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Query: UMLS:C0001511 (Adhesion)
 5,955 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Radical pelvic surgery has well-defined side effects, many of which may be related to the formation of pelvic adhesions. The effectiveness of different agents at limiting the formation of postradical pelvic surgery adhesions (PRPSA) has been variable to date. Use of a barrier could be beneficial not only by limiting adhesion formation but by acting as a "pelvic lid" to elevate the bowel out of a radiation treatment field and therefore limit subsequent radiation injury and associated fistula formation. We investigated the ability of the Gore-Tex Surgical Membrane (Gore-SM) to inhibit PRPSA in 20 adult female hogs undergoing radical hysterectomy, bilateral salpingo-oophorectomy, and resection of pelvic peritoneum. After completion of the radical resection, animals were randomized to either no attempt at covering the peritoneal defect or covering it and a 1-cm margin of intact peritoneum with a tailored sheet of Gore-SM. The membrane was secured in place using a continuous running 4-O Prolene suture around the perimeter. No intraoperative deaths occurred. No animal evidenced signs of bleeding, infection, bowel obstruction, or abscess formation. Four weeks after the initial surgery, the animals were again anesthetized, exploratory celiotomy was performed, and adhesions were quantified with specific note being made of any segments of small bowel that were adherent into the pelvis. Animals were then sacrificed. Adhesion scores for the Gore-SM-treated animals (n = 10; mean, 0.14 +/- 0.12; median, 0.21) were significantly less than those of animals with the noncovered pelvis (n = 10; mean, 1.33 +/- 0.41; median, 1.42; P less than 0.001). Similarly, significantly fewer animals treated with Gore-SM had small bowel loops adherent in the pelvis when compared to control animals (10% vs 70%; P less than 0.01). In this model, meticulously suturing the membrane in place with continuous permanent suture, the Gore-SM was an effective barrier for postoperative adhesion prophylaxis and successfully limited small bowel adherence into the pelvis.
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PMID:The Gore-Tex Surgical Membrane: effectiveness as a barrier to inhibit postradical pelvic surgery adhesions in a porcine model. 161 6

Thirty-one mongrel female dogs were submitted to a standard lesion on the right uterine horn, consisting of crushing, scratching, and ischemia of the segment. Three groups were formed for the study: control group (GC), experimental group I (G1), and experimental group II (G2). In GC, continuous washing with simple ringer solution was applied during surgery. In G1, heparin was added to the ringer solution at a doses of 100 IU/kg. In G2, in addition to the heparin diluted in the ringer solution, subcutaneous heparin was given at 12 hours intervals for three days, at a doses of 100 IU/kg/doses. The percentage of dogs with pelvic adhesions was determined by laparotomy. Adhesion intensity in the incision and in the pelvis was determined. 100% of dogs in G2 had adhesions in the incision, whereas 66.66% had incision adhesion in GC. There was no statistical difference. All groups presented around 50% of pelvic adhesions. Intensity of pelvic adhesions was not different in the three groups, but G2 had more adhesions than GC, such difference being statistically significant.
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PMID:[Heparin effect on prevention of pelvic adhesions. Experimental study]. 182 May 98

To assess the issue of the frequency and severity of adhesion reformation and de novo adhesion formation after operative laparoscopy, this multicenter collaborative report of early second-look procedures after operative laparoscopy was initiated. Sixty-eight subjects underwent operative laparoscopic procedures including adhesiolysis, followed by a second operative procedure within 90 days. The total mean adhesion score decreased from 11.4 +/- 0.7 at the initial operative procedure to 5.5 +/- 0.4 at the second-look procedure, a decrease of 52%. At the time of the second-look procedure, 66 of 68 women (97.1%) had pelvic adhesions. Adhesion reformation occurred in 66 of 68 women and at 230 of 351 sites (66%) at which adhesions were lysed. Despite this high incidence of adhesion reformation, de novo adhesion formation after operative laparoscopy occurred in only 8 of 68 women (12%) and at 11 of 47 available sites in these 8 women. We conclude that adhesion reformation is a frequent occurrence after operative laparoscopy; however de novo adhesion formation appears to occur much less frequently.
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PMID:Postoperative adhesion development after operative laparoscopy: evaluation at early second-look procedures. Operative Laparoscopy Study Group. 183 49

