The effects of different doses of melatonin treatment on endometrial implants in an oophorectomized rat endometriosis model.

AIMS: To determine the effects of different doses of melatonin treatment on endometrial implants, the activity of antioxidant enzyme superoxide dismutase (SOD), the angiogenesis factor, the vascular endothelial growth factor (VEGF) and the waste metabolite product of lipid peroxidation malondialdehyde (MDA) in an oophorectomized rat endometriosis model. METHODS: Thirty-two, female, non-pregnant, nulligravid Sprague-Dawley, albino rats were used in this prospective, randomized, controlled and experimental study. Endometriosis was surgically induced in oophorectomized rats, and estradiol treatment was started after the first operation and continued till the end of the study. Second look, third look and necropsy operations were performed in the 2nd, 4th and 6th weeks. Mean volumes, histological scores and biochemical parameters were evaluated throughout the study. RESULTS: The mean volumes of endometriotic foci were 98.8 mm(3) ± 17.2 vs. 108.2 mm(3) ± 17.5, 54.1 mm(3) ± 15.6 vs. 25.8 mm(3) ± 3.6, 42.8 mm(3) ± 10.5 vs. 32.7 mm(3) ± 6.0 and histopathological scores were 2.2 ± 0.2 vs. 1.7 ± 0.1, 2.6 ± 0.2 vs. 2.2 ± 0.2, 2.6 ± 0.1 vs. 2.7 ± 0.2 in the 10 vs. 20-mg/kg/day melatonin group at the end of the second, fourth and sixth weeks, respectively. When the groups were compared, no significant differences were seen in the histopathologic scores, SOD and VEGF levels between the groups. However, the endometriotic foci volumes were significantly decreased in both melatonin treatment groups with respect to the control group at the end of the fourth and sixth weeks. Moreover, the mean MDA levels were significantly lower in the control group than in the 10-mg/kg/day melatonin group at the end of the fourth and sixth weeks. CONCLUSION: Melatonin treatment resulted in the regression of endometriotic lesions in oophorectomized rats. Higher doses of melatonin treatment might be more effective in the regression of implants and improvement of histologic scores as well as in the precise evaluation of SOD, MDA and VEGF distributions in the rat experimental models.

Melatonin treatment results in regression of endometriotic lesions in an ooferectomized rat endometriosis model.

OBJECTIVE: We aimed to determine the effects of melatonin treatment on endometrial implants in an oopherectomized rat endometriosis model. MATERIAL AND METHODS: This study is a prospective, randomised, controlled experimental study. It was carried out at the Experimental Research Center of Yeditepe University (YUDETAM). Twenty-two, female, non-pregnant, nulligravid Spraque-Dawley albino rats were included in our study. Endometriosis was surgically induced in oopherectomized rats. Rats were randomised into two groups: control group and melatonin group. In the melatonin group, rats were treated with melatonin (20 mg/kg/day) for two weeks. After the operations were performed to assess the regression of the endometriotic lesions, melatonin treatment was stopped. At the end of the sixth week necropsies were performed to assess the rate of recurrence. The volume and histopathological scores of endometriotic foci were examined. RESULTS: Volumes of the endometriotic lesions significantly decreased in the melatonin group. Also, when the melatonin group was analysed within itself, endometriotic lesion volumes decreased and histopathological scores increased significantly. CONCLUSION: Melatonin causes regression of the endometriotic lesions in rats and improvement in their histopathological scores.

Medical ozone therapy decreases postoperative uterine adhesion formation in rats.

