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Carboxymethylcellulose adhesion barrier placement at primary cesarean delivery and outcomes at repeat cesarean delivery.

Giornale Obstetrics and gynecology
Year 2014
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Questo articolo fa parte di 1 Systematic review Systematic reviews (1 reference)

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OBJECTIVE: To assess associations of a commercially available carboxymethylcellulose adhesion barrier placed during primary cesarean delivery with clinical outcomes of repeat cesarean deliveries. METHODS: We performed a retrospective cohort study of women undergoing primary cesarean delivery on or after January 1, 2008, and first repeat cesarean delivery in one of four hospitals in the same system by June 30, 2011. Women were included if both deliveries were live singletons at 34-42 weeks of gestation delivered through transverse abdominal incisions and the first hysterotomy was low transverse. Exclusion criteria included intervening delivery; puerperal infection, bowel injury, or bladder injury at primary cesarean delivery; uterine incision or laparotomy (except primary cesarean delivery) before repeat cesarean delivery; and use of another adhesion barrier at primary cesarean delivery. As a surrogate for adhesion grading, the primary outcome was time from skin incision to neonate delivery at repeat cesarean delivery. We also assessed total operative time and rates of selected surgical complications. RESULTS: There were 517 women who met criteria; 248 received the adhesion barrier during primary cesarean delivery and 269 did not. There were no demographic differences between groups except delivery hospital. In the adhesion barrier and no adhesion barrier groups, respectively, mean±standard deviation times to delivery at repeat cesarean delivery were 6.1±3.0 compared with 5.8±2.5 minutes (P=.25), and total operative times were 31.2±10.6 compared with 31.8±11.6 minutes (P=.56). Surgical complications were not different between groups. CONCLUSION: Placing a commercially available carboxymethylcellulose adhesion barrier at primary cesarean delivery is not associated with decreased time to delivery, total operative time, or complications during repeat cesarean deliveries. LEVEL OF EVIDENCE: II.

Primary study

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Prevenzione aderenza peritoneale al taglio cesareo: un'analisi dell'efficacia di una barriera aderenza assorbibile.

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Giornale The Journal of reproductive medicine
Year 2011
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Questo articolo fa parte di 2 Systematic reviews Systematic reviews (2 references)

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OBIETTIVO: Per valutare l'efficacia di una barriera aderenza assorbibile utilizzata al momento del parto cesareo. STUDIO: Abbiamo condotto uno, due bracci di coorte, revisione retrospettiva della prima ripetizione tagli cesarei primari e successive dal 1 ° gennaio 2006 al 31 dicembre 2009. Criteri di esclusione sono stati rapporto operativo incomplete, storia della chirurgia addominale-pelvica prima, malattia infiammatoria pelvica, corionamniosite, il parto cesareo di emergenza o l'uso di corticosteroidi entro 2 settimane. Adesione incidenza / severità e incisione cutanea per i tempi di consegna appena nati sono stati analizzati. Sono stati esaminati gli effetti dei tipi di chiusura e di sutura peritoneali. RISULTATI: Dei 262 cesareans primarie eseguite, il 43% (n = 112) ha avuto il taglio cesareo ripetizione. Con barriera, il 74% non ha avuto adesioni a un intervento chirurgico di ripetizione, contro il 22% nel gruppo senza barriere (p = 0,011). Undici per cento aveva grado 2 aderenze con barriera, mentre il 64% aveva grado 2-3 nel gruppo barriera (p = 0.012). Il gruppo non ha avuto barriera di grado 3 adesioni. Quelli con parietale chiusura peritoneale aveva meno incidenza (p = 0,02) e media aderenza all'importanza (p = 0,03); nessuna differenza significativa è stata trovata per tipo di sutura. Nessuna differenza statistica nel tempo da incisione cutanea alla consegna neonato è stata osservata tra il gruppo primario e la barriera (p = 0,006); quelli senza barriere avevano un intervallo di consegna statisticamente più (p = 0,35). CONCLUSIONE: L'uso di una adesione assorbibile baóóórrier riduce l'incidenza e la gravità delle adesioni a cesareo.

Primary study

Unclassified

Adhesion formation after intracapsular myomectomy with or without adhesion barrier.