The ability of a polyglycolic acid (PGA)-derived mesh to limit the formation of immediate postoperative pelvic adhesions after radical resection of the pelvic viscera and peritoneum was investigated. Twenty female canines underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and infracolonic omentectomy. The entire peritoneum of the pelvis and lower abdomen also was removed. In ten animals, a single layer of PGA mesh, tailored to cover the deperitonealized area, was sutured in place. Reperitonealization was not performed in control animals. Four weeks after initial surgery, animals were reexplored and killed. Adhesions to the anterior abdominal wall and pelvis were quantified and graded: (Table: See Text) These data indicate that the placement of a PGA mesh induces significant pelvic adhesions and potentiates the formation of pelvic abscesses.
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PMID:Inability of polyglycolic acid mesh to inhibit immediate post-radical pelvic surgery adhesions. 216 81

1st-look laparoscopy (FL) on the 8th day after salpingostomy, fimbrioplasty, or adhesiolysis was peformed in 188 patients. Behavior of postoperative adhesions and the occurrence of pregnancy after tubal surgery were compared with a similar group of 127 patients in whom no FL was performed. In 50% of the cases (104/188), adhesions were found on the 8th postoperative day around both adnexa or only the remaining adnexum. Adhesions were mainly located between the ampulla and the ovary and between the ovary and the lateral pelvic wall or broad ligament. More than 1/2 of the adhesions that were separated at FL did not recur. It was concluded that FL significantly diminished the occurrence of permanent pelvic adhesions. The incidence of ectopic pregnancy after salpingostomy was significantly lower when FL was performed. FL on the 8th postoperative day can be considered a well-accepted procedure with few complications.
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PMID:Adhesion formation after tubal surgery: results of the eighth-day laparoscopy in 188 patients. 315 71

Despite use of surgical adjuvants, pelvic adhesions frequently develop following infertility surgery. Recently a resorbable biocompatible material, TC 7, has been designed to be used as a barrier to reduce adhesion formation. Reproducibly severe sidewall adhesions were only able to be created in one of six models tested. The model consisted of the following steps: excision of a full thickness 2 x 2-cm musculoperitoneal tissue mass, scraping of an adjacent 2-cm length of uterine horn, tamponading of all bleeding, and suturing (6-0 Vicryl) of normal tube and sidewall so as to directly approximate the traumatized tissues. Studies were conducted in 13 rabbits after creation of the bilateral sidewall and horn lesions, each serving as its own control. Choice of control and TC 7 sides was determined randomly. Adhesion formation was examined 2 weeks postoperatively. No residual material was noted at that time. Adhesion scores were the composite total of extent (0-4), type (0-4), and tenacity (0-3) of sidewall adhesions, and were significantly reduced on the TC 7 side as compared with the control side (mean 6.8 +/- 0.4 vs 9.0 +/- 0.3, median 6 vs 9, sign test P = 0.0032). No complications of use of the barrier were noted. It is concluded that use of TC 7, a resorbable biocompatible barrier, was able to significantly reduce postoperative adhesion formation on the rabbit sidewall.
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PMID:A model for sidewall adhesions in the rabbit: reduction by an absorbable barrier. 343 16

The effects of pelvic and periaortic peritoneal closure or (non-closure) on morbidity and adhesion formation were prospectively compared in 102 patients with ovarian cancer who had undergone a pelvic and periaortic lymphadenectomy. Hysterectomy with bilateral salpingoophorectomy, bilateral pelvic and periaortic lymphadenectomy, omentectomy, appendectomy and lysis of pelvic adhesions for the standardization of initial adhesion scores was performed on all patients. The pelvic and periaortic peritoneum were re-approximated in group I (n = 50) patients, and left open in group II (n = 52) patients. The groups were similar for mean age, previous surgery, tumour histology and disease stage. Morbidity characteristics such as blood loss, transfusion rate, post-operative infectious and non-infectious complications, and total hospital stay were also similar. After six courses of PAC (cisplatin 50 mg/m(2), Adriamycin 50 mg/m(2), cyclophosphamide 500 Mg/M(2)) chemotherapy, all patients underwent a second-look laparotomy. Persistent cancer was detected in 49 of 102 (48.03%) patients. Adhesion scores were detected at the time of second-look laparotomy. Adhesion scores for group I (8.9 +/- 2.9) were significantly higher than the group II (peritoneum non-closure) (5.8 +/- 2.3) (P<0.01). Closing the pelvic and periaortic peritoneum did not effect morbidity, but leaving the pelvic and periaortic peritoneum open significantly decreased the adhesion formation.
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PMID:Pelvic and periaortic pertioneal closure or non-closure at lymphadenectomy in ovarian cancer: effects on morbidity and adhesion formation. 865 13

