Optimization of Surgical Time Through the Implementation of a Rational Protocol to Prevent Bleeding in Sleeve Gastrectomy.

Introduction: Staple line oversewing (SLO) is a prophylactic alternative due to its low cost and its effect of decreasing the incidence and severity of bleeding complications in sleeve gastrectomy (SG). However, this approach significantly increases the surgical time and may be associated with stenosis. The study aims to identify whether its usage was sufficient to optimize the surgical time in patients whose screening for the risk of occult bleeding was negative. Materials and Methods: The study enrolled 103 patients. Having the systolic blood pressure goal of 140 mmHg, the staple line is checked for bleeding points, counting as follows: >5 bleeding points proceed to SLO, <5 bleeding points are managed using clips, and if no bleeding points are found, the procedure can be completed. Results: The bleeding test was positive in 79.6% of the cases and oversewing was necessary for 44.7% of the total. The bleeding test result was significant for the increased surgical time. The mean surgical time in SLO was 16.4% higher than in clipping. There was a significant difference in surgical time between SLO and clipping; however, no significant difference was identified between clipping and continuing the procedure without further measures. No postoperative complication related to staple line bleeding was identified. Discussion: In a scenario with limitations for the use of high-cost homeostatic agents, the stratified protocol to prevent bleeding in SG stapling line was able to significantly reduce surgical time without significant added risks. Conclusion: A stratified protocol to prevent bleeding in SG stapling line was able to significantly reduce surgical time.

Improvement in Muscle Strength and Metabolic Parameters Despite Muscle Mass Loss in the Initial Six Months After Bariatric Surgery.

BACKGROUND: An aggravation in pre-existing sarcopenia or the onset of sarcopenia may occur in the scenario of extensive and fast weight loss in the initial months following bariatric surgery. The accurate identification of sarcopenia criteria and its metabolic repercussions is vital for its correct management. The aim of this study is to evaluate the correlation between the diagnosis criteria for sarcopenia and metabolic repercussions during the first 6 months following bariatric surgery. METHODS: A prospective single-center cohort study was conducted. Convenience sampling was performed among patients with severe obesity undergoing preoperative evaluation for bariatric surgery. Metabolic parameters, nutritional evaluation, and skeletal muscle evaluation were assessed before surgery and 6 months later. RESULTS: A total of 129 patients were selected, 62 participants were included in the final analysis. Mean age was 37.7 years and 88.4% of participants were women. Mean body mass index was 41.8 kg/m2 and 47.8% of patients were sedentary. Sleeve gastrectomy was performed in 41 patients and Roux-en-Y gastric bypass in 21 patients. Significant improvement regarding muscle strength and function after surgery was observed. Sarcopenia criteria were not met by any participant before and after surgery. Blood glucose and ferritin levels remained independently associated with change in muscle strength. CONCLUSIONS: Functional evaluation methods did not reflect the reduction in skeletal muscle mass demonstrated in bioelectrical impedance analysis 6 months after bariatric surgery in comparison to the preoperative baseline. Improvement in muscle strength was followed by improvement in metabolic parameters.

What is the best method to assess the abdominal wall? Restoring strength does not mean functional recovery.

BACKGROUND: Restoring the contractile function to the abdominal wall is a major goal in hernia repair. However, the core understanding is required when choosing the method for outcome assessment. AIM: To assess the role of the anterolateral abdominal muscles on abdominal wall function in patients undergoing hernia repair by analysis of correlation between the surface electromyography activation signal of these muscles and torque produced during validated strength tests. METHODS: Activation of the rectus abdominis, external oblique, and internal oblique/transverse abdominis muscles was evaluated by surface electromyography during two validated tests: Step: 1-A, isometric contraction in dorsal decubitus; 1-B, isometric contraction in lateral decubitus; 2-A, isokinetic Biodex testing; and 2-B, isometric Biodex testing. RESULTS: Twenty healthy volunteers were evaluated. The linear correlation coefficient between root mean square/peak data obtained from surface electromyography signal analysis for each muscle and the peak torque variable was always <0.2 and statistically non-significant (p<0.05). The agonist/antagonist ratio showed a positive, significant, weak-to-moderate correlation in the external oblique (Peak, p=0.027; root mean square, 0.564). Surface electromyography results correlated positively among different abdominal contraction protocols, as well as with a daily physical activity questionnaire. CONCLUSIONS: There was no correlation between surface electromyography examination of the anterolateral abdominal wall muscles and torque measured by a validated instrument, except in a variable that does not directly represent torque generation.

