Postoperative Intestinal Adhesion Research Articles

Efficacy of Naldemedine on Intestinal Hypomotility and Adhesions in Rodent Models of Postoperative Ileus.

Postoperative ileus (POI) often decreases patients' QOL because of prolonged hospitalization and readmission. Alvimopan, a peripheral μ-opioid receptor antagonist, is currently the only therapeutic drug for POI. The aim of this study was to examine the efficacy of naldemedine (a peripheral μ-opioid receptor antagonist with a non-competitive pharmacological profile different from that of alvimopan) on postoperative intestinal hypomotility and adhesion in rodent models, and compare it with the effects of alvimopan. Oral administration of naldemedine (0.3 mg/kg) and alvimopan (3 mg/kg) significantly inhibited the decrease in intestinal motility induced by mechanical irritation in mice (p < 0.01, for both). Naldemedine (1 mg/kg) significantly shortened the adhesion length in chemical-induced postoperative adhesion model rats (p < 0.05). Alvimopan (3 mg/kg) also significantly reduced the adhesion ratio (p < 0.01). These findings suggest that naldemedine is effective for postoperative intestinal hypomotility and adhesions in rodents (i.e., as for alvimopan). Thus, naldemedine may be a useful option for the treatment of POI.

Pediatric laparoscopic partial cystectomy for the treatment of benign bladder tumors and urachal cysts

ObjectiveTo investigate the feasibility and efficacy of carrying out pediatric laparoscopic partial cystectomies (LPC) when treating benign bladder tumors and urachal cysts.MethodsRetrospectivey analyzing 4 clinical cases involving children with bladder tumors, which were collected from October 2017 to December 2018. In these clinical cases, there were 3 male children and 1 female child, aged from 4.5 to 9.4 years old, with an average age of 6.5 years. An intraperitoneal laparoscopic partial cystectomy was performed in the treatment of 3 of these patients with benign bladder tumors and in 1 patient with an urachal cyst. The surgical procedures included a partial cystectomy and a complete intracavitary bladder suture.ResultsAll 4 cases were successful and no operation was transferred to opensurgery. The operation time was 100–120 min, with an average time of 108 min. The intraoperative blood loss was 10–20 ml, with an average loss of 15 ml. 6 h after the operation, the patients still maintained a fluid diet and 1 case of hematuria had occurred, with the catheter removed 12 days after the operation. No postoperative urine leakage, intestinal adhesion or intestinal obstruction occurred, and the average postoperative hospitalization time was 14 days.ConclusionLaparoscopic partial cystectomy is a safe and feasible method to be used for the treatment of benign bladder tumors and urachal cysts. It presents the advantages of being minimally invasive, and having a quick recovery and short hospitalization time. It is an alternative surgical method for the treatment of pediatric benign bladder tumors.

Platelet-rich fibrin prevents postoperative intestinal adhesion.

Platelet-rich fibrin (PRF) was prepared from the blood of BALB/C inbred mice to explore potential effects on postoperative intestinal adhesion. A murine model of intestinal adhesion characterized by abdominal wall defect/and cecum damage was established by scraping caecum serosa and cutting peritoneum and muscles in the abdominal wall. The wound was covered with PRF (group A), sodium hyaluronate (group B), or left alone (blank control; group C). All animals were monitored for 28 days. The incidence of adhesion was 35.0, 66.7, and 73.7% in groups A, B, and C, respectively. The incidence of adhesion in group A was significantly lower than that in group C (p < .05). Histopathologically, severity of fibrosis and the number of fibroblasts or inflammatory cells in group A were lower than those in groups B and C (p < .05), whereas the number of mesothelial cells was higher (p = .001). Furthermore, the severity of fibrosis and number of fibroblasts or inflammatory cells were lower in low grade than those in high grade of adhesion (p < .05), whereas the number of mesothelial cells was higher (p < .05). Collectively, PRF applied to abdominal surgery may reduce the incidence of intestinal adhesion by promoting proliferation of mesothelial cells whereas inhibiting proliferation of fibroblasts and infiltration of inflammatory cells.