Repeat cardiac surgical procedures are associated with increased technical difficulty and risk because of the previous formation of dense adhesions between the heart and the surrounding tissues. Dilute solutions of sodium hyaluronic acid (NaHA) and carboxymethyl cellulose (CMC) have been shown to prevent postoperative abdominal and pelvic adhesions and could therefore potentially inhibit adhesion formation following cardiac surgery. Adhesion prevention using 0.1% NaHA, 0.4% NaHA, or 0.1% CMC solutions was examined in a canine abrasion/desiccation pericardial adhesion model (5 animals/group) and compared to 10 animals treated with Ringer's lactate (RL) solution alone. The pericardium and heart were coated with 25 ml of test or control solution prior to and after pericardiotomy, after controlled gauze abrasion, after 30 min of desiccation, and prior to closure. At 6 weeks, animals were reexplored and adhesions were scored in a blinded manner by three to four surgeons using a 0-4 scale. Scores of 2 or greater were considered clinically significant. Mean adhesion scores from the left epicardium were 0.0 in animals treated with 0.1% NaHA, 0.6 in animals treated with 0.4% NaHA or 1% CMC, and 2.3 in animals treated with RL (P < 0.05 Duncan's ANOVA). In addition, none of the animals treated with 0.1% NaHA, 20% of the animals treated with 0.4% NaHA, and 20% of the animals treated with 1% CMC had clinically significant adhesions, whereas 80% of animals treated with RL had such adhesions. Sodium hyaluronic acid and CMC solutions, used as tissue coatings during cardiac surgery, inhibit the formation of undesired postoperative adhesions. Application of these biocompatible polymer solutions during surgery could reduce the technical difficulty and risk of repeat cardiac surgical procedures.
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PMID:Prevention of postoperative pericardial adhesions using tissue-protective solutions. 912 96

Abdominal and pelvic adhesions are a major cause of morbidity. Appendicitis and appendicectomy are the commonest cause of intra-abdominal adhesion formation. Peritoneal injury, from a variety of causes, leads to peritoneal inflammation and with it the production of plasminogen activator inhibitors. These inhibitors result in the loss of normal mesothelial fibrinolytic activity, and if prolonged, this allows the organisation of fibrinous adhesions into permanent fibrous adhesions. Adhesions may be prevented by minimising injury and there is increasing evidence that laparoscopic surgery is an important method of adhesion prevention. A wide variety of products have been used experimentally to prevent adhesion formation but clinical interest at present is focused on the use of bioresorbable membranes which allow localised adhesion prevention. These products have been proven effective by randomised clinical trials and their use as a routine method of preventing intra-abdominal adhesion formation is likely to increase.
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PMID:Pathogenesis and prevention of adhesion formation. 984 79

Adhesions in the peritoneal cavity have been implicated in the cause of intestinal obstruction and infertility, but their role in the aetiology of chronic pelvic pain is unclear. Nerves have been demonstrated in human pelvic adhesions, but the presence of pain-conducting fibres has not been established. The purpose of this study was to use an animal model to examine the growth of nerves during adhesion formation at various times following injury and to characterize the types of fibres present. Adhesions were generated in mice by injuring the surface of the caecum and adjacent abdominal wall, with apposition. At 1-8 weeks post-surgery, adhesions were processed and nerve fibres characterized histologically, immunohistochemically, and ultrastructurally. Peritoneal adhesions had consistently formed by 1 week after surgery and from 2 weeks onwards, all adhesions contained some nerve fibres which were synaptophysin, calcitonin gene-related peptide, and substance P-immunoreactive, and were seen to originate from the caecum. By 4 weeks post-surgery, nerve fibres were found to originate from both the caecum and the abdominal wall, and as demonstrated by acetylcholinesterase histochemistry, many traversed the entire adhesion. Ultrastructural analysis showed both myelinated and non-myelinated nerve fibres within the adhesion. This study provides the first direct evidence for the growth of sensory nerve fibres within abdominal visceral adhesions in a murine model and suggests that there may be nerve fibres involved in the conduction of pain stimuli.
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PMID:Growth of nerve fibres into murine peritoneal adhesions. 1105 24


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