Natural orifice translumenal endoscopic surgery (NOTES) transvaginal cholecystectomy in a morbidly obese patient.

Transvaginal natural orifice translumenal endoscopic surgery (NOTES) is a new diagnostic and potentially therapeutic method of surgical endoscopy. The first case of NOTES transvaginal cholecystectomy in a morbid obese patient in the literature is described. IRB approval was obtained at the institution for transvaginal NOTES clinical trials. A 58-year-old female patient with cholelithiasis, hypertension, and type II diabetes, and BMI of 35.8 kg/m(2) was submitted to the technique. After transvaginal access, a two-channel gastroscope was introduced into the abdominal cavity along with a laparoscopic trocar. There were 2 umbilical punctures for use of 3 mm laparoscopic equipment. Operative time was 85 min. There was no use of postoperative analgesia, and the patient was discharged on the third postoperative day. Transvaginal NOTES is a feasible alternative method for cholecystectomy in the morbidly obese, although available technology is limited for natural orifice surgery.

What is the best method to assess the abdominal wall? Restoring strength does not mean functional recovery / Qual é o melhor método para avaliação da parede abdominal? Restabelecer força não significa recuperação funcional

ABSTRACT Background: Restoring the contractile function to the abdominal wall is a major goal in hernia repair. However, the core understanding is required when choosing the method for outcome assessment. Aim: To assess the role of the anterolateral abdominal muscles on abdominal wall function in patients undergoing hernia repair by analysis of correlation between the surface electromyography activation signal of these muscles and torque produced during validated strength tests. Methods: Activation of the rectus abdominis, external oblique, and internal oblique/transverse abdominis muscles was evaluated by surface electromyography during two validated tests: Step: 1-A, isometric contraction in dorsal decubitus; 1-B, isometric contraction in lateral decubitus; 2-A, isokinetic Biodex testing; and 2-B, isometric Biodex testing. Results: Twenty healthy volunteers were evaluated. The linear correlation coefficient between root mean square/peak data obtained from surface electromyography signal analysis for each muscle and the peak torque variable was always <0.2 and statistically non-significant (p<0.05). The agonist/antagonist ratio showed a positive, significant, weak-to-moderate correlation in the external oblique (Peak, p=0.027; root mean square, 0.564). Surface electromyography results correlated positively among different abdominal contraction protocols, as well as with a daily physical activity questionnaire. Conclusions: There was no correlation between surface electromyography examination of the anterolateral abdominal wall muscles and torque measured by a validated instrument, except in a variable that does not directly represent torque generation.

RESUMO Racional: A devolução da funcionalidade contrátil da parede abdominal é uma das metas no reparo das hérnias abdominais. Contudo, o entendimento do core deve necessariamente fazer parte na escolha do método de avaliação desse desfecho. Objetivo: Avaliar o papel dos músculos da parede anterolateral na função da parede abdominal com base na correlação entre o sinal de ativação muscular obtido na eletromiografia de superfície e torque produzido durante testes de força validados. Métodos: A ativação dos músculos reto abdominal, oblíquo externo, e oblíquo interno e transverso foi avaliada por eletromiografia de superfície durante dois testes validados. Etapa: 1-A, contração isométrica em decúbito dorsal; 1-B, contração isométrica em decúbito lateral; 2-A, teste isocinético no Biodex; e 2-B, teste isométrico no Biodex. Resultados: Foram avaliados 20 voluntários saudáveis. O coeficiente de correlação linear entre os dados de valor quadrático médio/Pico obtidos análise do sinal da eletromiografia de superfície para cada músculo e o Pico de torque foram sempre <0,2 e estatisticamente insignificantes (p<0.05). A relação agonista/antagonista demonstrou correlação positiva, significativa e de fraca a moderada no músculo externo oblíquo (Pico, p=0,027; valor quadrático médio, 0,564). Os resultados eletromiografia de superfície estiveram positivamente correlacionados nos diferentes protocolos de contração abdominal e também com um questionário de atividade física diária. Conclusões: Não houve correlação entre o exame de eletromiografia de superfície e o torque mensurado por um instrumento validado, exceto em uma variável que não representa diretamente a geração de torque.

