicates that laparoscopic colectomy for colorectal cancer can be developed safely by surgeons with adequate experience in other laparoscopic procedures in a regional hospital. Proper selection of patients, by avoiding cases with a BMI ＞30 kg/m^2 or previous major abdominal surgery, for example, is highly recommended to prevent conversion, and to reduce morbidity and mortality in the early period of the learning curve.

Human Peritoneal Membrane Controls Adhesion Formation and Host Tissue Response Following Intra-Abdominal Placement in a Porcine Model

Even with the advent of bioresorbable barriers, complications due to visceral adhesions following surgery continue to occur. The use of a homologous adhesive barrier such as human peritoneal membrane (HPM) could prevent adhesions formation and enhance wound healing. This study evaluates HPM as an effective adhesive barrier in a porcine model simulating a ventral hernia procedure. Through a midline laparotomy, meshes (10 cmx10 cm) were sewn onto the intact peritoneum of a pig, on each side of a midline incision in superior and inferior positions (4 randomized meshes/pig, n=9 pigs). The pigs were survived for 90 d. The meshes used were: HPM, compressed polytetrafluoro-ethylene (cPTFE), cPTFE+HPM, and polyester-collagen composite (PX). Exploratory laparoscopy was performed at 30 and 90 d to evaluate the extent of visceral adhesions. At necropsy, the extent and tenacity of visceral adhesions as well as material-abdominal wall integration were evaluated. Finally, host tissue response was assessed through scoring of inflammation, foreign body reaction, and mesothelialization. HPM and PX led to the least extent and tenacity of visceral adhesions compared to cPTFE and cPTFE+HPM, but integrated less strongly within the adjacent abdominal wall. PX displayed the most robust foreign body reaction among all prosthetic materials, while HPM scored similarly to the native peritoneum. The extent of mesothelialization was similar throughout the materials tested. The HPM barrier which promotes long-term peritoneal remodeling could diminish postsurgical intraperitoneal adhesions following hernia repair.

Authors' reply: Degradation of mesh coatings and intraperitoneal adhesion formation in an experimental model (Br J Surg 2009; 96: 305–313)

Authors' reply: Degradation of mesh coatings and intraperitoneal adhesion formation in an experimental model (<i>Br J Surg</i> 2009; 96: 305–313)

Degradation of mesh coatings and intraperitoneal adhesion formation in an experimental model (Br J Surg 2009; 96: 305–313)

Degradation of mesh coatings and intraperitoneal adhesion formation in an experimental model (<i>Br J Surg</i> 2009; 96: 305–313)

Effect of Ascitic Media Formed by Glycerin on the Prevention of Peritoneal Adhesions

Aim: We aimed to investigate whether or not artificial ascites media formed using glycerin are effective in the prevention of intraperitoneal adhesions. Methods: Thirty-six Wistar albino male rats were used in the study. The rats were divided into 3 groups as follows. Group I: control group; group II (isotonic group): 3 ml of 0.9% NaCl was injected into the peritoneal cavity, and group III (glycerin group): 0.5 ml of liquid glycerin and 3 ml of 0.9% NaCl was injected into the peritoneal cavity. Results: There were serious adhesions in the control group. Adhesion rates were lower in the isotonic group compared with the control group, but the difference was not statistically significant (p > 0.05). When adhesion rates of the glycerin group were compared with the control and isotonic groups, significant differences were found, especially between the glycerin and control groups (p < 0.05). Conclusions: According to the results of our study, the use of isotonic solution and liquid glycerin decreases postoperative adhesions. We suggest that glycerin was more effective as it has the chemical ability to draw water to its media. As such, the formation of adhesions may be decreased by increasing the amount of physiological liquid inside the abdomen.

