Effect of soft tissue mobilization techniques on adhesion-related pain and function in the abdomen: A systematic review.

OBJECTIVE: To systematically review the effects of soft tissue mobilization (STM) on both surgical and non-surgical abdominal adhesion-related symptoms. STUDY DESIGN: Systematic Review. BACKGROUND: It is known that abdominal adhesions can cause a variety of symptoms with one of the most common being abdominal pain. To date, there is no known systematic review that documents the effects of STM on adhesion-related abdominal symptoms. METHODS AND MEASURES: A systematic review of literature was indexed in the following databases: PubMed, Cochrane, Google Scholar, OVID, and EBSCO. The quality of the studies was assessed using the MINORS scale. RESULTS: Nine studies satisfied the eligibility criteria for this systematic review. The studies' population age ranged from 10.7 to 89.4 years. Four articles were nonrandomized and had scores ranging from 3 to 14 out of 16 total on the MINORS scale. Five articles were randomized controlled trials or comparative studies and scores ranged from 16 to 23 out of 24 total on the MINORS scale. There were five articles that used pain as an objective measure and all of them reported a decrease in pain after treatment. Two studies looked at quality of life and function and both saw objective improvements following abdominal adhesion treatment. Collectively, there were also improvements seen in scar mobility, infertility, posture, a reduction in medication, increased pressure tolerance and decreased postoperative ileus. CONCLUSION: The results of this review indicate preliminary strong evidence for the benefits of STM on symptoms relating to acute post-surgical adhesions, preliminary moderate evidence for the benefits of STM on symptoms relating to chronic non-surgical related adhesions (fertility and SBO) and moderate evidence for the benefits of STM on symptoms relating to chronic post-surgical adhesions.

Fabrication and characterization of pectin-based three-dimensional porous scaffolds suitable for treatment of peritoneal adhesions.

Formation of peritoneal adhesions is common complication after abdominal and pelvic surgery. They bear a significant health problem with an influence to quality of life and health care expenses. Promising approach for their prevention is using of biodegradable barrier films for physical separation of peritoneal surfaces. In the present study, highly porous pectin-based three-dimensional (3D) scaffolds were obtained by freeze-drying technique. Physico-chemical properties of the formed materials, including their morphology, porosity, density, and stability, have been studied. The evaluation of their biocompatibility, biodegradation, and potential antiadhesion effect was studied by in vivo experiment. To reinforce the scaffolds structure and improve their stability in physiological solutions, pectin chains were cross-linked with divalent cations. We determined optimal cross-linking conditions, which allow obtaining scaffolds with desired biodegradation rate. These cross-linked scaffolds fully dissolved within 8 days in the peritoneal cavity with low presence of complications and some antiadhesive effect. It has also been determined that mesenchymal stem cells from adipose tissue could effectively adhere to the scaffolds with preservation of their viability. Our results show that obtained materials can be suggested as mechanical scaffold for delivery of the stem cells culture to peritoneal surfaces as a part of complex antiadhesive barrier system.

Evaluation of a water-soluble contrast protocol for nonoperative management of pediatric adhesive small bowel obstruction.

BACKGROUND/PURPOSE: We examined outcomes before and after implementing an enteral water-soluble contrast protocol for management of pediatric adhesive small bowel obstruction (ASBO). METHODS: Medical records were reviewed retrospectively for all children admitted with ASBO between November 2010 and June 2017. Those admitted between November 2010 and October 2013 received nasogastric decompression with decision for surgery determined by surgeon judgment (preprotocol). Patients admitted after October 2013 (postprotocol) received water-soluble contrast early after admission, were monitored with serial examinations and radiographs, and underwent surgery if contrast was not visualized in the cecum by 24 h. Group outcomes were compared. RESULTS: Twenty-six patients experienced 29 admissions preprotocol, and 11 patients experienced 12 admissions postprotocol. Thirteen (45%) patients admitted preprotocol underwent surgery, versus 2 (17%) postprotocol patients (p = 0.04). Contrast study diagnostic sensitivity as a predictor for ASBO resolution was 100%, with 90% specificity. Median overall hospital LOS trended shorter in the postprotocol group, though was not statistically significant (6.2 days (preprotocol) vs 3.6 days (postprotocol) p = 0.12). Pre- vs. postprotocol net operating cost per admission yielded a savings of $8885.42. CONCLUSIONS: Administration of water-soluble contrast after hospitalization for pediatric ASBO may play a dual diagnostic and therapeutic role in management with decreases in surgical intervention, LOS, and cost. TYPE OF STUDY: Retrospective comparative study. LEVEL OF EVIDENCE: Level III.