Giornale Fertility and sterility
Year 2011
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Questo articolo fa parte di 3 Systematic reviews Systematic reviews (3 references)

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OBJECTIVE: To show the prevention of adhesion formation by placing an absorbable adhesion barrier after intracapsular myomectomy. DESIGN: Prospective blinded observational study. SETTING: University-affiliated Hospitals. PATIENT(S): Patients ≥ 18 years old with single or multiple uterine fibroids removed by laparoscopic or abdominal intracapsular myomectomy. INTERVENTION(S): A total of 694 women undergoing laparoscopic or abdominal myomectomy were randomized for placement of oxidized regenerated cellulose absorbable adhesion barrier to the uterine incision or for control subjects without barriers. The presence of adhesions was assessed in 546 patients who underwent subsequent surgery. MAIN OUTCOME MEASURE(S): The primary and secondary outcomes of the analysis were the presence and severity of adhesions for four groups: laparotomy with barrier, laparotomy without barrier, laparoscopy with barrier, and laparoscopy without barrier. RESULT(S): There was a higher rate of adhesions in laparotomy without barrier (28.1%) compared with laparoscopy with no barrier (22.6%), followed by laparotomy with barrier (22%) and laparoscopy with barrier (15.9%). Additionally, the type of adhesions were different, filmy and organized were predominant with an adhesion barrier, and cohesive adhesions were more common without an adhesion barrier. CONCLUSION(S): Oxidized regenerated cellulose reduces postsurgical adhesions. Cohesive adhesions reduction was noted in laparoscopy.

Primary study

Unclassified

Scegliere contro chiusura hysterotomy doppio strato al momento del parto e della vescica aderenze cesarei primari.

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Giornale BJOG : an international journal of obstetrics and gynaecology
Year 2010
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Questo articolo fa parte di 1 Systematic review Systematic reviews (1 reference)

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OBIETTIVO Determinare l'associazione tra monostrato (uno di sutura in esecuzione) e doppio strato (secondo livello o imbricating sutura) chiusura hysterotomy a parto cesareo primario e la successiva formazione di aderenze. DESIGN: Un'analisi secondaria da uno studio prospettico di coorte di donne sottoposte a taglio cesareo prima ripetizione. IMPOSTAZIONE: Dipartimento di Ostetricia e Ginecologia, la Stanford University, Stanford, CA, Stati Uniti d'America. POPOLAZIONE: Cento e ventisette donne in gravidanza sottoposte prima ripetizione taglio cesareo. METODI: record dei pazienti sono stati esaminati per stabilire se hysterotomies cesarei primari sono stati chiusi con un singolo o doppio strato. I dati sono stati analizzati da Fisher di test corretti e regressione logistica multivariata. Principale misura di esito tasso prevalenza di aderenze pelviche e addominali. RISULTATI: Dei 127 donne, chiusura hysterotomy primario era solo strato in 56 e doppio strato a 71. Chiusura hysterotomy monostrato è stato associato con adesioni alla vescica, al momento della ripetizione cesareo (24% contro il 7%, p = 0,01). Chiusura monostrato è stato associato in questo studio con un sette volte maggiore le probabilità di sviluppare aderenze vescica (odds ratio, 6,96; 95% intervallo di confidenza, 1,72-28,1), indipendentemente da altre tecniche chirurgiche, del lavoro precedente, infezioni ed età oltre 35 anni. Non c'era alcuna associazione tra chiusura a singolo strato e altre aderenze pelviche o addominali. In conclusione, primario monostrato chiusura hysterotomy può essere associato con le adesioni della vescica più frequenti durante il parto cesareo di ripetizione. La gravità e le implicazioni cliniche di questi adesioni dovrebbero essere valutate in ampi studi prospettici.

Primary study

Unclassified

Incidence of post-operative adhesions following Misgav Ladach caesarean section--a comparative study.

Autori Fatusić Z , Hudić I
Giornale The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
Year 2009
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Questo articolo fa parte di 1 Systematic review Systematic reviews (1 reference)

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AIM: To evaluate the incidence of peritoneal adhesions as a post-operative complication after caesarean section following the Misgav Ladach method and compare it with peritoneal adhesions following traditional caesarean section methods (Pfannenstiel-Dörffler, low midline laparotomy-Dörffler). METHODS: The analysis is retrospective and is based on medical documentation of the Clinic for Gynecology and Obstetrics, University Clinical Centre, Tuzla, Bosnia and Herzegovina (data from 1 January 2001 to 31 December 2005). We analysed previous caesarean section dependent on caesarean section method (200 by Misgav Ladach method, 100 by Pfannenstiel-Dörffler method and 100 caesarean section by low midline laparotomy-Dörffler). Adhesion scores were assigned using a previously validated scoring system. RESULTS: We found statistically significant difference (p < 0.05) in incidence of peritoneal adhesions in second and third caesarean section between Misgav Ladach method and the Pfannestiel-Dörffler and low midline laparotomy-Dörffler method. Difference in incidence of peritoneal adhesions between low midline laparotomy-Dörffler and Pfannenstiel-Dörffler method was not statistically different (p > 0.05). The mean pelvic adhesion score was statistically lower in Misgav Ladach group (0.43 +/- 0.79) than the mean score in the Pfannestiel-Dörffler (0.71 +/- 1.27) and low midline laparotomy-Dörffler groups (0.99 +/- 1.49) (p < 0.05). CONCLUSIONS: Our study showed that Misgav Ladach method of caesarean section makes possible lower incidence of peritoneal adhesions as post-operative complication of previous caesarean section.