Petit lumbar hernia--a double-layer technique for tension-free repair.

This report describes an alternative technique for Petit hernia repair. The treatment of lumbar hernias should follow the concept of tension-free surgery, and the preperitoneal space can be the best place for prosthesis placement. An obese patient had a bulge in the right lumbar region, which gradually grew and became symptomatic, limiting her daily activities and jeopardizing her quality of life. She had previously undergone 2 surgical procedures with different incisions. We created a preperitoneal space and attached a mesh in this position. Another prosthesis was placed on the muscles, with a suitable edge beyond the limits of the defect. There were no complications. It has been described as a safe and tension-free repair for Petit hernia. In larger defects, a second mesh can be used to prevent further enlargement of the triangle and also to provide additional protection beyond the bone limits.

May polyester with collagen coating mesh decrease the rate of intraperitoneal adhesions in incisional hernia repair?

BACKGROUND: Among meshes used in incisional hernias in open technique repair, the polypropylene is the most commonly used due to flexibility, cellular growth stimulation, satisfactory inflammatory response, easy manipulation and low price. However, it induces adhesions formation when in contact with the intra-abdominal contents. AIM: To evaluate the formation of adhesions after polypropylene and collagen coated polyester mesh with intraperitoneal placement. METHODS: Twenty six female Wistar rats were randomized in three groups. In the group 0 (sham) there was no prosthesis placement, in the polypropylene (group 1) the prosthesis was placed at the peritoneal surface and in the group 2, collagen coated polyester mesh was placed. The rats were killed on postoperative day 21 to evaluate adhesions regarding its degree, mesh percentage of involvement, bowel involvement and strength needed to cause rupture. RESULTS: There was no difference in weight between groups. The group 0 did not develop any adhesions. The groups 1 and 2 developed prosthetic mesh surface adhesions, mostly in the omentum. There was no difference in adhesion degree and percentage of surface involvement between groups. The collagen coated mesh did not develop adhesions. The adhesions occurred at the free edge of the mesh, in contact with the polyester. The Polypropylene group presented 80% of the surface involved with adhesions, while the collagen coated polyester group presented 10% (p<0,005). CONCLUSION: There was no difference between adhesion, degree of adhesion and strength needed to cause rupture. However, the polypropylene mesh presented significantly higher surface of adhesion when compared to the collagen coated polyester mesh.

Comparative study of intraperitoneal adhesions associated with the use of meshes of polypropylene and polypropylene coated with omega-3 fatty acid.

OBJECTIVE: To compare intraperitoneal adhesion formation with placement of polypropylene mesh and use of lightweight polypropylene mesh coated with omega-3 fatty in rats. METHODS: Twenty-seven Wistar rats were randomized into three groups. In group 0 no mesh was placed; in group 1 we implanted a polypropylene mesh; and in group 2 there was implantation of a polypropylene mesh coated with omega-3 fatty acid. We evaluated adhesions presence and degree, breaking strength, percentage of area covered and retraction of the implanted meshes. RESULTS: Group 0 had no adhesion. Groups 1 and 2 showed adhesions on the surface of the mesh, omentum, liver and intestinal loops. There were grades 1 and 2 adhesions in 100% of the polypropylene coated group and in 60% of the polypropylene group. The remaining were grade 3 adhesions, and differed significantly between groups (p <0.001). The breaking strength of adhesions on the polypropylene coated group was significantly higher than with the polypropylene alone (p = 0.016). There was no difference in mesh retraction or area covered by the mesh. The analysis of the mesh coated with omega-3 fatty acid distribution showed adhesions preferentially located at the edges when compared to polypropylene, predominantly in the center. CONCLUSION: The type of adhesions, percentage of surface affected and retraction were not significantly different between meshes. The fatty acids coated mesh had a lower degree of adhesions and these required a greater force to rupture, possibly by their occurrence at the edges of the mesh.

Analysis of adhesions resulted from mesh fixation with fibrin sealant and suture: experimental intraperitoneal model.