Effect of wound massage on neck discomfort and voice changes after thyroidectomy.

BACKGROUND: Neck discomfort and voice change are common complications after thyroidectomy. These symptoms might be due to damaged laryngeal nerves, intrinsic structures, or extralaryngeal muscles. They can also occur without injury to any structure as with wound adhesion after thyroidectomy. The objective of this study was to determine causes of neck discomfort and voice change after thyroidectomy and to evaluate the effect of wound massage on symptom relief. METHODS: Forty-five female patients who underwent total thyroidectomy were included (21 in the experimental group and 24 in the control group). Wound massage was used as an intervention to release surgical adhesion. After wound massage education, participants in the experimental group received wound massage from 4 to 12 weeks after thyroidectomy. Analysis was performed for both groups. RESULTS: No laryngeal pathology was found after thyroidectomy. The experimental group had significantly better recovery from surgical adhesion and subjective visual analog scale, voice impairment score, and swallowing impairment score (all P < .01) compared with the control group. Voice analysis results associated with laryngeal movement (speaking fundamental frequency, voice range profile maximum, voice range profile range) also indicated significant recovery (P < .01) in the experimental group. These results indicate that local adhesion after thyroidectomy might affect general movement of the larynx and that wound massage could help patients recover normal general movement of the larynx. CONCLUSION: Neck discomfort and voice change after thyroidectomy are related to local wound adhesion, possibly associated with impairment of laryngeal vertical movement. Release of wound adhesion could help patients recover from neck discomfort and voice changes after thyroidectomy.

Water-soluble contrast agent in adhesive small bowel obstruction: a systematic review and meta-analysis of diagnostic and therapeutic value.

BACKGROUND: Adhesive small bowel obstructions are the most common postoperative causes of hospitalization. Several studies investigated the diagnostic and therapeutic role of water-soluble contrast agent (WSCA) in predicting the need for surgery, but there is no consensus. METHODS: A systematic review and meta-analysis was done of studies on diagnostic and therapeutic role of oral WSCA. RESULTS: WSCA had a sensitivity of 92% and a specificity of 93% in predicting resolution of obstruction without surgery; diagnostic accuracy increased significantly if abdominal X-rays were taken after 8 hours. The administration of oral WSCA reduced the need for surgery (odds ratio .55, P = .003), length of stay (weighted mean difference -2.18 days, P < .00001), and time to resolution (weighted mean difference -28.25 hours, P < .00001). No differences in terms of morbidity or mortality were recorded. CONCLUSIONS: The administration of WSCA is accurate in predicting the need for surgery; the test should be taken after at least 8 hours from administration. WSCA is a proven safe and effective treatment, correlated with a significant reduction in the need for surgery and in the length of hospital stay.

Soft Tissue Mobilization to Resolve Chronic Pain and Dysfunction Associated With Postoperative Abdominal and Pelvic Adhesions: A Case Report.

STUDY DESIGN: Case report. BACKGROUND: Common complications from abdominal and pelvic surgery include adhesions and chronic pain. Laparoscopic adhesiolysis is sometimes used to reduce adhesions and related pain. Physical therapy interventions, such as soft tissue mobilization (STM), may be used for this condition; however, evidence to support its effectiveness is lacking. CASE DESCRIPTION: A 28-year-old woman with a history of 5 abdominal/pelvic surgeries presented with right-sided lower abdominal and anterior hip pain, which had been present since she had undergone a laparoscopic appendectomy with a right ovarian cystectomy surgery 1 year earlier. As an active-duty member in the US Navy, due to pain and weakness, she was unable to perform required curl-ups for her fitness test. Though she had been previously treated both surgically with laparoscopic adhesiolysis and nonsurgically with physical therapy consisting of stretching and strengthening exercises, her pain and function did not improve. She was again evaluated and treated with physical therapy and, based on the examination findings, STM was used to address her pain and dysfunction, which were thought to be related to intra-abdominal adhesions. OUTCOMES: Following 5 sessions of physical therapy over a 3-week period that included STM and therapeutic exercises, followed by 5 additional sessions over a 4-week period that focused on therapeutic exercises, the patient reported substantially decreased pain, improved function, and a full return to previous level of activity, including unrestricted physical training in a military setting. DISCUSSION: The outcomes for this patient suggest that STM may be effective as a conservative treatment option for pain and dysfunction related to intra-abdominal adhesions from abdominal/pelvic surgery. Studies with a higher level of evidence, including potential comparison between STM and traditional laparoscopic adhesiolysis, are needed to further determine benefits of nonsurgical care for this condition.