Laparoscopic adrenalectomy: Troublesome cases

Among 143 cases of laparoscopic adrenalectomy carried out from 1993 to the present, 13 patients in whom the surgical manipulation presented problems were examined. Problems occurred due to the condition of the adrenal tumors themselves in six patients, whereas problems occurred due to the operative history in four patients. There were three patients with no operative history but with strong intraperitoneal adhesion. In patients with a history of laparotomy in other fields such as open cholecystectomy, gastrectomy or colostomy, operations were possible in most patients by examining the trocar site preoperatively. Patients with strong adhesion even without a history of surgery could be handled by full separation of the adhesion during surgery. In patients with bleeding in the adrenal tumors, large adrenal tumors, or tumors impacted in the liver, methods such as changing the sequence of separation procedures were required. In patients with a history of renal subcapsular hematomas due to extracorporeal shock wave lithotripsy (ESWL), it was not possible to understand the conditions of adrenal or perinephritic adhesion in preoperative imaging diagnosis, but resection was possible by changing the order of separation procedures and by using optimal instruments and devices. As with any surgery, including open surgeries, it is necessary to obtain knowledge on how to deal with variations in laparoscopic adrenalectomy to assure safe outcomes and to always consider effective methods for coping with unexpected difficulties.

Transgastric Versus Laparoscopic Ventral Hernia Repair: A Randomized Controlled Trial in a Live Porcine Model

Background: Ventral hernia repair is currently performed via open or laparoscopic surgery approaches. Translumenal ventral hernia repair has been recently reported in an animal model. Objective: To compare transgastric and laparoscopic ventral hernia repair techniques. Methods: We performed 10 survival experiments on 50-kg pigs. Abdominal wall hernias were created through a 5 mm skin incision followed by 5cm long incision of the abdominal wall muscles and aponeurosis. All animals were survived for 2 weeks and then they were randomly assigned to either transgastric or laparoscopic hernia repair. In the laparoscopic repair group (5 animals), a Gore-Tex® mesh was delivered into the peritoneal cavity through a 12-mm laparoscopic trocar and attached to the abdominal wall with transfascial anchor sutures to repair the previously created abdominal wall hernia. In the transgastric repair group (5 animals), transgastric peritoneoscopy was performed and then a Gore-Tex® mesh was delivered into the peritoneal cavity through the gastric wall incision and attached to the abdominal wall with transfascial anchor sutures to repair the previously created abdominal wall hernia. Then the flexible endoscope was withdrawn into the stomach and the gastric wall opening was closed with T-bars. Animals in both groups were survived for another 2 week period and then sacrificed. Results: Ventral hernias were created without technical problems and all animals developed large abdominal ventral hernias after 2 weeks of observation. Ventral hernias were successfully repaired via transgastric or laparoscopic approaches in all animals. Adhesiolysis prior to hernia repair was required in 2 animals in the laparoscopic and in 3 animals in the transgastric repair group. Time needed for hernia repair was comparable (p= 0.08) in both groups: 60.8 ± 9.8 minutes (laparoscopic) versus 75.8 ± 7.0 minutes (transgastric repair). During necropsy intraperitoneal adhesions were found in 3 animals (60%) of each group. Necropsy also demonstrated 2 seromas under the mesh in the laparoscopic repair group and only 1 seroma in the transgastric repair group. In addition, there was an infected hematoma at the site of 12-mm trocar insertion in 1 animal in the laparoscopic repair group. There were no other complications in the transgastric repair group. Conclusion: Transgastric and laparoscopic ventral hernia repair appear equally fast and effective. However, the transgastric approach is less invasive than laparoscopic and may eliminate complications related to the insertion of the 12-mm laparoscopic trocar.

Polylactic acid film versus acellular porcine small intestinal submucosa mesh in peritoneal adhesion formation in rats

To assess intraperitoneal adhesion formation in rats after the single implantation of intraperitoneal polypropylene mesh versus SIS mesh, and the effect of PAF as a polypropylene mesh barrier. A total of 55 albino rats randomized into three groups were assessed. The type of adhesions, the percentage of mash covered with adhesions, and the rupture strength of the adhesions were evaluated. The type 2 and 3 adhesions were more frequent in group 1 (polypropylene mesh) and group 3 (Polypropylene+PAF), while type 0 and 1 adhesions were more frequent in group 2 (SIS). The mean rupture strength was 1,58 N (+/-0,719N) in group 1, 0,42 N (+/-0,432N) in group 2 and 1,23 N (+/-0,432N) in group 3. Over 50% of the mash was covered with adhesions in 12 (80%) cases of the group 1, in 4 (20%) cases of the group 2 and in 16 (84,2%) cases of the group 3. Group 2 differed significantly (p<0.001) from the other groups. Implantation of intraperitoneal polypropylene mesh yielded higher rates of adhesion and the use of PAF as a mesh barrier didn't reduced the rates of adhesion. SIS mesh implantation revealed lower rates of peritoneal adhesions.