OBJECTIVE: To compare surgical fixation of polypropylene mesh (PP) and coated polypropylene mesh (PCD) using polypropylene suture and fibrin glue, as for the formation of intraperitoneal adhesions. METHODS: A sample of 46 female Wistar rats were randomized into six groups: two control groups, with five rats each, were subjected to one medial incision (MI) and the other to a U-shaped incision (UI), none of these groups received the mesh. Two groups of PP mesh, with ten rats, fixed with suture (PPF), the other with six rats, fixed with biological glue (PPC). And two groups of PCD mesh, at first, with ten animals, the mesh was fixed with sutures (PCDFs) and the second with ten animals with biological glue (PCDC). RESULTS: After 21 days, the control groups showed no significant adhesions. The PPC group showed a lower degree of adhesion than the PPF group (p = 0.01). There was no difference between the groups with PCD. CONCLUSION: Comparison of fixation was statistically different only with PP mesh, with lesser degrees of adherence when using the glue. Adhesions were predominantly located at the extremities of the meshes studied.

Thoracotomy versus transhiatal esophageal dissection: which is the best surgical approach to short esophagus?

PURPOSE: To evaluate different approaches performed to obtain a more significant esophageal length. METHODS: An experimental model using 28 cadavers was conceived. Randomized groups: Group A (n=10) underwent laparotomic transhiatal approach; Group B (n=9) which differed from the first in the conduction of a wide phrenotomy and Group C (n=9) esophageal dissection was performed through a left anterolateral thoracotomy. RESULTS: Final length variations for Group A were 2.12cm and 3.29cm and for Group B 3.24 cm and 3.66cm, without and with esophageal traction, respectively. In Group C length gain observed was 3.81 cm. The mediastinal dissections conducted through the hiatus was considered the procedure that produced the better esophageal mobilization, and the association of wide phrenotomy significantly improved the results. CONCLUSION: The mediastinal dissection was the most effective to improving gain in abdominal esophagus. When toracotomy and laparotomy were compared, no significant differences were observed in the outcome.

Radiological evaluation of the patency of duodenal-esophageal anastomosis during a long postoperative follow-up: effectiveness of an alkaline reflux model in rats.

BACKGROUND: Performing experimental studies has played an important role in acquiring knowledge about esophageal carcinogenesis. In this context, the choice of a more reliable experimental model requires proof of its effectiveness in order to lend greater credibility to the results. The objective of this study was to evaluate the patency of duodenal-esophageal anastomosis during long-term postoperative follow-up in rats. METHODS: This was an experimental study in which 45 female Wistar rats were used. A side-to-side anastomosis was performed, going from the anterior side of the esophagus to the second duodenal portion. A standardized radiological technique was used to carry out a contrasted radiological study of the esophagus, stomach, and duodenum during weeks 4, 12, 20, and 30 after surgery. Different contrast media were used, and the animals were divided into groups, ie, group 1 (100% barium sulfate), group 2 (50% barium sulfate), and group 3 (60% aqueous iodinated contrast media). Contrast radiographs were taken in each group at weeks 4, 12, 20, and 30 after the surgical procedure. The radiographic images were evaluated by two radiologists who were blinded regarding the contrast groups. Macroscopic evaluation of each animal was compared with the radiological findings. RESULTS: Postoperative mortality was 13.33%. The remaining animals were divided into study groups. All the contrast radiological examinations showed evidence of the location of the esophagus, stomach, and proximal portion of the intestine, and demonstrated the laterolateral relationship of the distal esophagus and the duodenum in the epigastric region. Patency of the anastomosis was observed at each examination period. The different contrast media used were able to demonstrate this outcome shortly after the first phase of injection. Necropsies corroborated the radiological findings. CONCLUSION: Regardless of the contrast agent used, contrasted radiography revealed that side-to-side duodenal-esophageal anastomosis in rats allowed patent communication during long-term postoperative follow-up.

Risk index proposal to predict atrial fibrillation after cardiac surgery.