Clinical effect of hyperbaric oxygen therapy in adhesive postoperative small bowel obstruction.

BACKGROUND: Hyperbaric oxygen (HBO) therapy is a controversial treatment for adhesive postoperative small bowel obstruction, with only a few small studies reported. The aim of this study was to assess the clinical value of HBO therapy in the treatment of adhesive postoperative small bowel obstruction. METHODS: Between April 2006 and March 2012, all patients with adhesive postoperative small bowel obstruction were treated using either decompression therapy or HBO. Patients undergoing HBO therapy were treated once a day at a pressure of 2·0 atmospheres absolute and received 100 per cent oxygen. Patients showing no clinical and radiological improvement with HBO therapy were converted to decompression therapy by means of a long tube. Medical records were reviewed and outcomes analysed. RESULTS: A total of 305 patients were treated, of whom 142 underwent tube decompression therapy during the first 3 years and the remaining 163 had HBO therapy during the last 3 years. The median number of HBO treatments was 3 (range 1-7). A total of 143 patients (87·7 per cent) were treated successfully with HBO without long-tube decompression. HBO therapy was associated with earlier resumption of oral intake (mean 4·7 versus 6·5 days; P = 0·001) and a shorter hospital stay (mean 10·3 versus 14·1 days; P = 0·001). The rate of operation was 7·4 per cent in the HBO group and 14·8 per cent in group treated by decompression alone (P = 0·037). CONCLUSION: In this study, HBO therapy was safe for the treatment of adhesive postoperative small bowel obstruction. It reduced the need for surgery and time to recovery as well as the hospital stay.

[Adhesive ileus treated by electroacupuncture at Zhigou (TE 6) and Zusanli (ST 36): a randomized controlled study].

OBJECTIVE: To assess the clinical efficacy on adhesive ileus treated by electroacupuncture (EA) at Zhigou (TE 6) and Zusanli (ST 36), and to explore the different effects of acupoint and non-acupoint. METHODS: Forty cases were randomized into an acupoint group and a non-acupoint group, 20 cases in each one. At the same time of the basic treatment, in the acupoint group, EA was applied at bilateral Zhigou (TE 6) and Zusanli (ST 36). In the non-acupoint group, EA was applied at the sites (that were neither on any meridian nor belonged to any acupoint) that were 0.5 to 1 cm lateral to Zhigou (TE 6) and Zusanli (ST 36) on both sides. Acupuncture was given twice a day, lasting for 4 days totally. The situation of abdominal pain, the time for the improvement in abdominal distention, the time of first voluntary defecation, the time of solid food intake and the others were observed. RESULTS: In the acupoint group, the abdominal pain and distention were relieved rapidly as compared with those in the non-acupoint group. The results of the assessment face scale (AFS), the first anal exhaust time [(51.35 +/- 32.40) h vs (101.85 +/- 53.87) h], the first defecation time [(82.70 +/- 57.27) h vs (154.70 +/- 145.28) h] and the first solid food intake time [(119.65 +/- 56. 16) h vs (231.95 +/- 180.89) h] were all remarkably improved as compared with those in the non-acupoint group, presenting the statistical significance (P<0.05, P<0.01). Concerning the case number for the conversion to surgery, the death number and the number for the re-admission in 1 year follow-up visit, there was no significant difference in statistics between two groups (all P>0.05). But, the data suggested that the results were improved in tendency in the acupoint group. CONCLUSION: EA at Zhigou (TE 6) and Zusanli (ST 36) achieves the good clinical efficacy on adhesive ileus. This therapy can remarkably improve abdominal pain and distention and promote the intestinal peristalsis for the patients and is superior to EA at non-acupoint.

Visceral mobilization can lyse and prevent peritoneal adhesions in a rat model.

OBJECTIVE: Peritoneal adhesions are almost ubiquitous following surgery. Peritoneal adhesions can lead to bowel obstruction, digestive problems, infertility, and pain, resulting in many hospital readmissions. Many approaches have been used to prevent or treat adhesions, but none offer reliable results. A method that consistently prevented or treated adhesions would benefit many patients. We hypothesized that an anatomically-based visceral mobilization, designed to promote normal mobility of the abdominal contents, could manually lyse and prevent surgically-induced adhesions. MATERIAL AND METHODS: Cecal and abdominal wall abrasion was used to induce adhesions in 3 groups of 10 rats (Control, Lysis, and Preventive). All rats were evaluated 7 days following surgery. On postoperative day 7, unsedated rats in the Lysis group were treated using visceral mobilization, consisting of digital palpation, efforts to manually lyse restrictions, and mobilization of their abdominal walls and viscera. This was followed by immediate post-mortem adhesion evaluation. The rats in the Preventive group were treated daily in a similar fashion, starting the day after surgery. Adhesions in the Control rats were evaluated 7 days after surgery without any visceral mobilization. RESULTS: The therapist could palpate adhesions between the cecum and other viscera or the abdominal wall. Adhesion severity and number of adhesions were significantly lower in the Preventive group compared to other groups. In the Lysis and Preventive groups there were clear signs of disrupted adhesions. CONCLUSIONS: These initial observations support visceral mobilization may have a role in the prevention and treatment of post-operative adhesions.

