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Erschienen in: World Journal of Surgery 4/2010

01.04.2010

Peritoneal Infusion with Cold Saline Decreased Postoperative Intra-Abdominal Adhesion Formation

verfasst von: Cheng-Chung Fang, Tzung-Hsin Chou, Geng-Shiau Lin, Zui-Shen Yen, Chien-Chang Lee, Shyr-Chyr Chen

Erschienen in: World Journal of Surgery | Ausgabe 4/2010

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Abstract

Background

Postoperative intra-abdominal adhesion is a common morbidity after laparotomy. We try to determine whether peritoneal infusion with cold saline may decrease postoperative intra-abdominal adhesion formation.

Methods

Ninety-six male BALB/c mice weighing 25-30 g were randomized into four groups: (I) adhesion model with infusion of 4°C cold saline, (II) adhesion model with infusion of room temperature saline, (III) adhesion model without infusion of saline, and (IV) sham operation without infusion of saline. Adhesion scores, incidence of adhesion, and serum cytokines were measured at postoperative days 1, 3, 7, and 14.

Results

Group I had lower adhesion scores than groups II and III (P < 0.0001). IL-6, IL-10, and TNF-α were significantly increased in the groups I, II, and III compared to group IV (P < 0.0001). IL-6 in group I was significantly decreased compared to that in group III (P < 0.0004). IL-10 in group I was significantly increased compared to that in groups II (P < 0.0001) and III (P < 0.05). TNF-α in group I was significantly decreased compared to that in groups II (P < 0.0004), and III (P < 0.05).

