Has the use of anti-adhesion barriers affected the national rate of bowel obstruction?
Department of Colorectal Surgery, Lahey Clinic, Burlington, Massachusetts, USA. The American surgeon
(Impact Factor: 0.82).
In this study, we analyzed temporal trends in anti-adhesion barrier application and admission rates for small bowel obstruction. We used data from the Nationwide Inpatient Sample and identified patients with ICD-9 codes for "application or administration of anti-adhesion barrier substances" from October 2002 through December 2007. Next, we identified cases of bowel obstruction coded from January 1997 through December 2007. We then used Kendall correlation analyses and the Joinpoint regression program to evaluate changes in trends. From October 1, 2002 through December 31, 2007, a total of 28,014 patients had an anti-adhesion barrier substance applied. During the study period, application of anti-adhesion barriers increased from 0.7 applications per 100,000 to 2.6 applications per 100,000 population (Joinpoint and Kendall; P < 0.002). Since 1997 there has been a steady rise in hospitalizations for bowel obstruction, increasing from 18.3 cases per 100,000 to 19.8 cases per 100,000 population (Joinpoint and Kendall; P < 0.002). In conclusion, the application of anti-adhesion barriers has increased significantly since 2002, yet bowel obstructions continue to be a major health problem.
Available from: Edwin K Jackson
- "Although the etiology is complex, a unifying concept proposes that surgically induced trauma and microvascular ischemia evoke a robust inflammatory response leading to activation of the coagulation system with subsequent development of fibrin deposits [3–5]. Although there are numerous therapies, including solid and fluid/gel barriers, no FDA-approved device or pharmacologic agent appears to decrease the clinical consequences of adhesions [2, 6, 7]. Clearly, novel treatments for the prevention of post-surgical adhesions and tissue protection are needed, particularly those that can be easily and conveniently administered as a solution during minimally invasive surgery and are able to protect tissues both at the surgical site and throughout the abdominal cavity. "
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ABSTRACT: Intraperitoneal adenosine reduces abdominal adhesions. However, because of the ultra-short half-life and low solubility of adenosine, optimal efficacy requires multiple dosing.
Here, we compared the ability of potential adenosine prodrugs to inhibit post-surgical abdominal adhesions after a single intraperitoneal dose.
Abdominal adhesions were induced in mice using an electric toothbrush to damage the cecum. Also, 20 μL of 95 % ethanol was applied to the cecum to cause chemically induced injury. After injury, mice received intraperitoneally either saline (n = 18) or near-solubility limit of adenosine (23 mmol/L; n = 12); 5'-adenosine monophosphate (75 mmol/L; n = 11); 3'-adenosine monophosphate (75 mmol/L; n = 12); 2'-adenosine monophosphate (75 mmol/L; n = 12); 3',5'-cyclic adenosine monophosphate (75 mmol/L; n = 19); or 2',3'-cyclic adenosine monophosphate (75 mmol/L; n = 20). After 2 weeks, adhesion formation was scored by an observer blinded to the treatments. In a second study, intraperitoneal adenosine levels were measured using tandem mass spectrometry for 3 h after instillation of 2',3'-cyclic adenosine monophosphate (75 mmol/L) into the abdomen.
The order of efficacy for attenuating adhesion formation was: 2',3'-cyclic adenosine monophosphate > 3',5'-cyclic adenosine monophosphate ≈ adenosine > 5'-adenosine monophosphate ≈ 3'-adenosine monophosphate ≈ 2'-adenosine monophosphate. The groups were compared using a one-factor analysis of variance, and the overall p value for differences between groups was p < 0.000001. Intraperitoneal administration of 2',3'-cAMP yielded pharmacologically relevant levels of adenosine in the abdominal cavity for >3 h.
Administration of 2',3'-cyclic adenosine monophosphate into the surgical field is a unique, convenient and effective method of preventing post-surgical adhesions by acting as an adenosine prodrug.
Digestive Diseases and Sciences 04/2014; 59(9). DOI:10.1007/s10620-014-3139-x · 2.61 Impact Factor
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ABSTRACT: Adhesions are common after intra-abdominal surgery and are associated with significant morbidity, including bowel obstruction, pain, and infertility. Abdominal wall reconstruction carries the risk of adhesion formation, notably to synthetic or bioprosthetic mesh. This article reviews the pathophysiology of adhesion formation, adhesion grading, and adhesions to synthetic and biologic mesh in vitro and clinically. Bioprosthetic mesh in vitro appears to elicit fewer lower-grade adhesions than synthetic mesh. However, direct comparisons in humans of adhesions with synthetic versus bioprosthetic mesh are lacking. Future studies are warranted to determine whether there are significant differences in clinical outcomes, especially regarding secondary complications from adhesions.
Plastic & Reconstructive Surgery 11/2012; 130:206S-213S. DOI:10.1097/PRS.0b013e3182638d48 · 2.99 Impact Factor
Journal of Trauma and Acute Care Surgery 01/2013; 74(1):188-189. · 2.74 Impact Factor
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