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AMELİYAT SONRASI KARIN İÇİ YAPIŞIKLIKLARIN ÖNLENMESİNDE CHITIN'İN ETKİNLİĞİNİN DİĞER ADEZYON BARİYERLERİ İLE KARŞILAŞTIRILMASI

COMPARISON OF ANTI-ADHESION MATERIALS IN PREVENTING POSTSURGICAL ADHE¬SION IN ABDOMINAL CAVITY

Journal Name:

  • Selçuk Tıp Dergisi

Publication Year:

  • 2007

Key Words:

Keywords (Original Language):

Author NameUniversity of Author
Abstract (2. Language): 
Aim: The purpose of this study is to compare the effects of different anti-adhesion Materials in Preventing Postsurgical peritoneal adhesion. Material and Method: 60 rats from Wistar Albino spiece that weights 250-300 g and about 10-11 ages are used in the study. They were separated into 5 groups. The rats were operated after Kethamine HCL anesthesia. In all rats, a midline laparatomy was done, in a 4 cm length. To the right side of the abdominal wall, 2 cm along 10 par-ellel incision were applied. To the left side of it, a peritoneum layer was incised as 2x2 cm2. The abdominal wall was sutured with 3/0 silk by continue method. Group I: Control group, Group II: 3X3 cm2 in size Chitin layers (Suprofilm®) were placed on the incision areas. Group III: 3X3 cm2 in size Na-Hyaluronat / Carboxymethylcellulose layers (Seprafilm®) were placed on the incision areas. Group IV: To the abdominal cavity, 25 % diluted 2 cc Na-Hyaluronat gel was poured, Group V: 15mg/kg metilprednizolon was injected as I.M. On the 11th day of Research, under Ketamine anes¬thesia, abdominal wall opened and the adhesions were scored according to Granat Score. From all groups of rats, blood samples were taken. On the samples, Hb, AST, BUN and Albumin levels were studied. Results: The Adhesion frequency In Group I, was defined on the right abdominal wall as 82%, on the left as 91%, In Group II, on the right as 8.3%, on the left as 25%, In Group III, on the right as 17%, on the left as 33%, In Group IV, on the right as 50%, on the left as 58%, In Group V, on the right as 50%, on the left as 42%. The adhesion grade in groups was defined as; Group I: 2.63±1.22, Group II: 0.58±0.66, Group III: 1.08±1.08, Group IV: 1.41±1.44, Group V: 1.41±1.50. The adhesion phase in all study groups was found meaningfully low compared to the control group as p<0.05. Besides, the adhesion grade of Suprofilm® group was found meaningfully low com¬pared to the other groups as p<0.05. A meaningful difference was not observed among Serologic and hematological parameters in all groups as P>0.05. Conclusion: Chitin meaningfully decreases the postoperative peritoneal adhesion frequency and adhesion grade on Rats. Referencing this result, it has been understood that Chitin is much more effective than local and systemic anti-adhe¬sive methods.
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Abstract (Original Language): 
Amaç: Postoperatif peritoneal adezyonların önlenmesinde farklı antiadeziv maddelerin etkilerinin belirlenmesidir. Gereç ve Yöntem: Çalışmaya 60 adet Sprague-Dawley cinsi dişi rat alındı. Ratlar '2'şerli 5 gruba ayrıldılar. Bütün ratlar Ketamine HCL ile uyutulduktan sonra 4 cm'lik orta hat kesisi ile karına girildi. Karın duvarında, sağ tarafta 2cm uzunluğunda '0 adet peritoneal kesi yapıldı, sol tarafta 2X2 cm2 genişliğinde periton tabakası eksize edildi, batın 3/0 ipekle kontinu olarak kapatıldı. Grup I: herhangi bir işlem yapılmadı, Grup II: kesi alanlarına 3X3 cm2 boyutta chitin tabakası (Suprofilm®) konuldu, Grup III: kesi alanlarına 3X3 cm2 boyutta Na-Hyaluronat / Carboxymethylcellulose (Seprafilm®) konuldu, Grup IV: batın içine % 25 oranında sulandırılmış 2 cc Na-Hyaluronat jel döküldü, Grup V: '5mg/kg dozunda metilprednizolon i.m. olarak verildi. Çalışmanın 11. günü ratlar sacrifiye edilerek 5'er cc kan alındı. Batın açılarak adezyonlar Granat Skoruna göre skorlandı. Kan örneklerinden Hb, AST, BUN ve Albumin düzeyleri çalışıldı. Bulgular: Adezyon sıklığı Grup I'de sağda %82, solda % 9', Grup II'de sağda %8.3, solda %25, Grup III'te, sağda %'7, solda %33, Grup IV'te sağda %50, solda %58, Grup V'te sağda %50, solda %42 olarak bulundu. Adezyon evresi gruplarda; Grup I: 2.63±'.22, Grup II: 0.58±0.66, Grup III: '.08±'.08, Grup IV: '.4'±'.44, Grup V: '.4'±'.50 olarak belirlendi. Adezyon evresi tüm çalışma gruplarında kontrol grubuna göre anlamlı olarak düşük bulundu, p<0.05. Ayrıca Chitin grubunun evresi diğer gruplardan anlamlı olarak düşük bulundu, p<0.05. Serolojik ve hematolojik parametreler tüm gru¬plarda benzer bulundu, P>0.05. Sonuç: Chitin Ratlarda postoperatif peritoneal adezyon sıklığını ve evresini anlamlı olarak düşürmekterdir. Bu yönüyle lokal ve sistemik antiadezivlerden daha etkili olduğu kanaatine varılmıştır.
FULL TEXT (PDF): 
PDF icon arastirmax-ameliyat-sonrasi-karin-ici-yapisikliklarin-onlenmesinde-chitinin-etkinliginin-diger-adezyon-bariyerleri-ile-karsilastirilmasi.pdf
  • 4
189-195
  • Turkish