Conclusion

Peritoneal infusion with cold saline may decrease the degree of postoperative intra-abdominal adhesion formation.
Literatur
1.
Zurück zum Zitat Ellis H, Moran BJ, Thompson JN et al (1999) Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet 353:1476–1480CrossRefPubMed Ellis H, Moran BJ, Thompson JN et al (1999) Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet 353:1476–1480CrossRefPubMed
2.
Zurück zum Zitat Chen SC, Lin FY, Lee PH et al (1998) Water soluble contrast study predicts the need for early surgery in adhesive small bowel obstruction. Br J Surg 85:1692–1694CrossRefPubMed Chen SC, Lin FY, Lee PH et al (1998) Water soluble contrast study predicts the need for early surgery in adhesive small bowel obstruction. Br J Surg 85:1692–1694CrossRefPubMed
3.
Zurück zum Zitat Wilson MS, Hawkswell J, McCloy RF (1998) Natural history of adhesional small bowel obstruction: counting the cost. Br J Surg 85:1294–1298CrossRefPubMed Wilson MS, Hawkswell J, McCloy RF (1998) Natural history of adhesional small bowel obstruction: counting the cost. Br J Surg 85:1294–1298CrossRefPubMed
4.
Zurück zum Zitat Choi HK, Chu KW, Law WL (2002) Therapeutic value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: a prospective randomized trial. Ann Surg 236:1–6CrossRefPubMed Choi HK, Chu KW, Law WL (2002) Therapeutic value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: a prospective randomized trial. Ann Surg 236:1–6CrossRefPubMed
5.
Zurück zum Zitat Chen SC, Yen ZS, Lee CC et al (2005) Nonsurgical management of partial adhesive small-bowel obstruction with oral therapy: a randomized controlled trial. CMAJ 173:1165–1169PubMed Chen SC, Yen ZS, Lee CC et al (2005) Nonsurgical management of partial adhesive small-bowel obstruction with oral therapy: a randomized controlled trial. CMAJ 173:1165–1169PubMed
6.
Zurück zum Zitat Ellis H (2007) Postoperative intra-abdominal adhesions: a personal view. Colorectal Dis 9(Suppl 2):3–8CrossRefPubMed Ellis H (2007) Postoperative intra-abdominal adhesions: a personal view. Colorectal Dis 9(Suppl 2):3–8CrossRefPubMed
7.
Zurück zum Zitat Parker MC, Ellis H, Moran BJ et al (2001) Postoperative adhesions: ten-year follow-up of 12, 584 patients undergoing lower abdominal surgery. Dis Colon Rectum 44:822–830CrossRefPubMed Parker MC, Ellis H, Moran BJ et al (2001) Postoperative adhesions: ten-year follow-up of 12, 584 patients undergoing lower abdominal surgery. Dis Colon Rectum 44:822–830CrossRefPubMed
8.
Zurück zum Zitat Kossi J, Salminen P, Rantala A et al (2003) Population-based study of the surgical workload and economic impact of bowel obstruction caused by postoperative adhesions. Br J Surg 90:1441–1444CrossRefPubMed Kossi J, Salminen P, Rantala A et al (2003) Population-based study of the surgical workload and economic impact of bowel obstruction caused by postoperative adhesions. Br J Surg 90:1441–1444CrossRefPubMed
9.
Zurück zum Zitat Ellis H (1997) The clinical significance of adhesions: focused on intestinal obstruction. Eur J Surg 577:5–9 Ellis H (1997) The clinical significance of adhesions: focused on intestinal obstruction. Eur J Surg 577:5–9
10.
Zurück zum Zitat Ray NF, Larsen JW Jr, Stillman RJ et al (1993) Economic impact of hospitalizations for lower abdominal adhesionolysis in the United States in 1988. Surg Gynecol Obstet 176:271–276PubMed Ray NF, Larsen JW Jr, Stillman RJ et al (1993) Economic impact of hospitalizations for lower abdominal adhesionolysis in the United States in 1988. Surg Gynecol Obstet 176:271–276PubMed
11.
Zurück zum Zitat Greene AK, Alwayn IPJ, Nose V et al (2005) Prevention of intra-abdominal adhesions using the antiangiogenic COX-2 inhibitor Celecoxib. Ann Surg 242:140–146CrossRefPubMed Greene AK, Alwayn IPJ, Nose V et al (2005) Prevention of intra-abdominal adhesions using the antiangiogenic COX-2 inhibitor Celecoxib. Ann Surg 242:140–146CrossRefPubMed
