Preventive effect of sodium hyaluronate gel on postoperative adhesion of hysteroscopic intrauterine adhesions / 中国生化药物杂志

Objective To investigate the Preventive effect of sodium hyaluronate gel on postoperative adhesion of hysteroscopic intrauterine adhesions. Methods 84 cases of IUA patients undergoing hysteroscopy were retrospectively selected,and divided into two groups according to the different ways of prevention and control of IUA,42 cases in each group.The control group was treated with Foley balloon catheter after operation,the study group was treated with sodium hyaluronate gel prevention on the based of control group.The clinical signs of the patients before and after treatment one,two and three months were observed,the therapeutic effects and complication were compared between two groups. Results After treatment one,two and three months,the adhesion type score and the score scale of study group, were significantly decreased,and lower than the control group,the difference was statistically significant (P<0.05).The total effective rate of the study group was 90.48%,which was significantly higher than that of the control group (83.33%),the difference was statistically significant (P<0.05).In the course of treatment,the complication rate of the two groups was 11.90% (5/42),there was no significant difference between the two groups in the incidence of complications. Conclusion Hyaluronic acid sodium gel on hysteroscopic intrauterine adhesions in patients with postoperative adhesions have a significant preventive effect,can improve the treatment efficiency and clinical signs,and with high security.

Comparative Study for Preventive Effects of Intra-Abdominal Adhesion Using Cyclo-Oxygenase-2 Enzyme (COX-2) Inhibitor, Low Molecular Weight Heparin (LMWH), and Synthetic Barrier

PURPOSE: Postoperative adhesion is the most frequent complication of abdominal surgery. Therefore, we investigated the individual effects of synthetic barrier [hyaluronic acid/carboxymethylcellulose (HA/CMC)] and pharmacologic agents [low molecular weight heparin (LMWH) cyclo-oxygenase-2 inhibitor (COX-2 inhibitor)] using animal model of intra-abdominal adhesion. MATERIALS AND METHODS: The cecum was rubbed with sterile alcohol wet gauze until subserosal haemorrhage and punctate bleeding developed under the general anesthesia. Five animal groups were prepared using the film HA/CMC, gel HA/CMC, LMWH and COX-2 inhibitor. RESULTS: The grade of adhesion by modified Leach method for group I (control), II (film type HA/CMC), III (gel type HA/CMC), IV (LMWH) and V (COX-2 inhibitor) were 5.35+/-1.8, 6.15+/-1.3, 4.23+/-2.6, 5.05+/-0.7 and 5.50+/-0.9, respectively. Group III showed the least grade of adhesion and it is statistically significant in adhesion formation (p=0.028). The numbers of lymphocytes were significantly low in group III and group V compared to the control group (lymphocyte: p=0.004). The mast cell counts were generally low except for the control group (I: 1.05, II: 0.35, III: 0.38, IV: 0.20, V: 0.37), however, it was not statistically significant (p=0.066). CONCLUSION: The gel barriers were shown to be partly efficient in inhibiting the formation of postoperative adhesions and might provide an option for abdominal surgery to reduce postoperative adhesions. The LMWH and COX-2 inhibitor had been known for their inhibitor effect of fibrin formation and anti-angiogenic/anti-fibroblastic activity, respectively. However, their preventive effects of adhesion and fibrosis were found to be obscure.

Efficacy and Safety of the Electrospun Nanofibrous Adhesion Barrier for Laparoscopic Surgery in a Rabbit Model