Primary study

Unclassified

Adhesion development and morbidity after repeat cesarean delivery.

Giornale American journal of obstetrics and gynecology
Year 2009
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Questo articolo fa parte di 1 Systematic review Systematic reviews (1 reference)

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OBJECTIVE: The purpose of this study was to evaluate the development and implications of intraabdominal adhesions after repeat cesarean section delivery (CS). STUDY DESIGN: We reviewed the charts of 1283 women who underwent repeat CS and 203 other women who underwent primary CS. Primary outcome measures were incidence and extent of adhesions, incision-to-delivery interval, and operating time. RESULTS: No adhesions were found in primary CS. Compared with those women with a second CS (24.4%), significantly more women had adhesions after 3 CSs (42.8%; 95% confidence interval [CI], 0.84-0.99). Compared with a first CS (7.7 +/- 0.3 minutes), the delivery time was significantly longer at subsequent CSs (second CS, 9.4 +/- 0.1 minutes; 95% CI, 1-2; third CS, 10.6 +/- 0.3 minutes; 95% CI, 2-4; >or= 4 CSs, 10.4 +/- 0.1 minutes; 95% CI, 1-2). However, complication rates in those women with >or= 2 CSs were comparable with primary CS. CONCLUSION: Increased adhesion development and a longer time to delivery were found with each subsequent CS.

Primary study

Unclassified

Laparoscopic ileal pouch-anal anastomosis reduces abdominal and pelvic adhesions.

Giornale Surgical endoscopy
Year 2009
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Questo articolo fa parte di 1 Systematic review Systematic reviews (1 reference)

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BACKGROUND: Postoperative adhesions are an expected outcome for the majority of open abdominal operations, occurring in more than 90% of cases. Adhesions are responsible for more than 75% of small bowel obstruction cases. This study aimed to evaluate adhesions to the anterior abdominal wall and adnexal organs after laparoscopic ileal-pouch anal anastomosis (IPAA). METHODS: Patients who underwent laparoscopic IPAA for ulcerative colitis had laparoscopic evaluation of adhesions at loop ileostomy closure for assessment of adhesions to the anterior abdominal wall and for adhesions to the adnexae in the case of women. Adhesions to the adnexae were quantified using the American Fertility Society adhesion score. Data were maintained prospectively. RESULTS: In this study, 34 patients (21 women) ranging in age from 19 to 78 years (median, 36 years) underwent laparoscopic IPAA. With regard to anterior abdominal wall adhesions, 23 patients (68%) had no adhesions to the anterior abdominal wall, and the remaining 11 patients had few adhesions (filmy, avascular). No patients had dense adhesions to the abdominal wall. Of the 21 women, 15 (71%) had no adnexal adhesions, 5 had filmy adhesions enclosing less than one-third one adnexa, and 1 had filmy adhesions enclosing one-third to two-thirds of one adnexa. No patient had adhesions affecting both adnexae. CONCLUSIONS: Laparoscopic IPAA results in few adhesions to the anterior abdominal wall or to gynecologic organs. These adhesions were significantly fewer than previously reported for open operations with or without the use of a glycerol hyaluronate/carboxymethylcellulose bioresorbable (GHA/CMC) adhesion barrier.

Primary study

Unclassified

A safety and efficacy study of a resorbable hydrogel for reduction of post-operative adhesions following myomectomy.