12.
Zurück zum Zitat DiZerega GS, Campeau JD (2001) Peritoneal repair and post-surgical adhesion formation. Hum Reprod Update 7:547–555CrossRefPubMed DiZerega GS, Campeau JD (2001) Peritoneal repair and post-surgical adhesion formation. Hum Reprod Update 7:547–555CrossRefPubMed
13.
Zurück zum Zitat Beck DE, Cohen Z, Fleshman JW et al (2003) Adhesion Study Group Steering Committee. A prospective, randomized, multicenter, controlled study of the safety of Seprafilm adhesion barrier in abdominopelvic surgery of the intestine. Dis Colon Rectum 46:1310–1319CrossRefPubMed Beck DE, Cohen Z, Fleshman JW et al (2003) Adhesion Study Group Steering Committee. A prospective, randomized, multicenter, controlled study of the safety of Seprafilm adhesion barrier in abdominopelvic surgery of the intestine. Dis Colon Rectum 46:1310–1319CrossRefPubMed
14.
Zurück zum Zitat DeVirgilio C (1999) Fibrin glue reduces the severity of intra-abdominal adhesions in a rat model. Am J Surg 178:577–580CrossRef DeVirgilio C (1999) Fibrin glue reduces the severity of intra-abdominal adhesions in a rat model. Am J Surg 178:577–580CrossRef
15.
Zurück zum Zitat Vrijland WW, Tseng LN, Eijkman HJ et al (2002) Fewer intraperitoneal adhesions with use of hyaluronic acid-carboxymethylcellulose membrane: a randomized clinical trial. Ann Surg 235:193–199CrossRefPubMed Vrijland WW, Tseng LN, Eijkman HJ et al (2002) Fewer intraperitoneal adhesions with use of hyaluronic acid-carboxymethylcellulose membrane: a randomized clinical trial. Ann Surg 235:193–199CrossRefPubMed
16.
Zurück zum Zitat Oncel M, Kurt N, Remzi FH et al (2001) The effectiveness of systemic antibiotics in preventing postoperative, intraabdominal adhesions in an animal model. J Surg Res 101:52–55CrossRefPubMed Oncel M, Kurt N, Remzi FH et al (2001) The effectiveness of systemic antibiotics in preventing postoperative, intraabdominal adhesions in an animal model. J Surg Res 101:52–55CrossRefPubMed
17.
Zurück zum Zitat Tamion F, Richard V, Lyoumi S et al (1997) Gut ischemia and mesenteric synthesis of inflammatory cytokines after hemorrhagic or endotoxic shock. Am J Physiol 36:G314–G321 Tamion F, Richard V, Lyoumi S et al (1997) Gut ischemia and mesenteric synthesis of inflammatory cytokines after hemorrhagic or endotoxic shock. Am J Physiol 36:G314–G321
18.
Zurück zum Zitat Lee CC, Chang IJ, Yen ZS et al (2005) Effect of different resuscitation fluids on cytokine response in a rat model of hemorrhagic shock. Shock 24:177–181CrossRefPubMed Lee CC, Chang IJ, Yen ZS et al (2005) Effect of different resuscitation fluids on cytokine response in a rat model of hemorrhagic shock. Shock 24:177–181CrossRefPubMed
19.
Zurück zum Zitat Holmdahl L, Kotseos K, Bergstrom M et al (2001) Overproduction of transforming growth factor-beta1 (TGF-beta1) is associated with adhesion formation and peritoneal fibrinolytic impairment. Surgery 129:626–632CrossRefPubMed Holmdahl L, Kotseos K, Bergstrom M et al (2001) Overproduction of transforming growth factor-beta1 (TGF-beta1) is associated with adhesion formation and peritoneal fibrinolytic impairment. Surgery 129:626–632CrossRefPubMed
20.
Zurück zum Zitat Decker D, Tolba R, Springer W et al (2005) Abdominal surgical interventions: local and systemic consequences for the immune system–a prospective study on elective gastrointestinal surgery. J Surg Res 126:12–18CrossRefPubMed Decker D, Tolba R, Springer W et al (2005) Abdominal surgical interventions: local and systemic consequences for the immune system–a prospective study on elective gastrointestinal surgery. J Surg Res 126:12–18CrossRefPubMed
21.