REFERENCES

References: 

1.Ellis H. Wound repair-reaction of the peritoneum to
injury. Ann R. Coll. Surg. 1978;60:219-21.
2. Sahin M, Gürocak B, Tavlı fi, Avşar FM, Aksoy F, Aköz M. Effects of different doses of steroid in the pre¬vention of intra-abdominal adhesions. Int J Surgical Investigation 301-6.
3. Kağızman SH, Belviranlı M, Şahin M, Vatansev C, Karahan Ö, Alptekin H. Mekanik intestinal obstrüksiy-ona bağlı opere edilmiş hastaların klinik analizi. T. Klin.
1997;17:203-9.
4. Lehr C-M, Bouwstra JA, Schacht EH. In vitro evalua¬tion of mucoadhesive properties of chitosan and some other natural polymers. Int J Pharm 1992;78:43-4.
5. Obara K, Ishihara M, Ishizuka T. Photocrosslinkable chitosan hydrogel containing fibroblast growth factor-2 stimulates wound healing in healing-impaired db/db mice. Biomaterials 2003;24:3437-44.
6. Granat M, Tur-Kapsa I, Zylber-Katz E, Schenker JG. Reduction of peritoneal adhesion formation by colchicine: a comparative study in the rat. Fertil Steril
1983;40:369-72.
7. Stewardson RH, Bombeck CT, Nyhus LM. Critical operative management of small bowel obstruction.
Ann Surg. 1978;187:189-93.
8. Raf LE. Causes of abdominal adhesions in cases of intestinal obstructions. Acta Chir. Scand 1969;135:75-
6.
9. Sannella NA. Early and late obstruction of the small bowel after abdominoperineal resection. Am. J. Surg. 1975;130:270-2.

10. Raf LE. Causes of small intestinal obstruction. A study covering the Stockholm area. . Acta Chir. Scand
1969;135:67-72.
11. Özer ŞB, Kaymak E. Peritonun yaralanmaya karşı reaksiyonu ve periton içi yapışıklık problemi (In Turkish). izmir Devlet Hastanesi Tıp Dergisi. 1990;28:237-43.
12. Gazzaniga AB, James JM, Shobe JB. Prevention of peritoneal adhesions in the rat. The effects of dexam-ethasone, methylprednisone, promethazine and human fibrinolysin. Arch. Surg. 1975;110:429-32.
13. Milligan DW, Raftery AT. Observations on the pathogenesis of peritoneal adhesions: a light and elec¬tron microscopical study. Br. J. Surg. 1974;61:274-80.
14. VandeVord PJ, Matthew HWT, DeSilva SP.
Evaluation of the biocompatibility of a chitosan scaffold in mice. J Biomed Mater Res 2002;59:585-90.

