ABSTRACT
Intra-abdominal adhesions represent a major cause of postoperative morbidity, including chronic or recurrent pelvic pain and infertility in a significant percent of patients. The SprayShield™ Adhesion Barrier System (Covidien, Waltham, MA) is a next-generation sprayable adhesion barrier to prevent postoperative adhesions. Initially sprayed as a liquid, SprayShield™ solidifies within 2 seconds of contact with tissue through a polyethylene glycol (PEG) ester-Trilysine reaction to form an adherent, internal tissue barrier that protects the underlying tissues for several days after surgery. After tissue begins to heal, the adhesion barrier liquefies via hydrolysis and completely absorbs within 7 days. Safety testing has shown the product to be nongenotoxic, noncytotoxic, nonsensitizing, and nonirritating. SprayShield™ has been shown to adhere well to tissue, with the mechanism of adherence believed to be mainly due to tissue surface mechanical interlocking. In studies that compared SprayShield™ to good surgical technique, virgin hogs were randomized to receive SprayShield™ or good surgical technique (Control). Compared to Controls, SprayShield™ demonstrated a statistically significant reduction in the number of adhesions (46%, p=0.04) and in the area of adhesions (83%, p=0.012) to injured sites. With its ease of application, biocompatibility and adhesion prevention efficacy, SprayShield™ may be an effective next-generation adhesion prevention product for open and laparoscopic abdominopelvic procedures as an adjunct to good surgical technique.
Subject(s)
Aerosols/therapeutic use , Gynecologic Surgical Procedures/adverse effects , Membranes, Artificial , Tissue Adhesions/etiology , Tissue Adhesions/prevention & control , Animals , Drug Evaluation, Preclinical , Female , Humans , Swine , Tissue Adhesions/diagnosis , Treatment OutcomeABSTRACT
Objetivo. La oclusión de intestino delgado por causa adherencial es un proceso frecuente como causa de ingreso, cuya dificultad no se halla en el diagnóstico sino en su manejo, por lo que es importante encontrar factores predictivos que ayuden a elegir el tratamiento óptimo en cada caso. Pacientes y métodos. Estudio retrospectivo de 154 pacientes con oclusión adherencial del intestino delgado, anotándose aquellos datos objetivos (demográficos, radiológicos, analíticos y antecedentes quirúrgicos) e ingresos previos por la misma causa. Tras realizar el estudio descriptivo se aplicó el análisis inferencial bivariante para aquellos resultados relevantes. Los resultados llamativos del último ingreso se estudiaron mediante un análisis multivariante de regresión logística para buscar un conjunto de variables que ofrecieran el mejor modelo predictivo para la indicación quirúrgica. Resultados. El 38,8 por ciento de los pacientes ingresados fueron intervenidos, de los cuales el 34,6 por ciento presentaban un cuadro de estrangulación. Las cirugías ginecológicas y colorrectal presentan una mayor incidencia de indicación quirúrgica. Para la indicación quirúrgica, la ausencia de aireación colónica (55 por ciento) junto con la alteración del ionograma son las variables de mayor significación estadística. En el análisis multivariante, estas dos variables, junto a la cirugía previa de localización inframesocólica, presentan un poder predictivo independiente. Conclusiones. Existen factores pronósticos objetivos relacionados con la indicación quirúrgica en la oclusión adherencial de intestino delgado y, aunque su aplicación conjunta como modelo predictivo no ofrezca seguridad total, puede resultar orientador de cara a la estrategia a seguir en lo que respecta a la duración del período de observación bajo tratamiento médico. (AU)
Subject(s)
Adult , Aged , Female , Male , Middle Aged , Humans , Tissue Adhesions/surgery , Tissue Adhesions/diagnosis , Tissue Adhesions/complications , Intestinal Obstruction/surgery , Intestinal Obstruction/diagnosis , Surgical Procedures, Operative/methods , Surgical Procedures, Operative , Multivariate Analysis , Homeopathic Clinical-Dynamic Prognosis , Retrospective Studies , Intestine, Small/surgery , Intestine, Small/pathology , Intestine, Small , Abdominal Pain/diagnosis , Abdominal Pain/etiology , Epidemiology, Descriptive , Esophageal Stenosis/complications , Esophageal Stenosis/diagnosisABSTRACT
UNLABELLED: STUDY OBJECTIVE. To evaluate the feasibility of a new endoscopic technique, transvaginal hydrolaparoscopy, for early office screening of subfertile women. DESIGN. Retrospective, descriptive feasibility study (Canadian Task Force classification II-2). SETTING: Office in an infertility center. PATIENTS: One hundred fifty-seven continuous women with primary or secondary subfertility. INTERVENTION: Under local anesthesia, a Veress needle-cannula system was inserted into the posterior fornix with peritoneal distention by saline. MEASUREMENTS AND MAIN RESULTS: Access was achieved in 95% of patients. In 58.5% the findings were normal and in 28% an explorative or operative laparoscopy was indicated. No major complication occurred. Patients' pain scores were similar to those for office hysteroscopy. CONCLUSION: Transvaginal hydrolaparoscopy was successfully performed in the office. The technique allows early and complete endoscopic screening of subfertile women.