Analysis of risk factors for appendicitis caused by incarcerated inguinal hernia in infants

Objective To investigate the risk factors for appendicitis caused by incarcerated inguinal hernia in infants. Methods The retrospective case-control study was conducted. The clinicopathological data of 371 infants with incarcerated inguinal hernia who were admitted to Wuhan Children′s Hospital of Tongji Medical College of Huazhong University of Science and Technology between January 2010 and December 2018 were collected. There were 256 males and 115 females, aged from 0 to 90 days, with an average age of 47 days. Observation indicators: (1) situations of incarcerated hernia; (2) surgical and postoperative recovery; (3) postoperative pathological examination; (4) analysis of risk factors for appendicitis caused by incarcerated inguinal hernia in infants. Measurement data with skewed distribution were described as M (range). Count data were expressed as absolute numbers. Univariate analysis was performed using the chi-square test. Multivariate analysis was performed using the Logistic regression model. Results (1) Situations of incarcerated hernia: of the 371 infants, 264 had bowel incarceration, 102 had ovarian incarceration, 2 had both bilateral ovarian and bowel incarceration, 1 had bilateral ovarian and womb incarcerated into one side, and 2 had Meckel′s diverticulums incarceration. Among the 264 infants with bowel incarceration, 29 had Amyand′s hernia, including 18 of ileocecal incarceration (3 with appendicitis) and 11 of pure appendix incarceration (10 with appendicitis). (2) Surgical and postoperative recovery: of the 29 infants with Amyand′s hernia, 10 underwent laparoscopic hernia sac high ligation and 19 underwent inguinal explorations, relaxation of hernia ring and then hernia sac high ligation. One infant undergoing laparoscopic hernia sac high ligation had pure appendix incarceration. It showed that chorda at the blind end of appendix was connected with the bottom of hernia sac intraoperatively. There was no obvious inflammation in the appendix. Chorda was released, and the appendix was reset into the abdominal cavity. One infant was resected appendix because of its inflammation after ileocecal reduction. Twelve infants undergoing inguinal explorations, relaxation of hernia ring and then hernia sac high ligation had appendicitis (2 of ileocecal incarceration and 10 of pure appendix incarceration), and received appendectomy and hernia sac high ligation. One infant of ileocecal incarceration had postoperative intestinal adhesion, and was found local adhesion and stenosis after abdominal re-exploration. The infant underwent ileocecoectomy followed by ileum-ascending colon anastomosis. All infants recovered well after operation. (3) Postoperative pathological examination: 13 of 29 Amyand′s hernia infants had appendictis, 4 of which were confirmed as appendix suppuration by pathological examination, 2 were appendix suppuration and perforation, and 2 were gangrene. (4) Analysis of risk factors for appendicitis caused by incarcerated inguinal hernia. Results of univariate analysis showed that age, local swelling and erythema of the hemiscrotum, intestinal obstruction, and incarceration location were related factors for the appendicitis caused by incarcerated inguinal hernia (χ2=10.598, 15.603, 9.732, 3.866, P<0.05). Multivariate analysis showed that age less than 28 days, local swelling and erythema of the hemiscrotum, no obvious obstruction were the independant risk factors for appendicitis caused by incarcerated inguinal hernia (odds ratio: 4.537, 35.506, 34.565, 95% confidence interval: 1.014-20.296, 6.447-195.552, 6.370-187.546, P<0.05). Conclusion Age less than 28 days, local swelling and erythema of the hemiscrotum, and no obvious obstruction are independent risk factors for appendicitis caused by incarcerated inguinal hernia. Key words: Hernia; Incarcerated inguinal hernia; Amyand′s hernia; Appendicitis; Neonate; Risk factors

Effect of Bletilla striata on the Prevention of Postoperative Peritoneal Adhesions in Abrasion-Induced Rat Model.