PURPOSE: Various studies have been performed to find out novel treatment strategies to prevent postoperative adhesion formation. Ozone therapy (OT) is shown to reduce inflammation in several pathological conditions. Therefore, we aimed to evaluate the efficacy of OT in a rat model of experimental uterine adhesion (EUA). METHODS: Thirty female Wistar rats (200-250 g) were divided into three groups: sham, EUA and EUA+OT. EUA and EUA+OT groups were subjected to the postoperative adhesion procedure by bipolar coagulation on the uterine horns and corresponding pelvic sidewall parietal peritoneum. EUA+OT group received 0.7 mg/kg daily single dose for 3 days of ozone/oxygen mixture intraperitoneally after adhesion induction. All animals were killed on the 7th day and uterine adhesions were scored. Uterine tissues and peritoneal washing fluid were harvested for all analyses. RESULTS: Uterine malondialdehyde levels in the EUA group were significantly higher compared to the other groups. However, in the EUA group, uterine superoxide dismutase and glutathione peroxidase activities were lower than in other groups. Peritoneal fluid TNF-α levels were found to be significantly different for all groups (p < 0.001). Macroscopic total adhesion score was significantly higher in the EUA group compared to the other groups (p < 0.001). But, total score in the EUA+OT group was lower than in the EUA group (p = 0.006). CONCLUSIONS: Medical OT prevents postoperative uterine adhesions by modulating TNF-α levels and oxidative/antioxidative status in an experimental uterine adhesion model.

Efficacy of melatonin and hyaluronate/carboxymethylcellulose membrane in preventing adhesion reformation following adhesiolysis in a rat uterine model.

AIM: To evaluate the efficacy of hyaluronate/carboxymethylcellulose (HA/CMC) membrane and melatonin separately and in combination in reducing adhesion reformation following adhesiolysis of surgically induced adhesions in a rat uterine horn adhesion model. METHODS: A randomized, prospective study was carried out in a university animal laboratory. Ninety-eight female Sprague-Dawley albino rats were operated on. Following infliction of standard lesions, all the animals underwent second operations after one week. In all the animals, there were dense and vascular adhesions only between the uterine horns. These adhesions were lysed. Following the completion of adhesiolysis, the animals were randomized before closure of the abdomen to one of four groups (melatonin, HA/CMC membrane, combination of melatonin and HA/CMC membrane, control group). Seven days after the second surgery, the third operations were carried out and adhesions were scored. The main outcome measures were type, tenacity, and extent of adhesions. Total adhesion scores were determined. RESULTS: Adhesion scores in the melatonin and HA/CMC membrane groups were similar, and significantly lower than those in the control group (P < 0.001). Adhesion scores in the combination group were lower than those in the other three groups (P < 0.001). CONCLUSION: Melatonin and HA/CMC membrane are both effective separately in preventing adhesion reformation following adhesiolysis, but in combination they are significantly more beneficial.

Etanercept causes regression of endometriotic implants in a rat model.

OBJECTIVE: To determine the effects of etanercept (anti-TNF-α) on surgically induced endometriosis in a rat model. MATERIALS AND METHODS: This is a prospective, randomized, controlled, experimental study that was carried out at the Experimental Research Center of Yeditepe University (YUDETAM). Thirty female nonpregnant, nulligravid Wistar-Hannover albino rats were used. The summary of the technique: surgical induction of endometriosis, administration of estrogen for 2 weeks, and laparotomy; administration of etanercept for 2 weeks following the induction of endometriosis and laparotomy; administration of estrogen for 2 weeks and necropsy. The volume and histopathological scores of the endometriotic foci were evaluated. RESULTS: One-hundred twenty uterine horns were implanted in 30 rats. Endometriosis was completely formatted in 112 lesions (93.3%). No rats were lost. In the etanercept group, the lesions' volumes were 83.9 ± 13.1, 47.2 ± 8.4, and 96.7 ± 34.8 mm(3) at the end of the second week (pretreatment stage), at the end of the fourth week (post-treatment stage), and at the end of the sixth week, respectively (P = 0.007). Histopathologic scores were 2.3 ± 0.2, 1.7 ± 0.2, and 1.9 ± 0.1, respectively (P = 0.08). The changes in the other groups were not statistically significant. CONCLUSIONS: Etanercept, a fusion protein consisting of human recombinant soluble TNF receptor-2, neutralizes TNF activity. Anti-TNF therapy could be a new non-hormonal therapeutic option for the treatment of endometriosis in humans.