Subject(s)
Endometriosis/diagnosis , Infertility, Female/diagnosis , Laparoscopy/methods , Tissue Adhesions/diagnosis , Ambulatory Care , Anesthesia, Local , Fallopian Tube Diseases/diagnosis , Feasibility Studies , Female , Humans , Ovarian Diseases/diagnosis , Retrospective StudiesABSTRACT
Congenital mesocolic band is an uncommon aberration in the development of the mesentery. Large-bowel obstruction secondary to adhesion and/or congenital band is very rare in children. A 6-month-old male infant who had no history of previous surgery was admitted with unremitting crying. A barium enema showed extraintestinal compression of the sigmoid colon. Laparotomy revealed an adhesive mesocolic band compressing the proximal part of the sigmoid colon. The band was lysed. The patient has remained asymptomatic since the procedure.
Subject(s)
Intestinal Obstruction/etiology , Mesentery/abnormalities , Sigmoid Diseases/etiology , Diagnosis, Differential , Digestive System Abnormalities/diagnosis , Humans , Infant , Intestinal Obstruction/diagnosis , Intestinal Obstruction/surgery , Laparotomy , Male , Sigmoid Diseases/diagnosis , Sigmoid Diseases/surgery , Tissue Adhesions/diagnosis , Tissue Adhesions/etiology , Tissue Adhesions/surgeryABSTRACT
The clinical and experimental study of postoperative complications of suppurative peritonitis (the pathologic commissure formation) has been done. The authors believe that the combination of the break of cytodynamic correlation in peritonitis centre and GIT paresis is a basis of pathogenesis of the process. The authors advocate combination of anticomissural preventive stern with cytomodulation and GIT paresis treatment. The abdominal ultrasonography has been used for the diagnosis. The main role in surgical treatment belongs to laparoscopy that made it possible to decrease the amount of relaparotomy cases. There were no lethal complications or cases of recurrency.
Subject(s)
Peritoneal Cavity/pathology , Peritoneal Cavity/surgery , Peritonitis/complications , Peritonitis/surgery , Postoperative Complications/prevention & control , Child , Diagnosis, Differential , Electric Stimulation Therapy , Electromyography , Humans , Tissue Adhesions/diagnosis , Tissue Adhesions/etiology , Tissue Adhesions/prevention & control , Tissue Adhesions/surgeryABSTRACT
In a retrospective study the use of imaging modalities in the diagnosis of non-specific abdominal pain in patients under 31 years was evaluated. 253 patients with primarily non-specific abdominal complaints were analysed. For further investigation one of the following methods had to be applied: abdominal sonography and/or upper gastrointestinal tract roentgenograms and/or enteroclysis and/or barium enema. In 66% (167/253) of all cases abdominal pain remained non-specific. Clinical history and physical examination led to the final diagnosis in 66/86 (76.7%) of patients with pathologic findings. 21/561 (3.7%) radiographic examinations revealed abnormalities of clinical importance. In 10/253 (4%) patients the final diagnosis could be established only with the help of radiologic and/or endoscopic examinations. The low efficacy of conventional radiology justifies the demand for a stricter indication in the young patient suffering from non-specific abdominal pain.