PURPOSE: Most recently developed anti-adhesive membranes are not suitable for laparoscopic surgery due to weak mechanical properties or adhesive characteristics. To overcome these problems, we prepared electrospun bioabsorbable nanofibrous poly (lactic-co-glycolic acid)-based membranes as an adhesion barrier. We evaluated the efficacy and safety of this material for laparoscopic surgery in a rabbit model. METHODS: A standardized laparoscopic surgical trauma was made on the rabbit's uterine horn and adjacent abdominal wall to induce adhesion formation. The injured uterus was covered by a nanofibrous barrier or it was left untreated (the negative control group) (each group: n=14). To evaluate acute toxicity of this material, blood sampling was made 3 and 7 days after laparoscopic surgery to check liver and renal function. Three weeks after laparoscopy, a second look laparoscopy was performed and the adhesions were scored according to Blauer's scoring system. Tissue between abdominal wall and uterus was obtained to examine microscopically. Liver, kidney and uterus were harvested to examine chronic toxicity. RESULTS: 36.4% of the nanofiber treatment group and 70% of the untreated control group showed severe adhesions (grade>3) after laparoscopic surgery but failed to get a statistical significance (P=0.198). Acute and chronic toxicity induced by this material were not noted in the blood and tissue exam. CONCLUSION: This study showed that nanofiber barrier seems to be a novel resorbable biomaterial for the reduction of postoperative adhesions. Easy placement and handling of this material make these membranes potentially successful candidates for laparoscopic surgery. But further study is needed to get a statistical significance.

The Efficacy and Safety of HA/CMC Anti-adhesion Barrier Solution with Varying Viscosities

PURPOSE: Guardix-sol(TM) is solution type of anti-adhesion barrier, and it is composed of a mixture of hyaluronate (HA) and carboxymethylcellulose (CMC). The anti-adhesive effect was proved through several clinical trials with using this material, but the most efficient viscosity for this solution has not been shown by the previous research. The objective of this study was to evaluate the efficacy and safety of HA/CMC mixture solutions, with varying viscosities, in a rat model. METHODS: Three different viscosities (low=LV, mid=MV and high=HV) of the HA/CMC mixture solutions were prepared to evaluate their potential as a tissue adhesion barrier. The viscosity was measured by a Brookfield viscometer. To evaluate the anti-adhesion effect, a cecal-abdominal wall abrasion model was adopted. The denuded cecum was coated by a HA/CMC mixture of different viscosity or it was left uncoated (the negative control group) and then the denuded cecum was apposed to the abdominal wall (each group: n=10). All the rats underwent a second celiotomy after 14 days to evaluate the extent of their abdominal adhesions and tissue reactions (inflammatory response, granulation tissue formation and toxicity in organs). RESULTS: The viscosities of the HA/CMC mixture solutions were 248.+/-24.4 cps in the LV, 1,353.8+/-4.4 cps in the MV and 3,556.7+/-38.8 cps in the HV. The grade of adhesion and the adhesion area were significantly lower in the all HA/CMC mixture solution groups compared to the control regardless of their viscosity. The inflammatory responses were not remarkable at the application site and the major solid organs did not show histological change in the experimental groups. CONCLUSION: The difference of viscosity of HA/CMC mixture solutions did not affect the efficacy of the adhesion barrier. All the HA/CMC mixture solutions with varying viscosities showed a low inflammatory response and non-toxicity.

The Efficacy and Safety of HA/CMC Anti-adhesion Barrier Solution with Varying Viscosities

PURPOSE: Guardix-sol(TM) is solution type of anti-adhesion barrier, and it is composed of a mixture of hyaluronate (HA) and carboxymethylcellulose (CMC). The anti-adhesive effect was proved through several clinical trials with using this material, but the most efficient viscosity for this solution has not been shown by the previous research. The objective of this study was to evaluate the efficacy and safety of HA/CMC mixture solutions, with varying viscosities, in a rat model. METHODS: Three different viscosities (low=LV, mid=MV and high=HV) of the HA/CMC mixture solutions were prepared to evaluate their potential as a tissue adhesion barrier. The viscosity was measured by a Brookfield viscometer. To evaluate the anti-adhesion effect, a cecal-abdominal wall abrasion model was adopted. The denuded cecum was coated by a HA/CMC mixture of different viscosity or it was left uncoated (the negative control group) and then the denuded cecum was apposed to the abdominal wall (each group: n=10). All the rats underwent a second celiotomy after 14 days to evaluate the extent of their abdominal adhesions and tissue reactions (inflammatory response, granulation tissue formation and toxicity in organs). RESULTS: The viscosities of the HA/CMC mixture solutions were 248.+/-24.4 cps in the LV, 1,353.8+/-4.4 cps in the MV and 3,556.7+/-38.8 cps in the HV. The grade of adhesion and the adhesion area were significantly lower in the all HA/CMC mixture solution groups compared to the control regardless of their viscosity. The inflammatory responses were not remarkable at the application site and the major solid organs did not show histological change in the experimental groups. CONCLUSION: The difference of viscosity of HA/CMC mixture solutions did not affect the efficacy of the adhesion barrier. All the HA/CMC mixture solutions with varying viscosities showed a low inflammatory response and non-toxicity.