Postoperative peritoneal adhesions (PPAs) constitute a common complication of abdominal surgery with a high incidence. Bletilla striata (BS) is an important hemostatic drug used in China for nearly 2000 years. The purpose of this study was to investigate the effect of Bletilla striata on postoperative intestinal adhesion in rats. PPA was induced by cecal wall abrasion, and Bletilla striata was injected to observe its effect on adhesion in rats. The adhesion and inflammation score were assessed through visual observation and histopathologic evaluation. The levels of interleukin-1 (IL-1β), tumor necrosis factor (TNF-α), and interleukin-17F (IL-17F) in abdominal cavity and interleukin-6 (IL-6) in plasma were measured by enzyme-linked immunosorbent assay (ELISA) at 6 hours, 12 hours, 24 hours, and 1 week after operation. The tissue level of transforming growth factor beta-1 (TGF-β1) was also determined by ELISA on the seventh day after surgery. The expressions of collagen and TNF-α were, respectively, detected by Masson trichrome staining and immunohistochemical staining. The expression of TGF-β1 and alpha smooth muscle actin (α-SMA) was detected by Western blot. The result showed that Bletilla striata has obvious preventive effect on PPAs and celiac inflammation of PPAs. Bletilla striata could significantly reduce the level of IL-17F abdominal cavity and IL-6 in plasma. Masson trichrome staining and immunohistochemical staining results showed that Bletilla striata also decreased the expression of TNF-α and collagen. Western blot results showed that Bletilla striata decreased the expression of α-SMA and TGF-β1. Our results suggest that Bletilla striata decreased the development of abdominal adhesion in abrasion-induced model of rats and reduced the expression of the important substance which increased in PPAs. Bletilla striata can be further studied as a new and cheaper antiadhesive substance.

Comparison of the Protective Effects of Calendula officinalis Extract and Hyaluronic Acid Anti-adhesion Barrier against Postoperative Intestinal Adhesion Formation in Rats

Comparison of the Protective Effects of Calendula officinalis Extract and Hyaluronic Acid Anti-adhesion Barrier against Postoperative Intestinal Adhesion Formation in Rats

Polylactic acid nanosheets in prevention of postoperative intestinal adhesion and their effects on bacterial propagation in an experimental model.

Ultrathin films (nanosheets) adhere tightly to organ surfaces but prevent adhesion to other organs. The antiadhesive effect of nanosheets and their effect on bacterial propagation were investigated in a murine intestinal adhesion model. Polylactic acid nanosheets (approximately 80 nm thick) were produced. Serosal defects were created by peeling off the intestinal serosa; these were left open or covered with nanosheets or Seprafilm® and the formation of intestinal adhesions was analysed. To examine bacterial propagation, a nanosheet or Seprafilm® was placed on intact murine jejunum followed by Escherichia coli inoculation at the site. Treatment both with nanosheets and with Seprafilm® reduced postoperative intestinal adhesion (mean adhesion score 0·67 for nanosheets, 0·43 for Seprafilm® and 2·87 for no antiadhesive treatment; P < 0·001 for nanosheets or Seprafilm® versus no adhesive treatment). Nanosheet treatment did not affect bacterial propagation in the peritoneal cavity, whereas Seprafilm®-treated mice showed bacterial propagation, leading to increased mortality. Nanosheets may be effective novel antiadhesive agents even in the presence of bacterial contamination. Surgical relevance Intra-abdominal adhesions following surgical contamination can trigger postoperative complications and lead to deterioration in long-term quality of life. However, currently there are no effective antiadhesion materials to prevent the formation of adhesions. Treatment with ultrathin nanosheets effectively reduced postoperative intestinal adhesion in an experimental mouse model, and did not affect bacterial propagation in the peritoneal cavity. These nanosheets are potent novel antiadhesive materials that potentially can be applied even in contaminated conditions.

Postoperative anti-adhesion ability of a novel carboxymethyl chitosan from silkworm pupa in a rat cecal abrasion model

N,O-Carboxymethyl chitosan (NOCC) can prevent postsurgical adhesion formation. Here, we described the preparation of a novel silkworm pupa NOCC and its effects on the prevention of postoperative adhesion in a rat cecal abrasion model. The degree of deacetylation (DDA) of silkworm pupa chitosan was only 49.87±0.86%; regardless, it was used as the raw material to construct the novel silkworm pupa NOCC, which had a weaker crystallinity than the NOCC standard. Sixty male Sprague–Dawley rats were divided into three groups and treated as follows: 0.9% normal saline solution as a negative control, medical anti-adhesion gel as a positive control and the silkworm pupa NOCC anti-adhesion solution. Two and three weeks after surgery, the animals were killed and the adhesion formation was scored. The silkworm pupa NOCC solution significantly decreased the levels of WBC, TNF-α, IL-1β, IL-2, IL-6 and IL-8 but had no effect on IL-4. Additionally, a lower level of TGF-β1 expression was found in the silkworm pupa NOCC group, and significantly less collagen (P<0.01) and fewer inflammatory cells and fibroblasts were detected in the animals of this group. These results suggested that the novel NOCC from silkworm pupa using the method described here have potential applications in the prevention of postoperative intestinal adhesion.