Zurück zum Zitat Badia JM, Whawell SA, Scott-Coombes DM et al (1996) Peritoneal and systemic cytokine response to laparotomy. Br J Surg 83:347–348CrossRefPubMed Badia JM, Whawell SA, Scott-Coombes DM et al (1996) Peritoneal and systemic cytokine response to laparotomy. Br J Surg 83:347–348CrossRefPubMed
22.
Zurück zum Zitat van Berge Henegouwen MI, van der Poll T, Deventer SJH et al (1998) Peritoneal cytokine release after elective gastrointestinal surgery and postoperative complications. Am J Surg 175:311–316CrossRefPubMed van Berge Henegouwen MI, van der Poll T, Deventer SJH et al (1998) Peritoneal cytokine release after elective gastrointestinal surgery and postoperative complications. Am J Surg 175:311–316CrossRefPubMed
23.
Zurück zum Zitat Biffl WL, Moorev EE, Moore FA et al (1996) Interleukin-6 in the injured patient. Marker of injury or mediator of inflammation? Ann Surg 224:647–664CrossRefPubMed Biffl WL, Moorev EE, Moore FA et al (1996) Interleukin-6 in the injured patient. Marker of injury or mediator of inflammation? Ann Surg 224:647–664CrossRefPubMed
24.
Zurück zum Zitat Bone RC (1996) Toward a theory regarding the pathogenesis of the systemic inflammatory response syndrome: What we do and do not know about cytokine regulation. Crit Care Med 24:163–172CrossRefPubMed Bone RC (1996) Toward a theory regarding the pathogenesis of the systemic inflammatory response syndrome: What we do and do not know about cytokine regulation. Crit Care Med 24:163–172CrossRefPubMed
25.
Zurück zum Zitat van Westreenen M, van den Tol PM, Pronk A et al (1993) Peritoneal lavage promotes intraperitoneal adhesion in the rat. Eur Surg Res 31:196–201CrossRef van Westreenen M, van den Tol PM, Pronk A et al (1993) Peritoneal lavage promotes intraperitoneal adhesion in the rat. Eur Surg Res 31:196–201CrossRef
26.
Zurück zum Zitat Sortini D, Feo CV, Maravegias K et al (2006) Role of peritoneal lavage in adhesion formation and survival rate in rats: an experimental study. J Invest Surg 19:291–297CrossRefPubMed Sortini D, Feo CV, Maravegias K et al (2006) Role of peritoneal lavage in adhesion formation and survival rate in rats: an experimental study. J Invest Surg 19:291–297CrossRefPubMed
27.
Zurück zum Zitat Hague BA, Honnas CM, Berridge BR et al (1998) Evaluation of postoperative peritoneal lavage in standing horses for prevention of experimentally induced abdominal adhesions. Vet Surg 27:122–126CrossRefPubMed Hague BA, Honnas CM, Berridge BR et al (1998) Evaluation of postoperative peritoneal lavage in standing horses for prevention of experimentally induced abdominal adhesions. Vet Surg 27:122–126CrossRefPubMed
28.
Zurück zum Zitat Montz EJ, Monk BJ, Lacy SM et al (1993) Ketorolac tromethamine, a nonsteroidal anti-inflammatory drug: ability to inhibit postradical pelvic surgery adhesions in a porcine model. Gynecol Oncol 48:76–79CrossRefPubMed Montz EJ, Monk BJ, Lacy SM et al (1993) Ketorolac tromethamine, a nonsteroidal anti-inflammatory drug: ability to inhibit postradical pelvic surgery adhesions in a porcine model. Gynecol Oncol 48:76–79CrossRefPubMed
29.
Zurück zum Zitat Siegler AM, Kontopoulos V, Wang CF (1980) Prevention of postoperative adhesions in rabbits with ibuprofen, a nonsteroidal anti-inflammatory agent. Fertil Steril 34:46–49PubMed Siegler AM, Kontopoulos V, Wang CF (1980) Prevention of postoperative adhesions in rabbits with ibuprofen, a nonsteroidal anti-inflammatory agent. Fertil Steril 34:46–49PubMed
30.
Zurück zum Zitat Holtz G (1982) Failure of a nonsteroidal anti-inflammatory agent (ibuprofen) to inhibit peritoneal adhesion formation reformation after lysis. Fertil Steril 37:582–583PubMed Holtz G (1982) Failure of a nonsteroidal anti-inflammatory agent (ibuprofen) to inhibit peritoneal adhesion formation reformation after lysis. Fertil Steril 37:582–583PubMed
31.