Psychologic influence of male factor infertility on men who are undergoing assisted reproductive treatment: a preliminary study in a Turkish population.

OBJECTIVE: To investigate the psychologic impact of male factor infertility on men in couples undergoing assisted reproductive treatment in Turkey. STUDY DESIGN: A prospective study was carried out in a total of 105 men: 43 with male factor, 31 with female factor and 31 with unexplained infertility diagnoses. The men answered questionnaires-State Trait Anxiety Inventory, State Trait Anger Expression Inventory and Beck Depression Inventory-during treatment. The scores from each questionnaire were analyzed and compared according to the infertility diagnosis. RESULTS: No significant differences were found in measures of anxiety, anger or depression among men with male factor, female factor and unexplained infertility. CONCLUSION: In the current preliminary study performed on a group of Turkish men who applied for in vitro fertilization treatment, it was found that male factor infertility as the cause of the couple's infertility problem did not have an adverse effect on the psychologic status of men undergoing assisted reproductive treatment. It is suggested that men's psychologic adjustment to their own infertility diagnosis does not indicate that they are psychologically ill.

The significance of the number of CGG repeats and autoantibodies in premature ovarian failure.

The objective of this study was to determine whether there was a threshold for the number of CGG repeats in the FMR1 (fragile X) gene in premature ovarian ageing and premature ovarian failure and to investigate the association of this sequence with serum concentrations of anti-Müllerian hormone (AMH), inhibin B, anti-thyroid and anti-adrenal autoantibodies. In this prospective randomized controlled preliminary study, the number of triple CGG repeats and serum concentrations of FSH, AMH and aforementioned autoantibodies were evaluated in 79 women who were younger than 40 years old. FSH concentrations were between 12 and 50 IU/ml (premature ovarian ageing) in 30 women and were higher than 50 IU/ml (premature ovarian failure) in nine women; FSH concentrations were normal in 40 women. All women whose FSH concentrations were higher than 12 IU/ml had CGG repeats greater than 30. No women whose FSH concentrations were normal had a repeat number above 30. There was no significant relationship between the levels of antibodies and either CGG repeat numbers or FSH concentrations. In conclusion, the number of CGG repeats between 30 and 40 might be used to predict premature ovarian ageing and premature ovarian failure in infertile women.

Comparison of follicular fluid and serum cytokine concentrations in women undergoing assisted reproductive treatment with GnRH agonist long and antagonist protocols.

BACKGROUND: This study investigated whether follicular fluid (FF) and serum (S) concentrations of cytokines in women undergoing assisted reproductive treatment (ART) were different in GnRH antagonist cycles compared to agonist long ones. METHODS: A retrospective clinical study was performed at a University ART center. A total of 85 women who underwent ART either with agonist long (n = 34) or antagonist protocol (n = 51) were analyzed. FF and serum samples were collected at the time of oocyte retrieval and measured for interleukin (IL)- 1beta, IL-6, IL-8, IL-12, tumor necrosis factor (TNF)-alpha by the enzyme-linked immunosorbent assay (ELISA) technique, using commercially available kits and nitric oxide (NO) by the nitrate/nitrite colorimetric assay. The results were compared between GnRH antagonist and agonist cycles. RESULTS: No significant difference was found in the FF concentrations of those cytokines between the two protocols. The serum values were also similar in the two groups except IL-6 (14.3 +/- 4.8 vs. 20.5 +/- 12.2 pg/ml; p = 0.008) and NO (1.4 +/- 1.1 vs. 2.2 +/- 1.9 microm; p = 0.038) levels which were found to be significantly lower in antagonist cycles. CONCLUSIONS: There is no significant difference in follicular microenvironment in terms of IL-1beta, IL-6, IL-8, IL-12, TNF-alpha, and NO levels between agonist long and antagonist cycles. However, serum IL-6 and NO levels were lower in women given antagonists.