OBJECTIVE: Atrial fibrillation (AF) is a common complication following cardiac surgery and is associated with an increased patient morbidity and mortality. The objective of this study was to develop a risk index proposal to predict AF after cardiac surgery. METHODS: A prospective observational study in that 452 patients were selected to assess the incidence and risk factors associated with postoperative AF. Only patients following cardiac surgery were selected. Continuous cardiac monitor and daily electrocardiogram were assessed. The most associated in a multivariable logistic model were selected for the risk index. RESULTS: The average incidence of AF was 22.1%. The most associated factors with AF were: patients older than 75 years of age, mitral valve disease, no use of a beta blocker, withdrawal of a beta-blocker and a positive fluid balance. The absence risk factor determined 4.6% chance to postoperative AF, and for one, two and three or more risk factors, the chance was 16.6%, 25.9% and 46.3%, respectively. CONCLUSION: In a multivariable logistic model was possible to develop a risk index proposal to predict postoperative AF with a major risk of 46.3% in the presence of three or more risk factors.

Effectiveness of the combined use of lactic acid film and polypropylene mesh in the formation of intraperitoneal adhesions--an experimental model in rats.

OBJECTIVE: To evaluate the efficacy of a lactic acid biomaterial (SurgiWrap®) as a protector of the polypropylene mesh (Marlex®) regarding the formation of intraperitoneal adhesions in rats. METHODS: Forty Wistar rats formed the following groups: Group 0 (Sham)--only laparotomy; Group I--polypropylene mesh; Group II--polypropylene mesh protected by a film of lactic acid. These animals were submitted to laparotomy and placement (or not) of the meshes at closing. After 21 days they were sacrificed for analysis of the adhesion type (0-3), percentage of affected area and strength needed to rupture. RESULTS: Group 0 showed no intraperitoneal adhesions. Regarding classification, type 3 adhesions had the highest prevalence in both groups 1 and 2. As for the strength to break adhesions, Group 1 had an average of 1.58 N and Group 2, 1.23 N. The mesh was surrounded by adhesions in more than 50% of their surface area in 87% of Group 1 subjects and in 84% of Group 2 individuals. Through different statistical methods we found that there was no significant difference between groups for both variables. CONCLUSION: The combined use of polypropylene mesh and lactic acid bioprotector showed similar results in relation to intraperitoneal adhesion formation when compared to the sole use of the same mesh.

HIP FRACTURE: POST-OPERATIVE EVALUATION OF CLINICAL AND FUNCTIONAL OUTCOMES.

OBJECTIVE: To evaluate the clinical and functional outcomes from patients undergoing surgery to treat hip fractures, with regard to the ASA score and time spent waiting for definitive surgical treatment. METHOD: Over a one-year period, 154 patients with hip fractures, aged 65 years and over, underwent operations. Data on the preoperative ASA score and the time spent waiting for the operation were obtained. Two years after the operation, Zuckerman's Functional Recovery Score (FRS) questionnaire was used to assess the patients' current functional capacity. RESULTS: Mortality during the first postoperative year differed between patients with ASA 3 or 4 and those classified as ASA 1 or 2 (significant data; p < 0.05). Mortality up to the end of the second postoperative year was significantly higher (p < 0.05) in the ASA 3 or 4 group. The preoperative ASA score did not demonstrate any significant relationship with the patients' current functional capacity (p > 0.05). There was no significant difference between the group operated within 48 hours of admission and the group operated after 48 hours, in relation to mortality or current functional capacity (p > 0.05). The group aged 80 years and over showed significantly higher mortality (p < 0.05) than the group aged 65 to 79 years up to the end of the second postoperative year. CONCLUSION: The preoperative ASA score and an age of 80 years or over may be considered to be factors associated with higher mortality two years after hip fracture surgery. In isolation, time spent waiting for surgery was not significant.

Restless legs syndrome: study of prevalence among medical school faculty members.

The aim of this study was to assess the prevalence of idiopathic restless legs syndrome (RLS) and its correlations in a sample of Medical School faculty members. A transversal study was conducted at a Medical School in the south of Brazil included 78 faculty members. The subjects answered to a structured questionnaire specific to RLS diagnosis and the Epworth and the Stanford scales to measure daytime sleepiness. Severity of the disease was also evaluated. The variables were analyzed to statistical significance. RLS was diagnosed in 10.25% of the subjects evaluated and most were women (62.5%). The prevalence of daytime sleepiness was significantly greater among the subjects suffering from RLS (p=0.04). RLS subjects were significantly younger than the group without the syndrome (p=0.02). RLS had a considerable prevalence in the sample studied. Daytime sleepiness and young age showed an important correlation to this syndrome, as other potential factors were not confirmed.