Zurück zum Zitat Guvenal T, Cetin A, Ozdemir H et al (2001) Prevention of postoperative adhesion formation in rat uterine horn model by nimesulide: a selective COX-2 inhibitor. Hum Reprod 16:1732–1735CrossRefPubMed Guvenal T, Cetin A, Ozdemir H et al (2001) Prevention of postoperative adhesion formation in rat uterine horn model by nimesulide: a selective COX-2 inhibitor. Hum Reprod 16:1732–1735CrossRefPubMed
32.
Zurück zum Zitat Replogle RL, Johnson R, Gross RE (1966) Prevention of postoperative intestinal adhesions with combined promethazine and dexamethasone therapy: experimental and clinical studies. Ann Surg 163:580–588CrossRefPubMed Replogle RL, Johnson R, Gross RE (1966) Prevention of postoperative intestinal adhesions with combined promethazine and dexamethasone therapy: experimental and clinical studies. Ann Surg 163:580–588CrossRefPubMed
33.
Zurück zum Zitat Risberg B (1997) Adhesions: preventive strategies. Eur J Surg Suppl 577:32–39PubMed Risberg B (1997) Adhesions: preventive strategies. Eur J Surg Suppl 577:32–39PubMed
34.
Zurück zum Zitat Grosfeld JL, Berman IR, Schiller M et al (1973) Excessive morbidity resulting from the prevention of intestinal adhesions with steroids and antihistamines. J Pediatr Surg 8:221–226CrossRefPubMed Grosfeld JL, Berman IR, Schiller M et al (1973) Excessive morbidity resulting from the prevention of intestinal adhesions with steroids and antihistamines. J Pediatr Surg 8:221–226CrossRefPubMed
35.
Zurück zum Zitat Reijnen MM, Falk P, Van Goor H et al (2000) The antiadhesive agent sodium hyaluronate increases the proliferation rate of human peritoneal mesothelial cells. Fertil Steril 74:146–151CrossRefPubMed Reijnen MM, Falk P, Van Goor H et al (2000) The antiadhesive agent sodium hyaluronate increases the proliferation rate of human peritoneal mesothelial cells. Fertil Steril 74:146–151CrossRefPubMed
36.
Zurück zum Zitat Zeng Q, Yu Z, You J et al (2007) Efficacy and safety of Seprafilm for preventing postoperative abdominal adhesion: systematic review and meta-analysis. World J Surg 31:2125–2132CrossRefPubMed Zeng Q, Yu Z, You J et al (2007) Efficacy and safety of Seprafilm for preventing postoperative abdominal adhesion: systematic review and meta-analysis. World J Surg 31:2125–2132CrossRefPubMed
37.
Zurück zum Zitat Becker JM, Dayton MT, Fazio VW et al (1996) Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study. J Am Coll Surg 183:297–306PubMed Becker JM, Dayton MT, Fazio VW et al (1996) Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study. J Am Coll Surg 183:297–306PubMed
38.
Zurück zum Zitat Bahadir I, Oncel M, Kement M et al (2007) Intra-abdominal use of taurolidine or heparin as alternative products to an antiadhesive barrier (Seprafilm) in adhesion prevention: an experimental study on mice. Dis Colon Rectum 50:2209–2214CrossRefPubMed Bahadir I, Oncel M, Kement M et al (2007) Intra-abdominal use of taurolidine or heparin as alternative products to an antiadhesive barrier (Seprafilm) in adhesion prevention: an experimental study on mice. Dis Colon Rectum 50:2209–2214CrossRefPubMed
39.
Zurück zum Zitat Fazio VW, Cohen Z, Fleshman JW et al (2006) Reduction in adhesive small-bowel obstruction by Seprafilm adhesion barrier after intestinal resection. Dis Colon Rectum 49:1–11CrossRefPubMed Fazio VW, Cohen Z, Fleshman JW et al (2006) Reduction in adhesive small-bowel obstruction by Seprafilm adhesion barrier after intestinal resection. Dis Colon Rectum 49:1–11CrossRefPubMed
Metadaten
Titel
Peritoneal Infusion with Cold Saline Decreased Postoperative Intra-Abdominal Adhesion Formation
verfasst von
Cheng-Chung Fang
Tzung-Hsin Chou
Geng-Shiau Lin
Zui-Shen Yen
Chien-Chang Lee
Shyr-Chyr Chen
Publikationsdatum
01.04.2010
Verlag
Springer-Verlag
Erschienen in
World Journal of Surgery / Ausgabe 4/2010
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-009-0378-7

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