Exposure to industrially polluted water resulted in regressed endometriotic lesions and enhanced adhesion formation in a rat endometriosis model: a preliminary study.

The effects of water collected from an industrially polluted river in a rat model with surgically induced endometriosis were investigated in this preliminary study. Exposure to industrially polluted water resulted in regressed endometriotic lesions and enhanced adhesion formation.

The effects of letrozole and melatonin on surgically induced endometriosis in a rat model: a preliminary study.

OBJECTIVE: To determine the effects of letrozole and melatonin on surgically induced endometriosis in a rat endometriosis model. DESIGN: Prospective, randomized, controlled, experimental study. SETTING: Experimental Research Center of Yeditepe University (YUDETAM). ANIMAL(S): Thirty female, nonpregnant, nulligravid Wistar-Hannover albino rats. INTERVENTION(S): Surgical induction of endometriosis, administration of estrogen for 2 weeks, and laparotomy; administration of letrozole or melatonin for 2 weeks after induction of endometriosis, and laparotomy; administration of estrogen for 2 weeks and necropsy. MAIN OUTCOME MEASURE(S): The volume and histopathologic scores of endometriotic foci, and levels of superoxide dismutase, catalase, and malondialdehyde in the peritoneal fluid. RESULT(S): The mean volumes of the endometriotic foci were 99.6 +/- 18.8 mm(3), 21.5 +/- 7.4 mm(3), and 29.2 +/- 17.5 mm(3), and histopathologic scores were 2.5 +/- 0.7, 2.0 +/- 0.8, and 1.7 +/- 0.9 in the melatonin group at the end of the second, fourth, and sixth weeks, respectively. The mean volumes of the endometriotic foci were 75.9 +/- 26.3 mm(3), 29.8 +/- 14.7 mm(3), and 121.2 +/- 35.1 mm(3) and the histopathologic scores were 2.5 +/- 0.5, 2.2 +/- 0.8, and 2.7 +/- 0.4 in the letrozole group at the end of the second, fourth, and sixth weeks, respectively. In the melatonin group, peritoneal fluid superoxide dismutase and catalase levels increased statistically significantly. CONCLUSION(S): Melatonin caused more pronounced regression of endometriotic foci when compared with letrozole in a rat model. After the cessation of melatonin treatment, the recurrence rate was lower than that observed after the cessation of letrozole treatment.

Opinions concerning male and female sterilisation in Turkey.

BACKGROUND: Vasectomy is well accepted in some countries, but uncommonly used in others. The failure of family planning programmes may be the result of men failing to play a role in contraception. This study was carried out to determine the attitudes of women and men regarding male and female sterilisation. STUDY DESIGN: Women of reproductive age (17-35 years old; n = 1211) and their husbands (n = 1174) were enrolled in this study. Information was collected from the participants via face-to-face interviews using a questionnaire. RESULTS: In our study, 61.4% of women would agree to their husbands' undergoing a vasectomy but only 3.7% of husbands agreed to it. Most (92.7%) men said they would agree to their wives' undergoing a sterilisation and 83.1% of women would agree to tubal occlusion. Only 2% knew anyone who had been sterilised. Nearly a fifth of women thought vasectomy could lead to impotence. CONCLUSION: The prejudices against vasectomy are probably due to misinformation. Female sterilisation, however, is widely accepted by both participants. Family planning programmes organised equally for women and men, supported also by mass media could improve access to convenient and effective contraception.

Effects of pyrolytic carbon on postoperative adhesion formation in rats.