Effect of open and laparoscopic cholecystectomy on postoperative intestinal adhesions

Objective To explore the impact of open and laparoscopic cholecystectomy of different operation methods on postoperative intestinal adhesions. Methods 128 patients with acute cholecystitis were randomly divided into the observation group (64 cases) and control group (64 cases). The control group was treated with open cholecystectomy, the observation group was treated with laparoscopic cholecystectomy.The postoperative intestinal function, complications and intestinal adhesion were compared between the two groups. Results The bleeding amount, incision size, operation time of the observation group were (132.29±27.28)mL, (3.9±0.2)cm, (102.1±20.9)min, which were significantly better than those of the control group [(197.44±31.21)mL, (15.4±2.3)cm, (129.5±30.6)min], the differences were statistically significant(t=12.574, 38.850, 5.915, P<0.05). The incision healing time, bowel sounds recovery time, exhaust time of the observation group were (8.65±0.75)h, (23.63±5.14)h, (31.65±10.71)h, which were significantly shorter than those of the control group [(13.27±1.18)h, (36.17±7.14)h, (46.35±13.36)h], the differences were statistically significant (t=26.434, 11.403, 6.868, all P<0.05). The length of hospital stay and hospitalization expenses of the observation group were (3.9±1.6)d, (9 830±840)RMB, which were significantly less than those of the control group [(5.7±2.4)d, (1 2876±703)RMB] (t=4.992, 22.247, all P<0.05). Conclusion Laparoscopic cholecystectomy can not only reduce intraoperative bleeding volume and operation time, promote postoperative intestinal function recovery, but also can save the cost of hospitalization, reduce complications and the incidence of intestinal viscosity.Security is good, it is recommended. Key words: Cholecystectomy; Cholecystectomy, laparoscopic; Postoperation complications; Ankylenteron

Comparison of the effect of open and laparoscopic cholecystectomy operation on postoperative intestinal adhesion

目的 探讨开腹与腹腔镜胆囊切除的不同手术方式对术后肠黏连的影响,为临床有效防治肠黏连提供参考.方法 选取138例急性胆囊炎患者采用数字表法随机分为观察组和对照组各69例.观察组采用腹腔镜胆囊切除术治疗,对照组采用开腹胆囊切除术治疗,对比两组患者术后手术切口的愈合时间、首次肛门排气时间、肠鸣音恢复时间以及发生术后肠黏连的情况.结果 观察组手术的成功率为97.10%;与对照组(92.75%)差异无统计学意义(χ2=0.13,P＞0.05).观察组的手术切口愈合时间、首次肛门排气时间以及肠鸣音恢复时间均显著短于对照组(t=13.42、9.23、8.87,均P＜0.05);观察组术后肠黏连的发生率为5.80%,显著低于对照组的37.68%(χ2=36.05,P＜0.05).结论 腹腔镜胆囊手术能够有效减少术后肠黏连的发生率,促进术后肠道功能的恢复,有利于患者术后的康复,值得在临床上进一步推广应用。

Biodegradable and thermoreversible PCLA–PEG–PCLA hydrogel as a barrier for prevention of post-operative adhesion

Biodegradable polymers can serve as barriers to prevent the post-operative intestinal adhesion. Herein, we synthesized a biodegradable triblock copolymer poly(ɛ-caprolactone- co-lactide)- b-poly(ethylene glycol)- b-poly(ɛ-caprolactone- co-lactide) (PCLA–PEG–PCLA). The concentrated polymeric aqueous solution was injectable, and a hydrogel could be rapidly formed due to percolation of a self-assembled micelle network at the body temperature without requirement of any chemical reactions. This physical hydrogel retained its integrity in vivo for a bit more than 6 weeks and was eventually degraded due to hydrolysis. The synthesized polymer exhibited little cytotoxicity and hemolysis; the acute inflammatory response after implanting the hydrogel was acceptable, and the degradation products were less acidic than those of other polyester-containing materials. A rabbit model of sidewall defect-bowel abrasion was employed, and a significant reduction of post-operative peritoneal adhesion has been found in the group of in situ formed PCLA–PEG–PCLA hydrogels.

