Document Type : Original Article
Authors
- Narges DehghaniMohammadAbadi 1
- Abdulhamid Amooee 1
- Atiyeh Javaheri 2
- Hamid Owliaey 3
- Mohammad Amini 4
- Morteza Anvari 5
- Hamidreza Ghasemirad 6
1 Department of Surgery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
2 Department of Obstetrics and Gynecology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
3 Department of Forensic Medicine & Clinical Toxicology, Yazd Branch, Islamic Azad University, Yazd, Iran
4 Department of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
5 Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
6 Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Abstract
Background: Postoperative adhesions are a serious health problem with significant implications for quality of life and healthcare costs. This study aimed to investigate the effect of two substances, PerClot® Powder and Surgicel, in reducing adhesions after hysterectomy in rat models compared to the control group.
Methods: This study used an interventional laboratory trial design. The study population consisted of 30 adult female rats, which were randomly assigned to three groups (n=10 per group) and underwent hysterectomy under standard conditions. The three groups received either Surgicel, PerClot®, or no treatment (control group). Adhesions were graded using the Leach grading system and analyzed using SPSS version 22, through the Chi-square test.
Results: No significant difference was found among the Surgicel, PerClot®, and control groups regarding adhesion grades (p = 0.064). However, a significant difference was observed between the Surgicel and control groups (p = 0.014). The Surgicel group had a higher frequency of grade 0 adhesions (60%) and no grade 2 adhesions, while the control group had a frequency of 10% for grade 0 adhesions and 50% for grade 2 adhesions. Additionally, no significant difference was found between the PerClot® and control groups (p = 0.214), indicating similar adhesion grade distributions. No significant difference was observed between the Surgicel and PerClot® groups (p = 0.301).
Conclusion: According to the findings, Surgicel significantly reduces adhesion severity compared to the control, while PerClot® does not show a significant effect. In addition, there is no significant difference between the Surgicel and PerClot® groups regarding adhesion.
Keywords
Main Subjects
- Lindquist SA, Shah N, Overgaard C, Torp-Pedersen C, Glavind K, Larsen T, et al. Association of previous cesarean delivery with surgical complications after a hysterectomy later in life. JAMA Surg. 2017;152(12):1148–55.
- Ghobrial S, Ott J, Parry JP. An overview of postoperative intraabdominal adhesions and their role on female infertility: a narrative review. J Clin Med. 2023;12(6):2263.
- Boland GM, Weigel RJ. Formation and prevention of postoperative abdominal adhesions. J Surg Res. 2006;132(1):3–12.
- Lower AM, Hawthorn RJ, Clark D, Boyd JH, Finlayson AR, Knight AD, et al. Adhesion-related readmissions following gynaecological laparoscopy or laparotomy in Scotland: an epidemiological study of 24,046 patients. Hum Reprod. 2004;19(8):1877–85.
- Wallwiener M, Brölmann H, Koninckx PR, Lundorff P, Lower AM, Wattiez A, et al. Adhesions after abdominal, pelvic and intra-uterine surgery and their prevention. Gynecol Surg. 2012; 9:465–6.
- Giusto G, Cerullo A, Gandini M. Surgical colic caused by fibrous bands and adhesions in absence of previous abdominal surgery: 9 cases (2012–2019). Equine Vet Educ. 2022;34(7):e293–8.
- Takagi K, Araki M, Fukuoka H, Takeshita H, Hidaka S, Nanashima A, et al. Novel powdered anti-adhesion material: preventing postoperative intra-abdominal adhesions in a rat model. Int J Med Sci. 2013;10(4):467–72.
- Zhang Y, Liu Q, Yang N, Zhang X. Hyaluronic acid and oxidized regenerated cellulose prevent adhesion reformation after adhesiolysis in rat models. Drug Des Devel Ther. 2016; 10:3501–9.
- Holmdahl L. The role of fibrinolysis in adhesion formation. Eur J Surg Suppl. 1997;(577):24–31.
