Archive for October, 2011
Different types of adjuvants used to prevent adhesions?
Adhesion formation and reformation are still an unavoidable event in reproductive pelvic surgery in spite of the variable skills in microsurgery and endoscopic surgery.
This fact necessitates the search for barrier that can be used in the perioperative period.
There have various barriers or adjuvants that have been used but none have conclusively proven to be effective in various studies.
CLASSES OF ADHESION-REDUCTION ADJUVANTS AND THEIR PROPOSED MECHANISM OF ACTION
What is the principle how barriers prevent adhesions?
Adhesions are formed after all surgical measures involving laparotomy. But even during laparoscopy, which is a form of minimally invasive surgery, wound surfaces can be formed during certain procedures, such as for example endometriosis or myoma operations. These surfaces can adhere to each other, thus forming adhesions. These adhesions can later cause problems such as pain, adhesion of the uterine tubes (infertility) or of other organs (intestines / ovaries / uterus). They thus have the potential to cause chronic problems and pain requiring tedious treatment measures, and possibly even adhesiolysis, a follow-up surgical procedure to remove these adhesions. The long-term success of many different surgical procedures can be improved by the use of barriers that act as “internal bandages” and prevent adhesions Many of the available mechanical barriers in use today are derived from either industrial materials or animal sources. SprayShield™ (formerly SprayGel™) is a new barrier substance from Covidien to prevent postsurgical adhesions. SprayShield™, a largely water based tissue friend
SprayShield Application broshure
A broshure on SprayShield application can be opened and downloaded. Please click on the picture below: Ähnliche ArtikelAdhesiolysis with SprayShieldSprayShield application videoGynecologic adhesiolysis with SprayShieldAnother adhesions surgery with SprayShield™Another adhesiolysis with SprayShield™
SprayShield versus Spraygel
SprayGel™ was modified in some parts, so the resorption was promised to be shorter (5-7 days) than it was with SprayGel™(7-14 days). And the blue colour is not due to methylenblue anymore but a simple colour used frequently in food = Brilliant Blue FCF; http://en.wikipedia.org/wiki/Brilliant_Blue_FCF. For clinical comparison here you can see an image with similar adhesions after adhesiolysis and covered with the SprayGel™ and 7 days later in the 2nd look laparoscopy. One can see that the SprayGel™ is still there and a little tissue reaction (reddish areas with neovascularisation) is shown:
SprayShield™ – new adhesions barrier to prevent adhesions formation after surgical procedures
Since March 2001 we have been using this novel spray substance SprayShield™, (formerly SprayGel) to prevent adhesions following gynaecological surgical procedures. In general, adhesions are formed after all surgical measures involving laparotomy. But even during laparoscopy, which is a form of minimally invasive surgery, wound surfaces can be formed during certain procedures, such as for example endometriosis or myoma operations. These surfaces can adhere to each other, thus forming adhesions. These adhesions can later cause problems such as pain, adhesion of the uterine tubes (infertility) or of other organs (intestines / ovaries / uterus). They thus have the potential to cause chronic problems and pain requiring tedious treatment measures, and possibly even adhesiolysis, a follow-up surgical procedure to remove these adhesions. The new gel substance (SprayShield™) is sprayed onto the wound surfaces, where it remains in place for some days after surgery. Since adhesions
Extreme adhesions situs
Lift-Laparoscopy in combination with SprayGel have good results even in the worst cases, where nearly all abdomen is covered with adhesions and the bowel adheres with his wall to the abdominal peritoneum. Adhesions dissection is very dangerous: as bowel might be injured and has to be sutured: Application of SprayGel as adhesions barrier: and at the second look laparoscopy: bowel healed excellent, the sutures close sufficient, no infection or reformation of adhesions:
SprayShield™ – the new product by Covidien
Since December 2008 we are using the new SprayShield™ by COVIDIEN. SprayGel™ was modified in some parts, so the resorption was promised to be shorter (5-7 days) than it was with SprayGel™(7-14 days). And the blue colour is not due to methylenblue anymore but a simple colour used frequently in food. More components were modified and I should report later in this board. For now I just wanted to show the clinical results. This is a picture of adhesions on the left pelvic wall: and this after adhesiolysis and here after coverage with SprayShield™: and here the beautiful healed result at 2nd look laparoscopy ONLY 5 days later: For clinical comparison here you can see an image with similar adhesions after adhesiolysis and covered with the SprayGel™ and 7 days later in the 2nd look laparoscopy. One can see that the SprayGel™ is still there and a little tissue reaction (reddish areas with neovascularisation) is shown: And again for comparison again with SprayShield™, where after only 5 days, SprayShield™ is fully absorbed and the peritoneum is smooth without any reaction: Actually there seems to be a better and rapid resorption of the Hydrogel and the absence of methylenblue, which was taken from the market some times ago. I think that this result in less foreign body or allergic reactions as in some cases occurred with SprayGel™. We will continue research and if that is the case, we might decrease the time between Surgery and 2nd look laparoscopy to five days, so the time necessary to stay at the hospital will be shorter. Also some complications in regard to infections might decrease with the new product.
Another adhesiolysis with SprayShield™
A picture of adhesions on the left pelvic wall: and this after adhesiolysis and here after coverage with SprayShield™: and here the beautiful healed result at 2nd look laparoscopy 7 days later: Again to say this: the SprayShield™ is fully absorbed and the peritoneum is smooth and without any reaction. There are no reddish areas, like with SprayGel™ (see pictures above) and no reaction, the peritoneum is already completely healed.
Another adhesions surgery with SprayShield™
Again a picture of adhesions, here on the right pelvic wall. After an appendectomy the bowel (mid of picture) is completely adherent to the pelvic wall and has to be dissected: and this after adhesiolysis and here after coverage with SprayShield™: and here the beautiful healed result at 2nd look laparoscopy only 5 days later: Also here to see: the SprayShield™ is fully absorbed and the peritoneum is smooth and without any reaction. There are no reddish areas, like with SprayGel™ (see pictures above) and no reaction; the peritoneum is already completely healed. Here one can see the result in a higher magnification: ——————–
Gynecologic adhesiolysis with SprayShield
Most of our adhesions patients are presented with bowel adhesions after open surgeries. Here you can see a case with gynecological adhesions, that cause pain and infertility. Left pelvic area is completely covered with bowel. One can only recognize the apex of the ovary (white) and a small part of the tube: After lift-laparoscopic adhesiolysis the female anatomy can be recognized very well: left ovary and the left tube with the fimbria, bowel in the correct anatomical situation. Application of SprayGel as adhesions barrier… and in the second-look laparoscopy: no reformation or de-novo adhesions occure. See more here