Description of the technique of upper gastrointestinal series radiological examination for the evaluation of the esophagus, stomach and duodenum of Wistar female rats.

PURPOSE: To evaluate the anatomy of female Wistar rats and the workability of contrast radiography as a technique to investigate the gastrointestinal series. METHODS: Eight adult female Wistar rats were undergone to the contrast radiography as anteroposterior incidence and as posterior incidence in profile. The radiological examination was conducted at a 45 degrees angle to the radiological table. Film-focus distance (FFD) was 100 cm, film-object distance (FOD) was 0 cm, and object-focus distance (OFD) was 100 cm. An orogastric probe was used to inject barium contrast at 5-min intervals, for a total of four applications. After the radiological examination, animals were necropsy for confirmation of the radiological findings, and the radiographs were the absence of the normal anatomy variations inspected and described by an experienced radiologist. RESULTS: All the radiographs produced achieved satisfactory results in terms of position, exposure, location and quality. The upper esophageal sphincter (UES) was identified in the esophagus at the nerve C2, the lower esophageal sphincter (LES) was identified between spinal cord segments L1 and L2, the thoracic-abdominal junction was observed at T10, the esophageal-gastric junction (EGJ) at T13-L1, with the abdominal portion in the epigastric region. The stomach was observed mostly in the epigastric region, left hypochondrium, left and mesogastric flank. The duodenum findings presented higher variation, with most findings identified in the epigastric region, right hypochondrium, right flank and mesogastric ileal fossa at T13-L5. CONCLUSION: Contrast radiology is useful and may be employed to assess the anatomy of the animal being studied. The experimental model described afforded to fully identify all organs investigated, as well as other occasional relevant findings. No anatomical anomalies in the subsequent necropsy, confirming the radiographic findings.

New hybrid approach for NOTES transvaginal cholecystectomy: preliminary clinical experience.

OBJECTIVES: Natural orifice translumenal endoscopic surgery (NOTES) represents the first step toward scar-less surgery. The objective of this study is to evaluate early clinical results of transvaginal cholecystectomy using a new technique. METHODS: Institutional review board approval was obtained and transvaginal NOTES cholecystectomy was performed in 12 women for cholelithiasis. A 2-channel videoendoscope was inserted in the abdominal cavity through a posterior colpotomy. Two 3-mm trocars were inserted deep in the umbilicus, and a 10-mm trocar was placed through the colpotomy parallel to the endoscope. Dissection was performed with endoscopic instruments combined with 3-mm laparoscopic instruments. RESULTS: Mean operative time was 125.8 minutes. All procedures occurred without intraoperative complications or conversions, except for 1 vulvar laceration. There were no postoperative complications in the clinical follow-up. CONCLUSION: Transvaginal NOTES is a feasible and safe alternative for cholecystectomy in this preliminary clinical experience, allowing good cosmetic benefits and low analgesic requirement.

Pode a tela de poliéster coberta com colágeno diminuir as taxas aderências intraperitoneais na correção de hérnia incisional? / May polyester with collagen coating mesh decrease the rate of intraperitoneal adhesions in incisional hernia repair?