BACKGROUND: Peritoneal adhesion is a consequence of wound healing that sometimes causes severe postoperative complications. Despite all the preventive measures and agents, adhesions have still not been eliminated completely. The aim of this study was to evaluate the effects of pyrolytic carbon on the development of postoperative peritoneal and uterine tube adhesions. MATERIAL AND METHOD: Twenty female Wistar-Albino type rats were used in this study. The rats were divided into two groups: treatment and control groups. After ketamine anaesthesia (50 mg/kg IM), a lower midline abdominal incision was performed and a standard uterine lesion was created by electrocauterization. In the study group, pyrolytic carbon was applied to the surface of the uterus and no additional procedure was applied in the control group. After 2 weeks, all of the rats were killed and uterine adhesions were staged according to the Leach scoring system. RESULTS: In the control group, the total adhesion score was 8.8 +/- 0.42. In the study group, the total adhesion score was 3.3 +/- 1.49, significantly lower than that in the control group (P < 0.001). CONCLUSION: Pyrolytic carbon significantly reduces the prevalence of peritoneal and uterine tube adhesion formation in rats. However, further more detailed investigations are needed before this material is used in clinical practice.

Cytokine and nitric oxide concentrations in follicular fluid and blood serum of patients undergoing assisted reproductive treatment: relationship to outcome.

OBJECTIVE: The role of cytokines and nitric oxide (NO) in ovarian folliculogenesis and the development of mature and fertilizable oocytes is controversial. The aim of this study is to determine the concentrations of interleukin (IL)-1ß, IL-6, IL-8, IL-12, tumor necrosis factor (TNF)-α and NO in the follicular fluid (FF) and blood serum (S) of patients undergoing assisted reproductive treatment (ART) and to investigate whether these cytokines could be used as a predictive parameter for ART outcome. MATERIAL AND METHODS: A retrospective clinical study was performed at a university hospital including a total of 85 women who underwent ART. FF and serum samples were collected at the time of oocyte retrieval and measured for interleukin (IL)-1ß, IL-6, IL-8, IL-12, tumor necrosis factor (TNF)-α by the enzyme-linked immunosorbant assay (ELISA) technique, using commercially available kits and NO by the nitrate/nitrite colorimetric assay. The results were compared between the women who became pregnant and those who did not following ART. RESULTS: No significant difference was found in the FF and blood serum concentrations of the cytokines and NO between pregnant and non-pregnant women. CONCLUSION: Follicular fluid and blood serum concentrations of IL-1ß, IL-6, IL-8, IL-12, TNF-α and NO do not predict pregnancy achievement following ART.

The combination of letrozole and melatonin causes regression in size not histopathological scores on endometriosis in an experimental rat model.

OBJECTIVE: To determine the effects of the combination of letrozole and melatonin on surgically induced endometriosis. MATERIAL AND METHODS: This prospective, randomized, controlled, experimental study was carried out at Yeditepe University Experimental Research Center (YUDETAM). Female non-pregnant, 17 nulligravid Wistar - Hannover albino rats with surgically induced endometriosis were used in this study. Endometriosis was induced by using homologous uterine horn transplantation in the rats. Four operations were performed on each rat. The induction of endometriosis was performed in the first operation. After two weeks of estradiol treatment the second operation was performed and endometriotic lesions were evaluated. Estrogen was then discontinued and in the study groups medications were started. During two weeks the rats were given medications and the third operation was performed for the assessment of the effects of the medications on the endometriotic foci. Then all the medications were stopped and estrogen was started again. Two weeks later all the rats were euthanized and recurrence of endometriosis was evaluated. RESULTS: The sum of the lesion volumes in the control group was 93.6±31.7 mm(3) at the end of the second week. After the cessation of estradiol it decreased to 85.0±23.8 mm(3) (P=0.31) and increased to 119.7±29.4 mm(3) at the sixth week (P=0.02). A significant reduction in histopathologic scores were seen after cessation of the estradiol (p=0.04). At the end of the sixth week, histopathological scores reached the pretreatment values. In the letrozole and melatonin group the sum of the lesion volumes decreased significantly after the treatment (82.8±21.0 mm(3) and 15.7±8.0 mm(3) respectively). At the end of the sixth week, the mean volume was calculated as 43.9±31.8 mm(3) (p=0.002). Histopathologic scores were 2.3±0.1, 2.0±0.2 and 2.2±0.3 at the end of the second, fourth and sixth weeks, respectively, in the letrozole and melatonin group. CONCLUSIONS: Letrozole and melatonin caused a significant regression in lesion volumes; however, histopathological scores of endometriotic lesions did not change significantly.

