Hyaluronan-Based Antiadhesive Agents in Abdominal Surgery: Applications, Results, and Mechanisms of Action

Abstract:

Postsurgical intra-abdominal adhesions cause significant morbidity and mortality, with small bowel obstruction being the most common complication. The urge to prevent adhesion formation has resulted in multiple experimental and clinical trials and the development of numerous antiadhesive agents. Through the years, hyaluronan-based antiadhesives have proved to be successful in the reduction of adhesion formation. Despite the obvious effectiveness of hyaluronan, there is still much debate on its clinical use and mechanisms of action. Various hyaluronan-containing products have been introduced and withdrawn from the market. The application of hyaluronan in combination with meshes for hernia repair appears to be a promising concept. Not all different applications of hyaluronan are well known and its use in patients with a malignancy or abdominal infection remains controversial. Here an overview is given on the effects of hyaluronan-based antiadhesive agents in abdominal surgery, its use in infectious conditions, and its oncologic repercussions. The most important mechanism of action appears to be the mechanical separation of damaged peritoneal surfaces. However, the biological effects of hyaluronan, such as modulation of cell proliferation and peritoneal biology, might also be of influence.

Authors:

Cornelis J.J.M. Sikkink, M.D., VU Medical Center, Amsterdam, The Netherlands; Clark J. Zeebregts, M.D., Ph.D., University Medical Center Groningen, Groningen, The Netherlands; Michel M.P.J. Reijnen, M.D., Ph.D., Alysis Zorggroep, Lokatie Rijnstate, Arnhem, The Netherlands

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The Role of Fibrin Sealants in Hepatic Surgery

Abstract:

The repair of all tissue disruption begins with hemostasis and tissue sealing. Fibrin sealant is a concentrated mix of the factors required for the body to initiate this process. By applying this mixture directly to the site of injury, clotting and wound healing can be facilitated. Studies have demonstrated that fibrin sealant is effective in controlling bleeding and inducing tissue sealing in many organs. It is particularly useful in hepatobiliary surgery due to the soft nature of liver parenchyma and its propensity to bleed and leak bile. This chapter will discuss the basic science foundation of fibrin sealants and their applications in hepatic surgery.

Authors:

Umut Sarpel, M.D., Sasan Roayaie, M.D., Myron E. Schwartz, M.D., Daniel M. Labow, M.D., Mount Sinai Medical Center, New York, NY, USA

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Abdominal Dermolipectomy in Laparotomy with Stoma Surgery: Case Report

Abstract:

In cases of morbid obesity, excessive soft tissue in the abdomen forms an apron-like deformity called panniculus because of rapid weight loss due to cancer. In laparotomy with stoma aimed at cancer resection, obesity is reported as a major risk factor of stoma complications, one of the most frequent of which is necrosis. In one patient in whom a laparotomy was performed through a midline incision, the authors also carried out an abdominal dermolipectomy aimed at reducing distortion of the abdominal wall in relation to the stoma. This procedure provided two important advantages for stoma surgery, stability, and better postoperative care by the patient.

Authors:

Masaki Yazawa, M.D., Ph.D., Plastic and Reconstructive Surgery, Kenjiro Kotake, M.D., Takashi Matsui, M.D., Souta Asaga, M.D., Tochigi Cancer Center,Tochigi, Japan

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Perioperative Thermal Insulation

Abstract:

Perioperative hypothermia remains a common problem during anesthesia and surgery. Unfortunately, the implementation of new minimally invasive surgical procedures has not lead to a reduction of this problem. Heat losses from the skin can be reduced by thermal insulation to avoid perioperative hypothermia. However, only a small amount of information is available regarding the physical properties of insulating materials used in the Operating Room (OR). Therefore, several materials using validated manikins were tested. Heat loss from the surface of the manikin can be described as: “Q• = h · DT · A” where Q• = heat flux, h = heat exchange coefficient, DT = temperature gradient between the environment and surface, and A = covered area. Heat flux per unit area and surface temperature were measured with calibrated heat flux transducers. Environmental temperature was measured using a thermoanemometer. The temperature gradient between the surface and environment (DT) was varied and “h” was determined by linear regression analysis as the slope of “DT” versus heat flux per unit area. The reciprocal of the heat exchange coefficient defines the insulation. The insulation values of the materials varied between 0.01 Clo (plastic bag) to 2.79 Clo (2 layers of a hospital duvet). Given the range of insulating materials available for outdoor activities, significant improvement in insulation of patients in the OR is both possible and desirable.

Authors:

Anselm Bräuer M.D., PhD, D.E.A.A., University of Göttingen, Göttingen, Germany; Thorsten Perl, M.D., University of Göttingen, Göttingen, Germany; Michael J.M. English, M.D., F.R.C.A., Montreal General Hospital and McGill University Montreal, Canada; Michael Quintel, M.D., Ph.D., Emergency and Intensive Care Medicine University of Göttingen, Göttingen, Germany

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Novel Applications of Dermabond™ (2-Octyl -Cyanoacrylate) in Cardiothoracic Surgery

Abstract:

Dermabond™ (Ethicon Inc., Somerville, NJ, USA) is a cyanoacrylate adhesive normally indicated for skin wound closure. This study describes the emergency use of this adhesive to control bleeding close to coronary anastomoses in exceptional cases. Dermabond™ was used in 17 patients who underwent cardiac surgery during an eight-month period, where other haemostatic interventions were unsuitable. It was applied for haemorrhage in 15 patients and control air leaks in two of the patients. Haemostasis was successful with Dermabond™ alone in 11 patients; the remaining four required additional interventions. It effectively controlled haemorrhage from ventricular pacing wires, vascular sling holes, peri-anastomotic bleeding, and epicardial tears. The adhesive was not placed directly on any graft because of embolic risk. In the two patients with visible air leaks, it was successfully used. No patient events were recorded as a result of haemorrhage and no reported toxicity. Dermabond™ may be indicated in circumstances in which haemostasis with traditional methods has failed or is inappropriate. A need for further high-quality objective research exists on the effectiveness and long-term safety of 2-octyl cyanoacrylate in cardiac surgery.

Authors:

Omer Aziz, M.R.C.S., B.Sc., St. Mary's Hospital, Imperial College, London, UK; M.S. Rahman, M.B., B.S., St. Mary's Hospital, Imperial College, London, UK; V.G. Hadjianastassiou, M.R.C.S., St Thomas Hospital London, London, UK; John Kokotsakis, M.D., St. Mary's Hospital, Imperial College, London, UK; Malinovski Vitali M.B.B.S., St Mary's Hospital London, London, UK; Ashok Cherian, M.D., St Mary's Hospital London, London, UK; Ara Darzi, F.R.C.S., K.B.E., St. Mary's Hospital, Imperial College, London, UK; Thanos Athanasiou, Ph.D., F.E.T.C.S., St. Mary's Hospital, Imperial College, London, UK

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