Giornale Human reproduction (Oxford, England)
Year 2008
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Questo articolo fa parte di 3 Systematic reviews Systematic reviews (3 references)

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BACKGROUND: This multicenter, randomized, single-blind study assessed the safety and efficacy of a resorbable hydrogel ('Hydrogel') for the reduction of post-operative adhesion formation following myomectomy. METHODS: Women (n = 71) who were undergoing laparoscopic (67.6%) or laparotomic myomectomy were randomized (2:1) to Hydrogel (sprayed over surgically treated areas prior to wound closure, n = 48) or to control (standard care, n = 23). Patients (38 Hydrogel, 20 control) returned 8-10 weeks later for a second look. Adhesions were graded using a modified American Fertility Society (mAFS) scoring method. The primary efficacy measure was the posterior uterus mAFS score. RESULTS: For Hydrogel and control patients, respectively, mean +/- SD mAFS scores were 0.5 +/- 1.4 and 0.0 +/- 0.0 at baseline, and 1.1 +/- 1.9 and 2.6 +/- 2.2 at the second look. Similarly, mean changes from baseline were 0.8 +/- 2.0 and 2.6 +/- 2.2 (P = 0.01); 95% confidence intervals for these mean changes were (0.16-1.44) and (1.64-3.56). Adverse events were reported by 9.6 and 17.4% of Hydrogel and control patients, respectively. No intra-abdominal infections or post-operative site infections were reported. CONCLUSIONS: This 71-patient study provides the first clinical evidence of the safety and efficacy of Hydrogel for the reduction of adhesions following myomectomy. The ClinicalTrials.gov Identifier is NCT00562471.

Primary study

Unclassified

Adhesions are common and costly after open pouch surgery.

Giornale Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
Year 2008
Links Pubmed Health Technology Assessment (HTA) DOI crd.york.ac.uk

Questo articolo fa parte di 2 Systematic reviews Systematic reviews (2 references)

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PURPOSE: Open ileal pouch surgery leads to high rates of adhesive small-bowel obstruction (SBO). A laparoscopic approach may reduce these complications. We aimed to review the incidence of adhesive SBO-related complications after open pouch surgery and to model the potential financial impact of a laparoscopic approach purely as an adhesion prevention strategy. MATERIALS AND METHODS: We reviewed cases of open ileal pouch patients kept on a database and examined annually. Case notes were studied for episodes of adhesive SBO requiring admission or reoperation. Similar parameters were studied in a small series undergoing laparoscopic pouch surgery. The financial burden of the open access complications was estimated and potential financial impact of a laparoscopic approach modeled. RESULTS: Two hundred seventy-six patients were followed up after open surgery (median, 6.3; range, 0.2-20.1 years). There were 76 (28%) readmissions (median length of stay, 7.4 days) in 53 patients (19%) and 28 (10%) reoperations (43% within 1 year). Laparoscopic patients required less adhesiolysis at second-stage surgery (0% vs 36%, p < 0.0001) and had less SBO episodes within 12 months of surgery (0% vs 14%, p < 0.0001) than open patients. Modeling a laparoscopic approach cost $1,450 and saved $3,282, thus netting $1,832 per pouch constructed. CONCLUSION: Open ileal pouch surgery results in significant cumulative long-term access-related complications, particularly adhesions. These impose a large medical burden on patients and financial burden on health-care systems, all of which may be recouped by a laparoscopic approach, despite higher theater costs.

Primary study

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L'incidenza di aderenze a parto cesareo ripetizione.

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Autori Hamel KJ
Giornale American journal of obstetrics and gynecology
Year 2007
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Questo articolo fa parte di 1 Systematic review Systematic reviews (1 reference)

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OBIETTIVO: Per confrontare l'incidenza e la gravità delle adesioni a parto cesareo ripetizione sulla base della chiusura di parte primaria. STUDIO: Un retrospettivo è stato condotto per 62 casi di parti cesarei ripetuti. Un punteggio è stato assegnato in base alla gravità delle aderenze. Il rapporto operativo primario è stato rivisto, e il tipo di chiusura registrato. L'analisi statistica è stata effettuata con il test, Chi2 e ANOVA. RISULTATI: Quarantanove e otto decimi per cento dei casi avevano ampie adesioni. Chiusura del muscolo addominale peritoneale o retto portato a un numero significativamente inferiore adesioni ampie rispetto nonclosure (31,2% vs 70,0%; P = .013). Il punteggio medio di adesione per il gruppo nonclosure was 2,67, rispetto a 1,91 per il gruppo di chiusura peritoneale parietale (P = 0,044) e 1,73 per il gruppo muscolo retto (P = .009), dove 1 è alcuna aderenze e 4 è il più grave). CONCLUSIONE: Chiusura del muscolo retto o il peritoneo parietale a parte primaria ha provocato un numero significativamente inferiore adesioni al parto cesareo ripetizione.