Possible Involvement of the Transient Receptor Potential Vanilloid Type 1 Channel in Postoperative Adhesive Obstruction and Its Prevention by a Kampo (Traditional Japanese) Medicine, Daikenchuto

This study focused on the localization of transient receptor potential vanilloid type 1 (TRPV1) in the intestines in postoperative adhesion model rats and investigated the underlying mechanism for the anti-adhesion action of daikenchuto (DKT), especially in relation to TRPV1. Postoperative intestinal adhesion was induced by sprinkling talc in the small intestine. The expression of TRPV1 mRNA was examined by in situ hybridization and real-time RT-PCR. The effects of DKT and its major ingredient, hydroxy sanshool, with or without ruthenium red, a TRP-channel antagonist, on talc-induced intestinal adhesions were evaluated. The level of TRPV1 mRNA was higher in the adhesion regions of talc-treated rats than in normal small intestine of sham-operated rats. Localization of TRPV1 mRNA expression was identified in the submucosal plexus of both sham-operated and talc-treated rats; and in talc-treated rats, it was observed also in the myenteric plexus and regions of adhesion. Capsaicin, DKT, and hydroxy sanshool significantly prevented formation of intestinal adhesions. The effects of DKT and hydroxy sanshool were abrogated by subcutaneous injection of ruthenium red. These results suggest that pharmacological modulation of TRPV1 might be a possible therapeutic option in postoperative intestinal adhesion, which might be relevant to the prevention of postoperative adhesive obstruction by DKT.

The cholinergic nervous system plays an important role in rat postoperative intestinal adhesion

Postoperative adhesions can cause serious complications after abdominal surgery. This study demonstrates the role of the cholinergic nervous system in the development of postoperative intestinal adhesion. Postoperative intestinal adhesion was induced by sprinkling talc on the small intestines of rats, and the adhesion rate, histology, and gastrointestinal transit were evaluated. To investigate the involvement of the cholinergic nervous system in postoperative intestinal adhesion, we evaluated choline acetyltransferase (ChAT) activity, muscarinic receptor density, and the preventive effect of a muscarine receptor agonist, bethanechol, on talc-induced intestinal adhesion in rats. Histologic examination revealed inflammation in the intestinal adhesion regions, but no damage was seen in sham-operated rats. The rate of adhesion formation had significantly increased 3-7 days after surgery. The gastrointestinal transit was decreased by about 30% in the talc-induced intestinal adhesion rats. ChAT activity decreased by about 50% in adhesion regions. In contrast, the density of muscarinic receptors was higher in rats with talc-induced intestinal adhesions. Furthermore, bethanechol significantly prevented 30%-41% of adhesion formation in rats with talc-induced intestinal adhesions. This action was inhibited by subcutaneous injection of atropine. Postoperative intestinal adhesion affected the cholinergic nervous system as demonstrated by decreased ChAT activity and increased density of muscarinic receptors. These alterations of gastrointestinal function might be a cause of adhesion formation.

Mechanism of salvianolate in preventing postoperative intestinal adhesion in rats