Rescue cerclage in IVF pregnancies with second trimester cervical dilatation: Case report and literature review.

Despite being available for over 50 years, cervical cerclage remains one of the controversial interventions in obstetrics. Rescue cerclage is the operative cervical closure of a widely dilated cervix with or without unruptured membrane prolapsus. In the literature, the effectiveness of rescue cerclage in the prolongation of pregnancy is debatable. Prolongation of pregnancy and improvement of neonatal survival is of utmost importance in pregnancies achieved by in vitro fertilization (IVF). We report here two IVF pregnancies with second trimester cervical dilatation treated with rescue cerclage and who delivered healthy babies near term without maternal and neonatal morbidities.

Comparison of human amniotic membrane and hyaluronate/carboxymethylcellulose membrane for prevention of adhesion formation in rats.

OBJECTIVES: To investigate the effectiveness of human amniotic membrane (HAM) in the prevention of postoperative adhesion formation and to compare it with the efficacy of hyaluronate/carboxymethylcellulose (HA/CMC) membrane in a rat model. METHODS: Following pilot studies and computer-generated randomization, 23 female Wistar albino rats were operated on in the full study. One of the uterine horns with standard lesions was treated with either HAM (n = 13) or HA/CMC (n = 10) and the other uterine horn served as the control. Second look laparotomies were performed 2 weeks after the operations. Main outcome measures were extent, severity, degree, total adhesion scores and histopathologic characteristics of adhesions. RESULTS: Uterine horns treated with HAM had significantly lower total adhesion scores than the controls (5.15 +/- 2.67 vs. 7.92 +/- 1.50, P < 0.05). Total adhesion scores of uterine horns treated with HA/CMC membrane were significantly lower than those of the controls (4.30 +/- 1.95 vs. 7.50 +/- 1.84, P < 0.01). There were no significant differences between the HAM and HA/CMC groups regarding any adhesion scores. CONCLUSIONS: HAM and HA/CMC membrane are both effective for prevention of adhesion formation in a rat uterine horn model; however, one does not seem to be more effective than the other.

The addition of O2 to the CO2 does not prevent the systemic effects of the CO2 pneumoperitoneum in a rabbit model.

CO2 pneumoperitoneum used in endoscopic surgery induces systemic effects by CO2 absorption. It was claimed that a reduction in CO2 pneumoperitoneum-induced metabolic hypoxemia was achieved by the addition of small amounts of O2 to the CO2 in a rabbit ventilated model. We reevaluated the effects of the addition of O2 to the CO2 pneumoperitoneum upon CO2 absorption in a rabbit model. The effects of a pneumoperitoneum using 100% CO2, 90% CO2 + 10% O2, 95% CO2 + 5% O2, or 100% O2 on arterial blood gases, acid base and O2 homeostasis were evaluated in nonintubated rabbits. A pneumoperitoneum pressure of 10 cm H2O (approximately 7.35 mm Hg) was used. CO2 pneumoperitoneum of 120 minutes affected blood gases and acid base homeostasis. Whereas partial pressure of CO2 and HCO3 increased (P < 0.001) during pneumoperitoneum, pH and partial pressure of O2 decreased (P < 0.001). Similar results were obtained in O2-CO2 pneumoperitoneum (P > 0.05). CO2 pneumoperitoneum profoundly affected blood gases and acid base homeostasis, resulting in metabolic hypoxemia. The addition of O2 to the CO2 did not prevent the systemic effects of CO2 pneumoperitoneum in nonintubated animals.

Effect on sexual life--a comparison between tibolone and continuous combined conjugated equine estrogens and medroxyprogesterone acetate.

