0000000000075215
AUTHOR
Taufiek Konrad Rajab
Intraperitoneal adhesions-an ongoing challenge between biomedical engineering and the life sciences
Peritoneal adhesions remain a relevant clinical problem despite the currently available prophylactic barrier materials. So far, the physical separation of traumatized serosa areas using barriers represents the most important clinical strategy for adhesion prevention. However, the optimal material has not yet been found. Further optimization or pharmacological functionalization of these barriers could give an innovative input for peritoneal adhesion prevention. Therefore, a more complete understanding of pathogenesis is required. On the basis of the pathophysiology of adhesion formation the main barriers currently in clinical practice as well as new innovations are discussed in the present r…
The extent of adhesion induction through electrocoagulation and suturing in an experimental rat study.
Objective To investigate the effect of three types of peritoneal trauma occurring during surgery (high-frequency bipolar current, suturing, and mechanical damage) on postoperative adhesion formation in a rodent animal model. Design Randomized, controlled experimental trial in an in vitro animal model. Setting Laboratory facilities of a university department of obstetrics and gynecology. Animal(s) Thirty-five female Wistar rats. Intervention(s) Bilateral experimental lesions were created on the abdominal wall in every animal. The effect of minimal electrocoagulation was examined by creating lesions (n = 14) through sweeps of a bipolar forceps with a duration of 1 second and standardized pres…
A pilot study of laparoscopic adhesion prophylaxis after myomectomy with a copolymer designed for endoscopic application.
Abstract Study Objective To assess the laparoscopic handling and safety of D,L-polylactide-e-caprolactone-trimethylene carbonate (PCT) copolymer after myomectomy and compare it with icodextrin. In contrast to previously developed solid barriers, the material has rationally designed properties that are advantageous for convenient laparoscopic application. Design A randomized, single-blinded clinical study (Canadian Task Force Classification I). Setting Single-center study in a German University Hospital. Patients Thirty patients who underwent laparoscopic myomectomy were enrolled. Interventions After laparoscopic myomectomy and subsequent reconstruction of the uterus with interrupted sutures…
Adhesion prophylaxis using a copolymer with rationally designed material properties.
Physical barriers are the only licensed adjuncts for adhesion prophylaxis in the United States and Europe. Here, we investigate D,L-polylactide-epsilon-caprolactonetrimethylenecarbonate (PCT copolymer), which is a rationally designed biomaterial, as an adhesion barrier.PCT copolymer membranes were produced by polymerization of the monomers, dissolution in organic solvents, and subsequently processing them by means of modified phase inversion and freeze drying. In vitro cytotoxicity was assayed by fibroblast culture. In vivo adhesion prophylaxis was studied in a rat model that involved standardized traumatization by electrocautery and suturing. The quantity and quality of the resulting adhes…
Tissue response to five commercially available peritoneal adhesion barriers-A systematic histological evaluation
Separating wounded serosa by physical barriers is the only clinically approved adjunct for postoperative adhesion prevention. Since the optimal adhesion barrier has not been found, it is essential to improve our pathogenic understanding of adhesion formation and to compare the effects of different barrier materials on tissue and cells. Wistar rats underwent standardized peritoneal damage and were treated either with Seprafilm, Adept, Intercoat, Spraygel, SupraSeal or remained untreated as a control. 14 days postoperatively, the lesions were explanted and histomorphologically analyzed using the European ISO score to evaluate material implants. Striking differences between the material groups…
A Direct Comparison of Seprafilm, Adept, Intercoat, and Spraygel for Adhesion Prophylaxis
Background Commercially available agents for adhesion prophylaxis are legion but there is a lack of direct comparisons between them. Here we compare four of the most commonly used adhesion barriers against a control group in a clinically relevant rat model. Material and Methods Standardized lesions were created in Wistar rats using electrocautery and suturing. Subsequently, the experimental lesions were treated with Seprafilm (n = 30), Adept (n = 30), Intercoat (n = 30), Spraygel (n = 30), or no barrier (n = 30). The resulting adhesions were examined 14 d postoperatively. Results The mean area covered by adhesion was 77% in the control group, 46% in animals treated with Seprafilm, 54% in an…
Intra-operative locally injected pharmacotherapy as a novel strategy for adhesion prophylaxis.
Abstract Background Pharmacotherapy for peritoneal adhesion prophylaxis has been a focus for intensive research. Previous strategies included intravenous and intraperitoneal application of suitable pharmaceutical agents. However, success of these strategies in humans has been limited. Here we describe intra-operative local injection of pharmaceuticals as a novel strategy for adhesion prophylaxis. Methods N = 208 peritoneal lesions were created in 26 adult Wistar rats. In each animal, lesions on one flank were randomly chosen for treatment with locally injected prednisolone whereas the contralateral side was injected with normal saline. Half of the animals were randomly selected for early a…