Novel approaches for the management of tendinopathy.

Tendinopathy is a failed healing response of the tendon. Despite an abundance of therapeutic options, very few randomized prospective, placebo-controlled trials have been carried out to assist physicians in choosing the best evidence-based management. Eccentric exercises have been proposed to promote collagen fiber cross-link formation within the tendon, thereby facilitating tendon remodeling. Overall results suggest a trend for a positive effect of eccentric exercises, with no reported adverse effects. Combining eccentric training and shock wave therapy produces higher success rates compared with eccentric loading alone or shock wave therapy alone. The use of injectable substances such as platelet-rich plasma, autologous blood, polidocanol, corticosteroids, and aprotinin in and around tendons is popular, but there is minimal clinical evidence to support their use. The aim of operative treatment is to excise fibrotic adhesions, remove areas of failed healing, and make multiple longitudinal incisions in the tendon to detect intratendinous lesions and to restore vascularity and possibly stimulate the remaining viable cells to initiate cell matrix response and healing. New operative procedures include endoscopy, electrocoagulation, and minimally invasive stripping. The aim of these techniques is to disrupt the abnormal neoinnervation to interfere with the pain sensation caused by tendinopathy. Randomized controlled trials are necessary to better clarify the best therapeutic options for the management of tendinopathy.

Tratamiento de las plastrones apendiculares en pediatría: conservador v/s quirúrgico: ¿cuál es la mejor alternativa? / Treatment of appendiceal mass in children: conservative versus surgical management

Introducción: Existe discusión con respecto al manejo conservador versus quirúrgico en el tratamiento de los plastrones apendiculares, así como la necesidad de la apendicectomía diferida. Objetivo: Describir nuestra experiencia en el manejo de los plastrones apendiculares. Demostrar la utilidad del manejo médico conservador inicial y la validar la realización de la apendicectomía diferida. Material y método: Revisión de las fichas clínicas de los pacientes egresados con diagnóstico de plastrón apendicular entre enero 2000 a septiembre 2009. Se aplicó análisis estadístico a los resultados. Resultados: 107 pacientes, edad promedio de 8,50 años (2 a 14 años). 68 hombres y 39 mujeres. Se establecieron 2 grupos. El Grupo I constituido por 34 pacientes que se operaron al ingreso. Tiempo de evolución clínica 5,14 días en promedio. En 9 se palpó masa abdominal. Ningún paciente de este grupo contó con ecografía. Tiempo quirúrgico promedio 83 minutos. En 8 casos se presentaron complicaciones como abscesos residuales, obstrucción intestinal y necrosis con perforación intestinal. Tiempo de hospitalización 8,97 días en promedio. El Grupo II, 73 pacientes no se operaron y se manejaron con tratamiento antibiótico (endovenoso y oral). Días de evolución promedio de 6,6 días. 46 presentaban masa palpable y ecografía confirmatoria el 100 por ciento. No hubo complicaciones en este grupo. Tiempo de hospitalización promedio de 9,1 días. Se han realizado exploración laparoscópica diferida en 52 pacientes. Tiempo quirúrgico promedio 48,9 minutos promedio. Dentro de los hallazgos operatorios, en el 57,6 por ciento el apéndice se encontró con adherencias y posición anómala. La mayoría de las biopsias (68 por ciento) se informaron como normal y/o con inflamación. 13 pacientes presentaron un segundo episodio de apendicitis mientras esperaban la intervención diferida, siendo operados de urgencia. Conclusión: El tratamiento médico conservador inicial es de elección en los...

Effect of hyperbaric oxygen therapy on patients with adhesive intestinal obstruction associated with abdominal surgery who have failed to respond to more than 7 days of conservative treatment.