OBJECTIVES: To compare the effects of tibolone 2.5 mg with those of continuous combined conjugated equine estrogens 0.625 mg/day and medroxyprogesterone acetate 5 mg/day (CEE/MPA) on sexual life in postmenopausal women. METHODS: Eighty women were randomized to treatment with either tibolone or continuous combined CEE/MPA. Subjects were asked about sexual desire, sexual excitement, sexual arousal, orgasm capacity, vaginal lubrication during sexual activity and dyspareunia before and after the treatment. RESULTS: After 6 months of treatment, a total of 72 women completed the study. When tibolone was compared with continuous combined CEE/MPA, significantly higher scores were found for the items assessing sexual desire, sexual excitement, intercourse frequency and vaginal dryness (p < 0.05). CONCLUSION: This study indicates that both tibolone and continuous combined CEE/MPA treatment were associated with significant improvements in sexual function in postmenopausal women. However, tibolone treatment improved sexual function to a greater extent than continuous combined CEE/MPA.

The safety and efficacy of direct trocar insertion with elevation of the rectus sheath instead of the skin for pneumoperitoneum.

Abdominal access in endoscopic surgery carries a finite risk of visceral injury. Bleeding, subcutaneous emphysema, gastrointestinal tract perforation, minor and major vascular injury, and intraperitoneal adhesions are the potential complications associated with abdominal access and creation of pneumoperitoneum. There are 4 basic techniques used to create pneumoperitoneum: blind Veress needle, direct trocar insertion, optical trocar insertion, and open laparoscopy. Veress needle and direct trocar insertion are blind techniques, and their use can result in severe visceral and vascular injuries. To prevent visceral and vascular injuries caused by the technique used for the creation of pneumoperitoneum, laparoscopic surgeons and gynecologists look for safe and effective laparoscopic access techniques. Direct trocar insertion without previous pneumoperitoneum was reported to be a safe alternative to Veress needle insertion. We carried out this study to compare the ease of use, safety, and efficacy of direct trocar insertion with elevation of the rectus sheath and blind insertion of the Veress needle in laparoscopic surgery. In 578 laparoscopic procedures, the patients were assigned to one of the following groups: blind insertion of the Veress needle (group 1, n = 301) and direct trocar insertion with elevation of the rectus sheath using 2 towel clips (group 2, n = 277). Total complication rates were 15.7% (n = 33) and 3.3% (n = 4) in groups 1 and 2, respectively (P < 0.05). Direct trocar insertion with elevation of the rectus sheath using 2 towel clips is an easy, safe, and effective technique.

Comparison of hyaluronate/carboxymethylcellulose membrane and melatonin for prevention of adhesion formation in a rat model.

BACKGROUND: To investigate the effectiveness of melatonin in preventing post-operative adhesion formation and to compare it with the efficacy of hyaluronate/carboxymethylcellulose membrane in a rat model. MATERIALS AND METHODS: Following pilot studies, 35 rats were operated on in the full study. In 15 animals (group one), 10 standard lesions were inflicted in each uterine horn (total 30 horns) and melatonin was applied before closure of the abdomen. In the second group, 20 animals were operated on and one of the uterine horns (total 20 horns) with standard lesions was treated with hyaluronate/carboxymethylcellulose membrane and the other uterine horn served as a control. Second-look operations were performed 1 week later and adhesion scores were compared. RESULTS: The adhesion scores of uterine horns treated with melatonin and of uterine horns treated with hyaluronate/carboxymethylcellulose membrane were significantly lower than the scores of the controls (P < 0.001). There was no statistically significant difference between the adhesion scores of uterine horns treated with melatonin and of uterine horns treated with hyaluronate/carboxymethylcellulose membrane (P > 0.05). CONCLUSIONS: Both melatonin and hyaluronate/carboxymethylcellulose membrane were effective in prevention of adhesion formation in a rat uterine horn model.