Degradation of mesh coatings and intraperitoneal adhesion formation in an experimental model

In laparoscopic ventral hernia repair a mesh is placed in direct contact with the viscera, often leading to substantial adhesions. In this experimental study the ability of different coated and uncoated meshes to attenuate adhesion formation was examined. Six commercially available meshes were placed intraperitoneally against a closed peritoneum in rats: Prolene (polypropylene), Timesh and Ultrapro (polypropylene composites with titanium and polyglecaprone respectively), Proceed and Parietex Composite (polypropylene and polyester meshes coated with a layer of cellulose and collagen respectively) and C-Qur (polypropylene mesh coated with a layer of omega-3 fatty acids). Adhesions and incorporation were evaluated macroscopically and microscopically after 7 and 30 days. Parietex Composite and C-Qur significantly reduced adhesion formation at 7 days' follow-up compared with all other meshes. By 30 days, this effect had diminished as a significant increase in adhesions together with phagocytosis of the coating was seen for all meshes with layered coatings (Proceed, Parietex Composite and C-Qur. Incorporation was insufficient for all meshes. The absorbable layers of Parietex Composite and C-Qur reduce adhesion formation to intraperitoneal mesh in the short term, but the effect diminishes and phagocytosis of absorbable coatings may contribute to adhesion formation.

Cilostazol and pentoxifylline decrease angiogenesis, inflammation, and fibrosis in sponge-induced intraperitoneal adhesion in mice

Aims Adhesion formation following abdominal intervention is an abnormal peritoneal healing process. Our aim was to investigate the effects of controlling adhesion development by inhibiting its key components (angiogenesis, inflammation and fibrosis) using phosphodiesterase (PDE) inhibitors. Main methods Two PDE inhibitors including cilostazol a PDE3 inhibitor (40 and 400 mg/kg), and pentoxifylline (PTX), a PDE 1–5 inhibitor (50 and 500 mg/kg) were used for a period of 7 days to inhibit angiogenesis, inflammation, and fibrosis in a murine model of sponge-induced peritoneal adhesion. Angiogenesis was assessed by hemoglobin content, vascular endothelial growth factor (VEGF) levels, and morphometric analysis. Accumulation of neutrophils and macrophages was determined by measuring myeloperoxidase (MPO) and N-acetylglucosaminidase (NAG) activities, respectively. Levels of TNF-α were also determined. Fibrosis was assessed by determining the amount of collagen in the implant; TGF-β1 levels in the implant were also measured. Key findings Our results show that the treatments attenuated the main components of the adhesion tissue by reducing the amount of fibrovascular tissue that infiltrated the sponge matrix (wet weight). Hemoglobin content and VEGF levels were also decreased by approximately 40%. Neutrophil accumulation was unaffected by the compounds. However, NAG activity was reduced by pentoxifylline, but not by cilostazol. These compounds also decreased the levels of the pro-inflammatory and pro-fibrogenic cytokines TNF-α and TGF-β1, respectively, and collagen synthesis. Significance Our results suggest that cilostazol and PTX decreased the development of peritoneal adhesions in the model, which might be associated with cyclic nucleotide modulation. Therapies to intervene in these pathways may be beneficial for the prevention of these lesions.