10 Wolberg AS, Campbell RA. Thrombin generation, fibrin clot formation and hemostasis. Transfus Apher Sci. 2008;38(1):15–23.
- Dowling MB, Smith W, Balogh P, Duggan MJ, MacIntire IC, Harris E, et al. Hydrophobically-modified chitosan foam: description and hemostatic efficacy. J Surg Res. 2015;193(1):316–23.
- Wang Y, Xu M, Dong H, Liu Y, Zhao P, Niu W. et al. Effects of PerClot® on the healing of full-thickness skin wounds in rats. Acta Histochem. 2012;114(4):311–7.
- Rottenstreich M, Rotem R, Hirsch A, Farkash R, Rottenstreich A, Sela HY, et al. The use of absorbable adhesion barriers to reduce the incidence of intraperitoneal adhesions at repeat cesarean delivery. Arch Gynecol Obstet. 2020; 302:101–8.
- Raimondo D, Raffone A, Saccone G, Travaglino A, Degli Esposti E, Mastronardi M, et al. Cellulose absorbable barrier for prevention of de-novo adhesion formation at the time of laparoscopic myomectomy: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2020; 245:107–13.
- Naito M, Ogura N, Yamanashi T, Sato T, Nakamura T, Miura H, et al. Prospective randomized controlled study on the validity and safety of an absorbable adhesion barrier (Interceed®) made of oxidized regenerated cellulose for laparoscopic colorectal surgery. Asian J Endosc Surg. 2017;10(1):7–11.
- Wen N, Yi L, Zhi-chao L, Yan-xia W, Man-ling L, Yan L, et al. Preventive effect of starch-derived absorbable polysaccharide hemostat on postoperative intestinal adhesion formation. J Clin Rehabil Tissue Eng Res. 2009;13(12):2287–90.
- Temiz A, Ozturk C, Bakunov A, Kara K, Kaleli T. A new material for prevention of peritendinous fibrotic adhesions after tendon repair: oxidised regenerated cellulose (Interceed), an absorbable adhesion barrier. Int Orthop. 2008;32(3):389–94.
- Underwood W, Anthony R. AVMA guidelines for the euthanasia of animals: 2020 edition. AVMA. 2020;2013(30):2020–1.
- Chiu LH, Chen CH, Tu PC, Chang CW, Yen YK, Liu WM. Comparison of robotic surgery and laparoscopy to perform total hysterectomy with pelvic adhesions or large uterus. J Minim Access Surg. 2015;11(1):87–93.
- Leach RE, Burns JW, Dawe EJ, Smith-Barbour MD, Diamond MP. Reduction of postsurgical adhesion formation in the rabbit uterine horn model with use of hyaluronate/carboxymethylcellulose gel. Fertil Steril. 1998;69(3):415–8.
- Kim YI. 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. Yonsei Med J. 2013;54(6):1491–7.
- Practice Committee of the American Society for Reproductive Medicine, Society of Reproductive Surgeons. Pathogenesis, consequences, and control of peritoneal adhesions in gynecologic surgery. Fertil Steril. 2008;90(5 Suppl): S144–9.
- Güney G, Kaya C, Oto G, Yildirim S, Özdemir H, Tokmak A. Effects of quercetin and Surgicel® on preventing adhesions after gynecological surgery: A rat uterine horn model. J Turk Ger Gynecol Assoc. 2016;17(Suppl 1): S130.
- Aktekin A, Sahin I, Sezer UA, Gulmez M, Ozkara S, Sezer S. Carboxymethyl cellulose/oxidized regenerated cellulose hydrogels as adhesion barriers: comparative study with different molecular weights and substitution degrees. Cellulose. 2016;23(5):3145–56.
- Karimi N, Amooee A, SafiDahaj F. Comparison of the effect of PerClot® powder and a chitosan derivative on postoperative intra-abdominal adhesions in rat animal models. Pol J Surg. 2021;94(2):27–31.
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