RACIONAL: Entre as telas utilizadas na reparação de hérnias incisionais na técnica aberta, a de polipropileno é a mais utilizada devido à flexibilidade, estimulação do crescimento celular, resposta inflamatória satisfatória, fácil manipulação e baixo preço. No entanto, induz a formação de aderências, quando em contato com os conteúdos intra-abdominais. OBJETIVO: Avaliar as aderências formadas após a colocação intraperitoneal da tela de polipropileno e a tela de poliéster coberta com colágeno. MÉTODO: Foram utilizadas 26 ratas Wistar fêmeas, randomizadas em três grupos. No grupo 0 (sham) não houve colocação de prótese, apenas laparotomia; no grupo 1 foi implantada a prótese de polipropileno na superfície peritoneal; e no grupo 2, a prótese composta por poliéster coberta por colágeno. Todos os animais foram mortos 21 dias após o procedimento e avaliados quanto às vísceras envolvidas nas aderências, grau das aderências, percentual da tela acometimento por aderências e a força necessária para a sua ruptura. RESULTADOS: Não houve diferença de peso entre os grupos. O grupo 0 não apresentou aderência. Os grupos 1 e 2 apresentaram aderências na superfície da prótese, predominante no omento. O grau de aderências, superfície acometida não teve diferença representativa entre os grupos. A cobertura de colágeno não demonstrou aderências. As aderências ocorreram na borda livre da tela, em contato com a face de poliéster. Análise do tipo de superfície comprometida por aderências, o grupo polipropileno teve 80% e o grupo poliéster com colágeno apenas 10% (p<0,005). CONCLUSÃO: Para os parâmetros avaliados aderência, grau e força máxima de ruptura não houve diferença. No entanto, a tela de polipropileno teve superfície acometida pela aderência significativamente maior em relação à tela de poliéster protegida com colágeno.

BACKGROUND: Among meshes used in incisional hernias in open technique repair, the polypropylene is the most commonly used due to flexibility, cellular growth stimulation, satisfactory inflammatory response, easy manipulation and low price. However, it induces adhesions formation when in contact with the intra-abdominal contents. AIM: To evaluate the formation of adhesions after polypropylene and collagen coated polyester mesh with intraperitoneal placement. METHODS: Twenty six female Wistar rats were randomized in three groups. In the group 0 (sham) there was no prosthesis placement, in the polypropylene (group 1) the prosthesis was placed at the peritoneal surface and in the group 2, collagen coated polyester mesh was placed. The rats were killed on postoperative day 21 to evaluate adhesions regarding its degree, mesh percentage of involvement, bowel involvement and strength needed to cause rupture. RESULTS: There was no difference in weight between groups. The group 0 did not develop any adhesions. The groups 1 and 2 developed prosthetic mesh surface adhesions, mostly in the omentum. There was no difference in adhesion degree and percentage of surface involvement between groups. The collagen coated mesh did not develop adhesions. The adhesions occurred at the free edge of the mesh, in contact with the polyester. The Polypropylene group presented 80% of the surface involved with adhesions, while the collagen coated polyester group presented 10% (p<0,005). CONCLUSION: There was no difference between adhesion, degree of adhesion and strength needed to cause rupture. However, the polypropylene mesh presented significantly higher surface of adhesion when compared to the collagen coated polyester mesh.

Estudo comparativo de aderências intraperitoneais associadas ao uso das telas de polipropileno e de malha leve de polipropileno revestida com ácido graxo ômega-3 / Comparative study of intraperitoneal adhesions associated with the use of meshes of polypropylene and polypropylene coated with omega-3 fatty acid

OBJETIVO: Comparar as aderências entre dois grupos de ratas Wistar submetidas à colocação intraperitoneal da tela de polipropileno e malha leve de polipropileno revestida com ácido graxo ômega-3. MÉTODOS: Foram utilizadas 27 ratas Wistar randomizadas em três grupos. No grupo 0 não houve colocação de prótese, no grupo 1 houve implantação da prótese de polipropileno e no grupo 2, implantação de prótese de polipropileno revestida com ácido graxo ômega-3. Foi avaliadas a presença de aderências, grau, força de ruptura, percentual de área recoberta e retração das telas aferidas. RESULTADOS: O grupo 0 não apresentou aderência. Os grupos 1 e 2 apresentaram aderência na superfície da prótese, omento, fígado e alça intestinal. Foram encontradas aderências grau 1 e 2 em 100% do grupo polipropileno revestida com ácido graxo ômega-3 e em 60% do grupo polipropileno. As demais eram aderências grau 3, e diferiram significativamente entre os grupos (p< 0,001). A força de ruptura da aderência na tela polipropileno revestida com ácido graxo ômega-3 foi significativamente maior do que na tela de polipropileno (p= 0,016). Não houve diferença na retração das telas ou superfície acometida pelas telas. A análise da tela revestida com ácido graxo ômega-3 demonstrou distribuição preferencialmente nas bordas em relação ao polipropileno, com predomínio no centro. CONCLUSÃO: O tipo de aderência, percentual de superfície acometida e retração não foram significativamente diferentes entre as telas. A tela de baixo peso apresentou menor grau de aderências, e, estas, necessitaram força maior para ruptura, possivelmente pelo predomínio de sua ocorrência nas bordas da tela.

