Intra-abdominal Adhesions (intra-abdominal + adhesion)

Distribution by Scientific Domains

Selected Abstracts

Controversies in the laparoscopic treatment of hepatic hydatid disease

HPB, Issue 4 2004
Koray Acarli
Background Laparoscopic treatment of hydatid disease of the liver can be performed safely in selected patients. Methods Six hundred and fifty patients were treated for hydatid disease of the liver between 1980 and 2003 at the Hepatopancreato-biliary Surgery Unit of Istanbul Medical Faculty, Istanbul University. Of these, 60 were treated laparoscopically between 1992 and 2000. A special aspirator-grinder apparatus was used for the evacuation of cyst contents. Ninety-two percent of the cysts were at stages I, II or III according to the ultrasonographic classification of Gharbi. Results Conversion to open surgery was necessary in eight patients due to intra-abdominal adhesions or cysts in difficult locations. There was no disease- or procedure-related mortality. Most of the complications were related to cavity infections (13.5%) and external biliary fistulas (I 1.5%) resulting from communications between the cysts and the biliary tree. There were two recurrences in a follow-up period ranging between 3.5 and I I years. Discussion Laparoscopic treatment of hydatid disease of the liver is an alternative to open surgery in well-selected patients. Important steps are the evacuation of the cyst contents without spillage, sterilization of the cyst cavity with scolicidal agents and cavity management using classical surgical techniques. Our specially designed aspirator-grinder apparatus was safely used to evacuate the cyst contents without causing any spillage. Knowledge of the relationship of the cyst with the biliary tree is essential in choosing the appropriate patients for the laparoscopic technique. In our experience of 650 cases, the biliary communication rate was as high as 18%; half of these can be detected preoperatively. In the remaining, biliary communications are usually detected during or after surgery. Endoscopie retrograde cholangiopancreatography (ERCP) and sphincterotomy are helpful to overcome this problem. As hydatid disease of the liver is a benign and potentially recurrent disease, we advocate the use of conservative techniques in both laparoscopic and open operations. [source]

The new adhesion prophylaxis membrane A-part®,From in vitro testing to first in vivo results

Bernd Martin Jaenigen
Abstract Introduction: Formation of postoperative intra-abdominal adhesions is a severe problem in surgery. Apart from standard surgical procedures, a variety of different substances is available to prevent adhesions, but no universal method has been developed so far. A membrane consisting of polyvinyl alcohol (PVA) and carboxymethylcellulose (CMC) has been demonstrated to be antiadhesive. Here, the in vitro testing and first in vivo results in a rabbit sidewall model are reported. Materials and Methods: A-part® membrane contains a PVA/CMC mixture in a thickness of 40 ,m. The composition, dissolution, tensile strength, and elasticity were examined to characterize the membrane in vitro. Experiments in vivo were carried out using a ,rabbit sidewall model' in which a standardized peritoneal trauma was covered with a 5 × 6 cm A-part® membrane. Adhesion formation in A-part®-treated animals was compared with that in Adept® (15 mL/kg body weight) and untreated controls. Results: An 80/20 PVA/CMC mixture forms a stable, elastic, transparent membrane, which can easily be placed intraoperatively. The dissolution shows a half-life of about 2 weeks [day 15: (45.1 ± 4.9)% SD], which affords good adhesion protection during the initial critical phase of adhesion formation. In wet conditions, the membrane follows abdominal movements without tearing (tensile strength 5.0 ± 4.2 N/cm SD; elasticity 29.5%). In a rabbit sidewall model, A-part® membrane significantly reduced adhesion development by (83.1 ± 31.5)% SD compared with the control and the Adept group (p < 0.001). Conclusion: The properties of the A-part® membrane suggest that it may be useful as an antiadhesive in surgery. A-part® is effective in invivo testing as determined in a rabbit sidewall model. © 2008 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2009 [source]

Protection against atypical furunculosis in Atlantic halibut, Hippoglossus hippoglossus (L.); comparison of a commercial furunculosis vaccine and an autogenous vaccine