Effects of Three Different Types of Anti-adhesive Agents in a Rat Abdominal Wall Defect Model

Purpose: Postsurgical adhesion formation is a significant clinical problem within every surgical specialty. Several adhesion barriers have been developed in the form of solution, membrane or film in an attempt to solve these problems. The purpose of the present study is to compare the efficacy of antiadhesive agents in the prevention of postsurgical adhesion formation in a standardized rat adhesion model. Methods: We examined forty Sprague-Dawley rats, which is a cecal abrasion with partial peritonectomy model. Three treatment groups (Group I: Film-type Surgiwrap Ⓡ , Group II: Solution-type Guardix-sol Ⓡ , Group III: Membrane-type Interceed Ⓡ ), each consists of 10 rats, and a control group of 10 rats were used by saline. Ten days after surgery, the rats were killed, and the levels of adhesion were graded. Immunohistochemical staining for microvessel density (CD34, MVD) and macrophage (ED1) were performed in adhesion tissue. Results: The peritoneum adhesion mean scores are as follows: control group: 2.2±0.78, Group I: 1.0±1.06, Group II: 0.9±0.99, Group III: 0.6±0.84. All treatment groups showed significantly less peritoneum adhesion (P=0.006), while there was no significant difference in each group. The intraperitoneal organs adhesion mean scores are as follows: control group: 2.8±0.91, Group I: 2.6±1.06, Group II: 1.4±0.84, Group III: 1.0±0.81. Group I had no significant difference about intraperitoneal organs adhesion with control group, but Group II and Group III showed less intraperitoneal organs adhesion. The mean numbers of microvessel density are as follows: control group: 42.5±4.83, Group I: 40.8±6.53, Group II: 30.9±6.15, Group III: 15.60±4.37, from which there was a significant difference between Group II and Group III with control group (P＜0.001). The mean numbers of macrophage are as follows: control group: 223.3±33.12, Group I: 211.25±10.96, Group II: 171.60±23.96, Group III: 147.0± 12.22, from which there was a significant difference between Group II and Group III with control group (P＜0.001). Conclusion: In our animal model, three different types of antiadhesive agents (Surgiwrap Ⓡ , Guardix-sol Ⓡ , Interceed Ⓡ ) were effective in adhesion prevention, but Surgiwrap Ⓡ had less antiadhesive effect for intraperitoneal organs adhesion. Membrane-type Interceed Ⓡ had a better effect for microvessel density (MVD) and macrophage than solution-type Guardix-sol Ⓡ . (J Korean Surg Soc 2009;77:7-14)

Effect of 2-Octyl-Cyanoacrylate on Ischemic Anastomosis of the Left Colon

Introduction: 2-octyl-cyanoacrylate may be a good alternative in ischemic colon anastomosis without impairment of tissue perfusion. Methods: Forty male Wistar albino rats were randomized into four experimental groups (n = 10 in each group). In group 1 (control), a well-perfused left colonic segment was transected, and free ends were anastomosed by propylene sutures. In groups 2, 3, and 4, the animals underwent a standardized surgical procedure to induce ischemic left colon anastomosis. In group 2, an end-to-end anastomosis was created using six interrupted 6-0 polypropylene sutures between ischemic edges. In group 3, after approximating the mesenteric and antimesenteric edges of the anastomosis with two 6-0 polypropylene sutures, 2-octyl-cyanoacrylate was applied between the edges. In group 4, anastomosis was created by the same technique as described in group 2, and additionally 2-octyl-cyanoacrylate was applied on suture line. Rats were killed on day 4 following operation. Anastomotic integrity, intraperitoneal adhesion scores, anastomotic bursting pressures, and tissue hydroxyproline levels were recorded. Histopathological examination of the anastomosis was also performed. Results: There were no statistically significant differences among groups with respect to anastomotic integrity (p =.142). The mean bursting pressure values were 81.1 ± 23.83, 43.3 ± 26.06, 15.8 ± 11.3, and 17.6 ± 18.02 in groups 1, 2, 3, and 4, respectively. There were no statistically significant differences among groups 2, 3, and 4 with respect to tissue hydroxyproline levels and bursting pressure levels. The highest adhesion scores were observed in groups 3 and 4. Discussion: 2-octyl cyanoacrylate does not have additional advantages in the healing of experimental ischemic colon anastomosis.