Anti-adhesive Effect of Poloxamer/Alginate/CaCl2 Mixture in the Rat Model

PURPOSE: The occurrence of post-surgical adhesion is still a major cause of postoperative morbidity due to the lack of satisfactory treatment or prophylaxis. Several adhesion barriers have been developed in the form of solutions or membrane in an attempt to solve these problems. However both types of tissue barriers have some limitations in their practical applications. In order to overcome these problems, a temperature-sensitive Poloxamer/Alginate/CaCl2 mixture was prepared as an adhesion barrier. With this material, toxicity, inflammation and the adhesion prevention effect was evaluated in an animal model. METHODS: The sol-gel transition behavior was measured using a viscometer. An in vitro gel stability test and an in vivo degradation test was performed. The anti-adhesion effect was evaluated using a cecal-abdominal wall abrasion model. The denuded cecum was coated with Poloxamer/ Alginate/CaCl2 mixture, GUARDIX-SL (positive control group) or neither (negative control group) and apposed to the abdominal wall (each n=14). One week after surgery, the level of adhesion was graded from zero to three using a whole-number system. RESULTS: The LCST of the poloxamer/sodium alginate mixture was 25 degrees C. The gel stability of Poloxamer was improved by adding mild cross-linked sodium Alginate/CaCl2 mixture. The adhesion grade and area were significantly lower in the experimental group than in the control. CONCLUSION: The anti-adhesive effect of the Poloxamer/Alginate/CaCl2 mixture was comparable to the previously- developed solution type barrier and all the materials had degraded within 21 days. From these results, Poloxamer/ Alginate/CaCl2 mixture is a good candidate for use as a coatable or injectable tissue adhesion barrier.

Evaluation of Resorbable Materials for Preventing Surgical Adhesion on Rat Experiment

PURPOSE: Postsurgical adhesion formation is still a cause of postoperative morbidity because no satisfactory treatment or prophylaxis has yet been developed. Therefore, we have established an animal model for adhesion prevention, and evaluated the toxicity, inflammation and adhesion prevention effect of available water soluble materials as barriers against adhesion formation. METHODS: Four-week old female Sprague-Dawley rats (Sam: TacN(SD)BR, Smatako Co., Seoul Korea) were used. The 2 cm2 of cecal serosa and adjacent abdominal wall were abraded with bone burr, and the serosa of the cecum was sutured to the abdominal wall 1 cm apart from the injured site. The denuded cecum was covered with either sodium hyaluronate (HA), sodium alginate (Alg), sodium carboxymethyl cellulose (CMC), polyethylene glycol-polypropylene glycol-polyethylene glycol (PEG-PPG, Poloxamer), or polyethylene glycol (PEG) on both sides, or neither side (control group) and apposed to the abdominal wall. Two weeks after operation, the quality of adhesion was graded using a whole-number system of zero to five. RESULTS: Adhesion grades were highest in the control group (average 4.8), were a little lower in the PEG-PPG (aver. 4.6) and PEG (aver. 4.1) groups, and were significantly lower in the HA (aver. 3.1), Alg (aver. 3.3) and CMC (aver. 3.0) groups (all, P<0.05). However but inflammation was revealed in the Alg and CMC groups. CONCLUSION: In our animal model for adhesion prevention, a fairly good antiadhesion effect was attained with Alg, CMC and HA, whereas inflammation was revealed with Alg and CMC. In conclusion, HA is the best candidate for adhesion prevention.