S Gudmundsdóttir
Abstract Atlantic halibut, Hippoglossus hippoglossus (L.), was shown to be sensitive to infection by three different isolates of Aeromonas salmonicida ssp. achromogenes in pre-challenge tests using intraperitoneal (i.p.) and intramuscular (i.m.) injections as well as bath challenges. A commercial furunculosis vaccine, Alphaject 1200, and an autogenous vaccine, AAS, based on the challenge strain, induced immune protection as shown in challenge tests 8 weeks post-immunization. The survival rate of vaccinated fish after i.p. challenge was 100%, whereas mortality of control fish was 61%. Employing i.m. challenge, relative percentage survival induced by the furunculosis vaccine and the AAS vaccine was 47 and 44, respectively. Mortality of i.m. injected controls was 68%. Vaccinated fish behaved normally following vaccination but the weight gain was significantly reduced in vaccinated fish 8 weeks post-vaccination compared with control fish receiving phosphate-buffered saline. At the same time, intra-abdominal adhesions were observed in fish injected with either of the two vaccines or adjuvant alone. Antibody response against A. salmonicida ssp. achromogenes was detected in sera from fish receiving either vaccine. [source]


R. J. Whitfield
Purpose Endometriosis is defined as the presence of aberrant endometrial tissue outside of the uterus that responds to stimulation by ovarian hormones. A large, circumscribed mass of such tissue is commonly termed an endometrioma. Abdominal wall endometriomas in association with caesarean section scars have been reported repeatedly in the obstetrics and gynaecology literature, but rarely in general surgical journals. Methodology In this paper, six patients are reviewed who presented between 2001 and 2006 with painful, tender nodules in and around caesarean section scars. Of these, four reported exacerbation of symptoms during, or just prior to menstruation. One patient had experienced 12 years of symptoms, previously attributed to intra-abdominal adhesions. Results All patients had their scar nodules excised. Five procedures were performed electively. One patient underwent emergency exploration of her caesarean scar for possible incarcerated incisional hernia. Ectopic endometrial tissue was seen in the histological specimens of all patients. Four patients reported resolution of their symptoms following surgery. One patient had ongoing symptoms post-operatively, with an additional mass lesion seen on ultrasound consistent with a second endometrioma. One patient did not attend follow-up. Conclusion General surgeons are commonly required to assess and manage abdominal wall masses, and should have an awareness of endometrioma in the differential diagnosis when such a lesion is seen in association with a caesarean section scar. Wide excision is usually very effective at alleviating symptoms of abdominal wall endometrioma. [source]

Application of Polycaprolactone as an Anti-Adhesion Biomaterial Film

Hsien-Yi Lo
Abstract Adhesions are unavoidable consequences of surgery and other trauma. How to prevent the adhesions remains a big issue in healthcare system. The objective of this study is to test the efficacy of polycaprolactone (PCL) films as physical barriers in reducing postoperative intra-abdominal adhesions in the rat cecum-abdominal wall model. PCL is quite cheap compared with the agents recently used in the market. The fabrication method is also very easy to perform. Scanning electron microscope (SEM) showed multiple pores over upper and bottom surfaces but too small to permit cells to migrate from one surface onto another surface. Those pores were proven to be not interconnected. The PCL film did not show any evidence of cytotoxic effects as it did not induce any significant increase in cytoplasmic lactate dehydrogenase release from the NIH3T3 cells that it came in contact with. In animal studies, the PCL films led to fewer adhesions than Seprafilm in rat adhesion model. PCL films were efficacious in reducing postoperative intra-abdominal adhesion formation in rat cecum-abdominal wall models. [source]

Laparoscopic compared with conventional treatment of acute adhesive small bowel obstruction,

C. Wullstein
Background: Although laparoscopy may be associated with fewer intra-abdominal adhesions and quicker recovery of bowel function, it remains unclear whether patients with acute small bowel obstruction (SBO) might benefit from laparoscopic techniques. Method: The results of patients with acute SBO treated laparoscopically (LAP; n = 52) and conventionally (CONV; n = 52) were compared in a retrospective matched-pair analysis. Conversions were included in the laparoscopic group. Results: Complete laparoscopic treatment was performed in 25 patients (48·1 per cent). Major intraoperative complications occurred in 15 patients in the LAP group and eight in the CONV group (P = 0·156). Intraoperative perforations were more frequent in patients who had undergone more than one previous laparotomy (P = 0·066). Postoperative complications occurred in ten patients (19·2 per cent) in the LAP group and in 21 patients (40·4 per cent) who had conventional surgery (P = 0·032). Bowel movements started 3·5 days after operation in the LAP group and 4·4 days after conventional operation (P = 0·001). The length of hospital stay was 11·3 and 18·1 days respectively (P < 0·001). Conclusion: Laparoscopic treatment of acute SBO was feasible in about half of these patients. Postoperative recovery was improved after laparoscopic procedures but the risk of intraoperative complications increased. A laparoscopic approach seems justified in a subset of patients. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]