To observe the effects of salvianolate on rats with postoperative intestinal adhesion and to explore the prevention mechanism. Forty SD male rats with intestinal adhesion were randomly divided into four groups: untreated group, low-dose salvianolate-treated group (12 mg/kg), medium-dose salvianolate-treated group (24 mg/kg) and high-dose salvianolate-treated group (48 mg/kg), with another ten SD male rats as normal control. Intraperitoneal injection of glucose was administered to the rats in the normal control group and the untreated group, and intraperitoneal injection of salvianolate was administered to the rats in the low-, medium- and high-dose salvianolate-treated groups. They were all treated for 8 days and once a day. On the eighth day after surgery the blood samples of each group were collected. Grades of intestinal adhesion were ranked by macroscopic observation. The adhesive tissues between viscera and belly wall were taken for pathological observation. The levels of interleukin-1beta (IL-1beta), interleukin-4 (IL-4) and tumor necrosis factor-alpha (TNF-alpha) were determined by enzyme linked immunosorbent assay. Salvianolate can significantly reduce the extent of postoperative intestinal adhesion, obviously decrease the levels of IL-1beta, TNF-alpha and inhibit the hyperplasy of fibrous connective tissue. However, there was no significant impact on the level of IL-4. Salvianolate can reduce the extent of postoperative intestinal adhesion, decrease the expression of IL-1beta and TNF-alpha and inhibit the hyperplasy of fibrous connective tissue. This may be the mechanism of salvianolate in preventing intestinal adhesion.

The preventive effect of Daikenchuto on postoperative adhesion-induced intestinal obstruction in rats

The present study investigated the effect of Daikenchuto (DKT) on postoperative intestinal adhesion in rats. We evaluated the effects of DKT, constituent medical herbs and active compounds on talc-induced intestinal adhesion in rats and DKT-induced contractions using isolated guinea pig ileum. DKT significantly prevented adhesion formation, and this action was inhibited by pretreatment with atropine or ruthenium red. The constituent medical herbs, Zanthoxylum Fruit and Maltose Syrup Powder significantly prevented adhesion formation. Moreover, hydroxy sanshool (HS) prevented adhesion formation, and this action was inhibited by pretreatment with ruthenium red. In contrast, DKT-induced contractions were inhibited by tetrodotoxin, atropine, and capsazepine. These results suggested that DKT had a preventive action on postoperative adhesive intestinal obstruction, and that this action was mediated by sensory and cholinergic nerves. Furthermore, HS was found to be one of the active compound of DKT, and its action was mediated by sensory nerves.

Clinical study on Preventive effect of Taozhi Zhipu Mixture ("Equation missing" No EquationSource Format="TEX", only image )on postoperative intestinal adhesion)on postoperative intestinal adhesion

Objective: To study the clinical effect of Taozhi Zhipu Mixture( Open image in new window , TZM) in preventing postoperative intestinal adhesion.Methods: The total of 396 patients who had received abdominal operation were randomly divided into the treated group (188 cases) and the control group (208 cases). Same treatment was given to both groups except that the treated group received TZM orally or via nasogastric tube. The time of borborygmus recovering and first passing of flatus-defecation after operation was recorded. Patients’ gastro-intestinal motility was observed by isotope tracing with I131 capsule. The frequency and intensity of borborygmus were measured by a tracer. All patients had been followed up for 2-3 years.Results: The recovery of borborygmus, the first passing of flatus-defecation were much earlier, the I131 capsule passed gastro-intestinal tract more quickly, and the tracer showed higher frequency and intensity of borborygmus in the treated group than those in the control group. Follow-up study also showed the treated group was better than the control group in the non-adhesion rate and the total effective rate (P < 0.05).Conclusion: TZM has good effect on stimulating postoperational gastro-intestinal peristalsis and preventing the occurrence of postoperational intestinal adhesion.

Effects of Dai-kenchu-to on intestinal obstruction following laparotomy.

To confirm the usefulness of Dai-kenchu-to for intestinal obstruction, investigation of the effects of Dai-kenchu-to on postoperative intestinal adhesion was conducted. Repeated administrations of Dai-kenchu-to (100 or 300 mg/kg) significantly inhibited the formation of intestinal obstruction. Motor disturbance and inflammation are thought to be involved in the etiology of intestinal adhesion. A single treatment of Dai-kenchu-to (300 mg/kg) significantly reduce intestinal transit time in postoperative ileus and chemically induced ileus. Dai-kenchu-to (10(-4) g/ml) significantly inhibited COX-2 activity. These results suggest that Dai-kenchu-to prevents postoperative intestinal adhesion by gastroprokinetic and anti inflammatic effects. Dai-kenchu-to thus demonstrates positive effect on postoperative ileus.

Study on prevention of postoperative intestinal adhesion

Study on prevention of postoperative intestinal adhesion