BACKGROUND/AIMS: To investigate the effects of hyperbaric oxygen (HBO) therapy on patients with adhesive intestinal obstruction who have failed to respond to more than 7 days of conservative treatment. METHODOLOGY: Six hundred eighty-five patients, who were admitted a total of 879 times for adhesive intestinal obstruction, were divided into groups according to the treatment and interval between the first day of the therapy and clinical symptoms of obstruction; tube decompression therapy within 7 days after appearance of clinical symptoms (Group I: n = 321), clinical symptoms that have persisted for less than 7 days before the start of HBO therapy (Group II: n = 498), and for more than 7 days (Group III: n = 60). RESULTS: The overall resolution and mortality rates in the cases of adhesive intestinal obstruction were 79.8% and 2.2% in Group I, 85.9% and 1.4% in Group II, and 81.7% and 1.6% in Group III, respectively. Group II had significantly better resolution rates than Group I (odds ratio 1.6, p < 0.02). CONCLUSIONS: HBO therapy may be useful in management of adhesive intestinal obstruction associated with abdominal surgery, even in patients who fail to respond to other conservative treatments. HBO therapy may be a preferred option for treatment of patients for whom surgery should be avoided.

Hyperbaric oxygen therapy as a prophylactic and treatment against ileus and recurrent intestinal obstruction soon after surgery to relieve adhesive intestinal obstruction.

BACKGROUND AND AIM: Nonoperative management of cases of adhesive intestinal obstruction would be ideal, especially for patients who have recently undergone surgery to relieve the same condition. We aimed to examine whether hyperbaric oxygen (HBO) therapy might have therapeutic potential for the treatment of postoperative paralytic ileus and recurrent adhesive intestinal obstruction soon after surgery, to relieve adhesive intestinal obstruction, because of its unique mechanisms in these contexts. METHODS: A total of 133 patients were enrolled in the present study. We examined non-per os periods, hospital stay, and clinical course according to the postoperative course of the 133 patients. RESULTS: After surgical intervention, 75 patients left the hospital without morbidity. Nineteen patients were successfully administered prophylactic HBO therapy to facilitate intestinal motility and to prevent paralytic ileus. The remaining 39 patients suffered from postoperative paralytic ileus or early recurrence of obstruction during the same hospitalization period. The patients who underwent prophylactic HBO therapy had significantly shorter non-per os periods and hospital stays after surgery than those who were not initially given HBO therapy (P < 0.05). Similarly, there were significant differences in duration of hospital stay after surgery between patients with HBO therapy as treatment and those who received other conservative therapies (P < 0.05). CONCLUSIONS: HBO therapy may have a prophylactic effect on postoperative paralytic ileus and may be of therapeutic benefit in the management of early recurrent adhesive intestinal obstruction following surgery to relieve adhesive intestinal obstruction.

[Effects of combined use of therapeutic physical factors on early postoperative adhesion process in experiment].

Experimental adhesion process in the abdominal cavity was provoked in 36 guinea-pigs by autoimmune injury of the abdomen. The adhesions were exposed to impulse magnetic field and low-intensive infra-red laser radiation. The effects of the latter modalities on adhesion in early postoperative period, further use of lidase electrophoresis and ultrasound were studied. A combined action of various physical factors changes adhesion process: limits adhesion and visceral deformity, makes adhesions elastic.

[The treatment of synechia labiorum minorum]. / Kum vuprosa za lechenieto na synechia labiorum minorum.

The data of 89 girls aged 4 months to 12 years, with synechia labiorum minorum, diagnosed for the first time in 1991 at the Outpatient Department of Pediatric and Adolescent Gynecology at the University Ob. & Gyn. Hospital in Sofia were analyzed (age distribution, type of synechia, kind of treatment and the effects). The same girls were followed up during the next two years (healing, adverse reactions, reappearance). According to the treatment the girls were divided in two main groups. The first group (72 girls) were treated with blunt dissection of synechia under local anesthesia (two drops anesthetic jelly), followed by two weeks treatment with non-hormonal ointment. The second group, due to old, solid synechiae, the girls were treated only with oestriol ointment. Statistically there is no significant difference in the number of reappearances between the two groups. There were no cases of scars, narrows and adverse reactions. There are differences in the duration of the treatment and in it's costs. In the first group the duration was two weeks and the costs were several times lower than in the second group which duration is 4-8-12 weeks.

Terapêutica alternativa na coalescência de ninfas / Alternative therapy in adhesions of the labia minora

O objetivo deste trabalho é demonstrar a viabilidade de tratamento alternativo em casos de aglutinaçäo de pequenos lábios em crianças. A terapêutica preconizada baseou-se na utilizaçäo de vaselina sólida associada à massagem da área aderente. Discutem-se as vantagens sobre outras forma de tratamento