15. Nordtveit RJ, Varum KM, Smidsr0d O. Degradation of partially N-acetylated chitosans with hen egg white and human lysozyme. Carbohydr Polym 1996; 29:163-7.
16. Varurn KM, Myhr MM, Hjerde RJN. In vitro degra¬dation rates of partially N-acetylated chitosans in
human serum. Carbohydr Res 1997;299:99-101.
17. Tomihata K, Ikada Y. In vitro and in vivo degrada¬tion of films of chitin and its deacetylated derivatives.
Biomaterials 1997;18:567-75.
18. Dargenio R, Cimino C, Ragusa G. Pharmacological prevention of postoperative adhesions experimentally induced in the rat. Actu Eur Fertil. 1986;17:276-2.
19. Diamond MP, DeCherney AH. Pathogenesis of adhesion formation/reformation; application to repro¬duce pelvic surgery. Microsurgery 1987;8:101-7.
20. Kappas AM, Barsoum GH, Ortiz JB. Prevention of peritoneal adhesions in rats with verapamil, hydrocor¬tisone sodium succinate and phosphatidylcholine. Eur.
J. Surg. 1992;158:33-5.
21. Cohen BM, Heyman T, Mast T. Use of intraperi-toneal solutions for preventing pelvic adhesions in the
rat. J. Reprod. Med. 1983;28:649-53.
22. Christin D, Buchmann P. Peritoneal adhesions after laparotomy: prophylactic measures. Hepato-
Gastroenterol. 1991;38:283-6.
23. Reijnen MM, Falk P, van Goor H. The antiadhesive agent sodium hyaluronate increases the proliferation rate of human peritoneal mesothelial cells. Fertil Steril 2000;74:146-51.
24. Laurent TC, Laurent UB, Fraser JR. The structure
and function of hyaluronan: an overview. Imunol Cell
Biol. 1996;74:1-7.
25. Adams ME, Lussier AJ, Peyron JG. A risk-benefit assessment of injections of hyaluronan and its deriva¬tives in the treatment of osteoarthritis of the knee.
Drug Saf. 2000;23:115-30.
26. Balazs EA, Denlinger JL. Viscosupplementation: a new concept in the treatment of osteoarthritis. J.
Rheumatol Suppl 1993;39:3-9.
27. Takeuchi H, Yamamoto H, Niwa T. Mucoadhesion of polymer-coated liposomes to rat intestine in vitro.
Chem Pharm Bull (Tokyo) 1994;42(9):1954-6.
28. Bol'shakov IN, Nasibov SM, Kulaev DB. Use of liq¬uid sorbents based on chitosan for treatment of diffuse forms of peritonitis. Patol Fiziol Eksp Ter 1994;3:49-50.
29. Biagini G. Wound management with N-carboxy butyl chitosan. Biomaterials 1991;12:28-31.
30. Weibel, Majno G. Peritoneal adhesions and their relation to abdominal surgery. A postmortem study.
Am J Surg. 1973;126:345-53.
31. Moreno A, Aguayo JL, Zambudio G. Influence of
abdominal incision on the formation of postoperative peritoneal adhesions: an experimental study in rats.
Eur J. Surg. 1996;162:181-5.
32. Avsar FM, Şahin M, Özel H, Saygun O, Kafalı ME, Hengirmen S, Paşaoğlu H. Effects of hyaluronic acid derivatives on the postoperative peritoneal adhesions.
Int J Surg Invest 2001;3:437-42.
33. Avsar FM, Şahin M, Aksoy F, Avşar AF, Aköz M, Hengirmen S, Bilici S. Effects of diphenhydramine HCL and methylprednisolone in the prevention of abdomi¬nal adhesions. Am J Surg 2001;181:512-5.

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