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ABSTRACT: Adjuvant therapy is needed to prevent adhesion formation as a major cause of postoperative morbidity and mortality. The efficacy of phospholipids (PLs) has been proven; however, information on dosage and drug safety are still outstanding.
Forty-eight Chinchilla rabbits underwent median laparotomy, abrasion of the peritoneum, jejunal anastomosis, and an electrocautery incision of the liver. The operation was completed by intraperitoneal administration of PLs in two different concentrations (30 mg/kg and 70 mg/kg body weight). In the control group, the abdomen was closed without additional treatment. Adhesion area, anastomotic bursting pressure, tensile strength of the midline incision, and healing of the liver wound were assessed on days 3, 5, 7, and 10, respectively.
The mean areas of adhesions in the control group were slightly larger than in the PL groups after 3 days and 5 days. On day 7 and day 10, both PL groups presented with significantly smaller adhesion areas (P<0.05). In all groups, we measured equal anastomotic bursting pressures on the 3rd, 5th, and 10th postoperative days. After 7 days, the mean value of the PL 70-mg group (17.2 kPa) was significantly lower than in the other groups (control 22.1 kPa, PL 30 mg 20.7 kPa; P<0.05). The tensile strengths of the laparotomy wound measured after intervals of 5 days and 7 days were not statistically different. On day 3, it was reduced after 30 mg PL but enhanced after 70 mg PL, whereas 10 days after surgery the strength increased with the PL dosage. The inflammatory reparative response to hepatic injury, jejunal anastomosis, and midline incision was not affected by PLs as assessed by histological analysis.
These results prove the efficacy of PLs in adhesion prevention in two concentrations. The findings reveal an unimpeded healing of anastomoses, laparotomy wounds, and liver incisions at different periods after surgery.
Langenbeck s Archives of Surgery 08/2001; 386(4):278-84. · 1.81 Impact Factor
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ABSTRACT: Postoperative peritoneal adhesions are a major complication of abdominal surgery. Adjuvant therapy is needed to prevent adhesion formation and subsequent sequelae. Previously published data proved the efficacy of phospholipids (PL) for this indication; however, additional information on drug safety was still outstanding. The underlying study was designed to investigate the influence of phospholipids on three different types of healing tissue.
A total of 48 Chinchilla rabbits underwent median laparotomy, standardized abrasion of the visceral and parietal peritoneum, jejunal anastomosis, and an electrocautery incision of the liver. The operation was completed by intraperitoneal administration of 10 ml/kg of either normal saline (NaCl) or phospholipids (12%).
After 5 (NaCl 691 mm(2) vs PL 192 mm(2)) and 10 days (NaCl 625 mm(2) vs PL 88 mm(2)) the control group presented with significantly larger adhesion areas (P < 0.05). The bursting pressure of the anastomosis on the 5th (NaCl 16.1 kPa vs PL 18.2 kPa) and 10th (NaCl 19.7 kPa vs PL 18.6 kPa) postoperative days showed no statistically significant difference. The tensile strength of the laparotomy wound measured after intervals of 5 (NaCl 8.5 N cm(-1) vs PL 6.8 N cm(-1)) and 10 days (NaCl 23.0 N cm(-1) vs PL 20.2 N cm(-1)) was not statistically different either. The collagen protein ratio of anastomoses, laparotomy wounds, and liver incisions as well as the inflammatory-reparative response of the different tissues was not affected by PL.
These results confirm the efficacy of phospholipids in adhesion prevention. The findings of uncompromised healing of anastomoses, laparotomy wounds, and liver incisions demonstrate the safety of this agent. Further data may qualify phospholipids for a clinical trial.
Journal of Surgical Research 04/2001; 96(1):68-74. · 2.25 Impact Factor
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ABSTRACT: To investigate the incidence of adhesions after intraperitoneal instillation of mitomycin C adsorbed on activated carbon (MMC-CH).
Animal and laboratory studies.
University hospital, Germany.
90 Sprague-Dawley rats.
Laparotomy, small bowel anastomosis, and intraperitoneal instillation of saline (controls, n = 27), activated carbon alone (n = 24) or MMC-CH (n = 26). Cultures of monolayers of human mesothelial cells.
Measurements of adhesions by planimetry. Toxicity of mitomycin C alone and charcoal alone in mesothelial cell monolayers as reflected by cell proliferation and measurement of lactate dehydrogenase activity. Concentrations of plasminogen activator (tPA) and plasminogen activator inhibitor 1 (PAI-1) as measures of the fibrinolytic activity of mesothelial cells.
Both activated carbon and MMC-CH caused a significant increase of adhesion formation in rats. Activated carbon also reduced the fibrinolytic activity of mesothelial cells, and mitomycin C caused concentration-dependent cytotoxicity in vitro.
Activated carbon combined with high concentrations of mitomycin C may cause intraperitoneal infective complications by increasing the rate of adhesion formation and reducing the fibrinolytic activity of mesothelial cells. We recommend a new absorbable carrier for intraperitoneal chemotherapy.
The European Journal of Surgery 08/2000; 166(7):572-6.
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ABSTRACT: To study the effect of transplantation of mesothelial cells on the formation of adhesions after peritoneal abrasion.