OBJECTIVE: To compare intraperitoneal adhesion formation with placement of polypropylene mesh and use of lightweight polypropylene mesh coated with omega-3 fatty in rats. METHODS: Twenty-seven Wistar rats were randomized into three groups. In group 0 no mesh was placed; in group 1 we implanted a polypropylene mesh; and in group 2 there was implantation of a polypropylene mesh coated with omega-3 fatty acid. We evaluated adhesions presence and degree, breaking strength, percentage of area covered and retraction of the implanted meshes. RESULTS: Group 0 had no adhesion. Groups 1 and 2 showed adhesions on the surface of the mesh, omentum, liver and intestinal loops. There were grades 1 and 2 adhesions in 100% of the polypropylene coated group and in 60% of the polypropylene group. The remaining were grade 3 adhesions, and differed significantly between groups (p <0.001). The breaking strength of adhesions on the polypropylene coated group was significantly higher than with the polypropylene alone (p = 0.016). There was no difference in mesh retraction or area covered by the mesh. The analysis of the mesh coated with omega-3 fatty acid distribution showed adhesions preferentially located at the edges when compared to polypropylene, predominantly in the center. CONCLUSION: The type of adhesions, percentage of surface affected and retraction were not significantly different between meshes. The fatty acids coated mesh had a lower degree of adhesions and these required a greater force to rupture, possibly by their occurrence at the edges of the mesh.

Análise das aderências resultantes da fixação de telas cirúrgicas com selantes de fibrina e sutura: modelo experimental intraperitoneal / Analysis of adhesions resulted from mesh fixation with fibrin sealant and suture: experimental intraperitoneal model

OBJETIVO: Comparar fixação cirúrgica de telas de polipropileno (PP) e telas de polipropileno revestido (PCD), usando fio de sutura de polipropileno e cola biológica, quanto à formação de aderências intraperitoneais. MÉTODOS: Amostra de 46 ratas Wistar, randomizadas em seis grupos: dois grupos-controle, com cinco ratas cada, que foram submetidos um à incisão medial (IM) e o outro à uma incisão em forma de U (IU); nenhum desses grupos recebeu tela. Dois grupos com tela de PP, um com dez ratas, fixada com sutura (PPF), e o outro, com seis ratas, fixada com cola biológica (PPC). E Dois grupos com tela de PCD, no primeiro, com dez animais, a tela foi fixada com sutura (PCDF), e no segundo, com dez animais, com cola biológica (PCDC). RESULTADOS: Após o prazo de 21 dias, os grupos-controle não apresentaram aderências significantes. O grupo PPC apresentou menor grau de aderência do que o grupo PPF (p=0,01). Não houve diferença entre as fixações nos grupos com PCD. CONCLUSÃO: A comparação da fixação apresentou diferença estatística significativa apenas à tela de PP, com menor grau de aderência utilizando a cola. As aderências se localizaram predominantemente nas extremidades das telas estudadas.

OBJECTIVE: To compare surgical fixation of polypropylene mesh (PP) and coated polypropylene mesh (PCD) using polypropylene suture and fibrin glue, as for the formation of intraperitoneal adhesions. METHODS: A sample of 46 female Wistar rats were randomized into six groups: two control groups, with five rats each, were subjected to one medial incision (MI) and the other to a U-shaped incision (UI), none of these groups received the mesh. Two groups of PP mesh, with ten rats, fixed with suture (PPF), the other with six rats, fixed with biological glue (PPC). And two groups of PCD mesh, at first, with ten animals, the mesh was fixed with sutures (PCDFs) and the second with ten animals with biological glue (PCDC). RESULTS: After 21 days, the control groups showed no significant adhesions. The PPC group showed a lower degree of adhesion than the PPF group (p = 0.01). There was no difference between the groups with PCD. CONCLUSION: Comparison of fixation was statistically different only with PP mesh, with lesser degrees of adherence when using the glue. Adhesions were predominantly located at the extremities of the meshes studied.