Animal study.
Teaching hospital, Germany.
30 isologous eight-week old Lewis rats to allow for harvesting of the greater omentum from a separate group.
The first group (n = 10) served as mesothelial cell donors. The other animals had laparotomy and induction of adhesions by standardised abrasion of the peritoneum. The trial group (n = 10) were given a suspension of 10(6) mesothelial cells/100 g body weight intraperitoneally and the control group (n = 10) an equal volume of culture medium. After 10 days the animals were killed.
Measurements of the areas of adhesions by computer aided morphometry.
The trial group developed a mean (SD) adhesion area of 122.7 (176.7) mm2, and the controls 310.5 (179.1) mm2. The corresponding medians (range) were 51.2 (0-547.1) and 274.3 (100.6-575.4). Transplantation of mesothelial cells resulted in a significant reduction in adhesion formation (Wilcoxon test, p<0.01).
Intraperitoneal transplantation of mesothelial cells is an effective way of reducing the formation of adhesions.
The European Journal of Surgery 08/1999; 165(7):705-9.
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ABSTRACT: A second case of true carcinosarcoma of the colon is reported. A 79-year-old women was diagnosed as having an obstructing
tumour of the caecum and liver metastases in both lobes. Histological examination of the operative specimen from a right hemicolectomy
revealed malignant epithelial and mesenchymal components. Despite postoperative chemotherapy, the patient died of liver failure
resulting from extensive metastatic growth.
Es wird über den 2. Fall eines eindeutigen Karzinomsarkoms des Kolons berichtet. Eine 79jährige Frau mit einem obstruierenden
Tumor des Zäkums und Lebermetastasen in beiden Leberlappen wurde untersucht. Die histologische Untersuchung der operativen
Proben der rechten Hemikolektomie ergab maligne epitheliale und mesenchymale Komponenten. Trotz der postoperativen Chemotherapie
starb die Patientin an Leberversagen aufgrund des extensiven metastatischen Wachstums.
Langenbeck s Archives of Surgery 04/1997; 382(3):173-174. · 1.81 Impact Factor
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ABSTRACT: A second case of true carcinosarcoma of the colon is reported. A 79-year-old women was diagnosed as having an obstructing tumour of the caecum and liver metastases in both lobes. Histological examination of operative specimen from a right hemicolectomy revealed malignant epithelial and mesenchymal components. Despite postoperative chemotherapy, the patient died of liver failure resulting from extensive metastatic growth.
Langenbecks Archiv fü Chirurgie 02/1997; 382(3):173-4.
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ABSTRACT: The study was designed to asses the adhesiogenic capacity of silicone drainages and the protective effect of phospholipids (PL).
A total of 75 Wistar rats were randomly assigned to the different groups. In a preliminary trial (pt; n = 15), all rats underwent midline laparotomy. The control group (C(pt); n = 5) received no further treatment. In the other animals, either an 'easy flow' drainage (EF(pt); n = 5) or an 'Aachen' drainage (AC(pt); n = 5) was placed into the abdominal cavity. In the final study (fs; n = 60), rats underwent laparotomy and colonic anastomosis. The control groups (C(fs)) received no drainages. In the other groups either one of the two types of drainages (EF(fs), AC(fs)) were introduced. In 50% of the rats, 75 mg/kg of PL were administered intraperitoneally (C(fs)+PL, EF(fs)+PL, AC(fs)+PL). The other rats received no additional treatment (C(fs)ØPL, EF(fs)ØPL, AC(fs)ØPL). All animals were sacrificed 10 days after surgery. Areas of adhesions and anastomotic bursting pressures were measured (mean +/- SD).
In the preliminary trial, analysis of variance (ANOVA) revealed no differences between the groups after application of drainages (values are given in mean +/- SD): C(pt) mean 23.3 +/- 29.4 mm(2), EF(pt) 829.7 +/- 679.3 mm(2), AC(pt) 609.9 +/- 219.4 mm(2). In the final study, 2-factorial ANOVA showed a significant effect (p < 0.001) for the use of drainages but not for the application of PL (C(fs)ØPL 140.6 +/- 124.2 mm(2), C(fs)+PL 67.7 +/- 60.4 mm(2), EF(fs)ØPL 1,217.0 +/- 458.3 mm(2), EF(fs)+PL 1,266.8 +/- 368.3 mm(2), AC(fs)ØPL 861.7 +/- 274.8 mm(2), AC(fs)+PL 544.2 +/- 193.8 mm(2)). Post hoc test for pairwise comparisons adjusted to Bonferroni showed significant differences (p < 0.001) between all of the three pairs (C(fs) 104.1 +/- 92.3 mm(2) vs. EF(fs) 1,241.9 mm(2) +/- 413.3 mm(2); C(fs) vs. AC(fs) 702.9 mm +/- 234.3 mm(2); EF(fs) vs. AC(fs)).
The final study demonstrates the adhesiogenic capacity of silicone drainage tubes in combination with anastomoses. Any protective effect of PL alone or in combination with drainages could not be shown.
Indication for the use of drainages in standard surgical procedures should be reconsidered within the scope of their potential to cause adhesions and subsequent complications.
European Surgical Research 35(2):92-7. · 0.93 Impact Factor
