Pelvic Surgery: Adhesion Formation and Prevention

274 Pages·1997·5.99 MB·English

by  Andrew T. Raftery (auth.)

Pelvic Surgery
Ad Hoc Organizing Committee
Dr. Gere S. diZerega
Dr. Alan H. DeCherney
Dr. Michael P. Diamond
Dr. Randall C. Dunn
Dr. Eugene P. Goldberg
Dr. John A. Rock
Dr. Togus Tulandi
Springer Science+Business Media, LLC
Gere S. diZerega, M.D.
Alan H. DeCherney, M.D. Michael P. Diamond, M.D.
Randall C. Dunn, M.D. Eugene P. Goldberg, Ph.D.
Arthur F. Haney, M.D. John A. Rock, M.D.
Togus Tulandi, M.D. Kathleen E. Rodgers, Ph.D.
Editors
Pelvic Surgery
Adhesion Formation and Prevention
With 52 Figures
Springer
GGeerree SS.. ddiiZZeerreeggaa
DDeeppaarrttrmneenntt ooff OObbsstteettrriiccss aanndd GGyynneeccoollooggyy
LLiivviinnggssttoonn LLaabboorraattoorriieess
UUnniivveerrssiittyy ooff SSoouutthheerrnn CCaalliiffoorrnniiaa
LLooss AAnnggeelleess,, CCAA 9900003333,, UUSSAA
LLiibbrraarryy ooff CCoonnggrreessss CCaattaallooggiinngg--iinn--PPuubblliiccaattiioonn DDaattaa
PPeellvviicc ssuurrggeerryy:: aaddhheessiioonn ffoornmnaattiioonn aanndd pprreevveennttiioonn // [[eeddiitteedd bbyy]] GGeerree
SS.. ddiiZZeerreeggaa..
pp.. ccmm..
PPrroocceeeeddiinnggss ooff tthhee 33rrdd IInntteerrnnaattiioonnaall CCoonnggrreessss oonn PPeellvviicc SSuurrggeerryy &&
AAddhheessiioonn PPrreevveennttiioonn,, hheelldd iinn SSaann DDiieeggoo,, CCaalliiff,. ,f rforomm FFeebb.. 2299 t oto MMaarrcchh
22,, 11999966..
IInnccl\uuddeess bbiibblliiooggrraapphhiiccaall rreeffeerreenncceess aanndd iinnddeexx..
IISSBBNN 997788--11--44661122--77331166--55 IISSBBNN 997788--11--44661122--11886644--77 ((eeBBooookk))
DDOOII 1100..11000077//997788--11--44661122--11886644--77
11.. PPeellvviiss—-SSuurrggeerryy-—CCoonnggrreesssseess.. 22.. AAddhheessiioonnss—-CCoonnggrreesssseess..
1I.. DDiiZZeerreeggaa,, GGeerree SS.. IIII.. IInntteerrnnaattiioonnaall CCoonnggrreessss oonn PPeellvviicc SSuurrggeerryy &&
AAddhheessiioonn PPrreevveennttiioonn ((33rrdd :: 11999966 :: SSaann DDiieeggoo,, CCaalliiff..))
[[DDNNLLMM:: 11.. PPeellvviiss—-ssuurrggeerryy—-ccoonnggrreesssseess.. 22.. AAddhheessiioonnss—-pprreevveennttiioonn &&
ccoonnttrrooll—-ccoonnggrreesssseess.. WWPP 115555 PP33993355 11999977]]
RRDD554499..PP445533 11999977
617.5'5-dc20 96-35592
617.5'5—dc20 96-35592
Printed on acid-free paper.
Printed on acid-free paper.
©© 11999977 SSpprriinnggeerr SScciieennccee++BBuussiinneessss MMeeddiiaa NNeeww YYoorrkk
OOrriiggiinnaall1lyy ppuubblliisshheedd bbyySSpprriinnggeerr--VVeerrllaagg NNeeww YYoorrkk iinn 11999977
SSooffttccoovveerr rreepprriinntt ooff tthhee hhaarrddccoovveerr 1Isstt eeddiittiioonn 11999977
AAlIIl rriigghhttss rreesseerrvveedd.. TThhiiss wwoorrkk mmaayy nnoott bbee ttrraannssllaatteedd oorr ccooppiieedd iinn wwhhoollee oorr iinn ppaarr!t wwiitthhoouutt tthhee wwrriitttteenn
ppeerrmmiissssiioonn ooff tthhee ppuubblliisshheerr ((SSpprriinnggeerr SScciieennccee++BBuussiinneessss MMeeddiiaa,, LLLLCC)),, eexxcceepptt ffoorr bbrriieeff eexxcceerrppttss iinn
ccoonnnneeccttiioonn wwiitthh rreevviieewwss oorr sscchhoollaarrllyy aannaallyyssiiss.. UUssee iinn ccoonnnneeccttiioonn wwiitthh aannyy ffoorrmm ooff iinnffoorrmmaattiioonn ssttoorraaggee
aanndd rreettrriieevvaall,, eelleeccttrroonniicc aaddaappttaattiioonn,, ccoommppuutteerr ssooffttwwaarree,, oorr bbyy ssiimmiillaarr oorr ddiissssiimmiillaarr mmeetthhooddoollooggyy nnooww
kknnoowwnn oorr hheerreeaafftteerr ddeevveellooppeedd iiss ffoorrbbiiddddeenn..
TThhee uussee ooff ggeenneerraall ddeessccrriippttiivvee nnaammeess,, ttrraaddee nnaammeess,, ttrraaddeemmaarrkkss,, eettcc..,, iinn tthhiiss ppuubblliiccaattiioonn,, eevveenn iiff tthhee
ffoorrmmeerr aarree nnoott eessppeecciiaallllyy iiddeennttiiffiieedd,, iiss nnoott ttoo bbee ttaakkeenn aass aa ssiiggnn tthhaatt ssuucchh nnaammeess,, aass uunnddeerrssttoooodd bbyy t hthee
TTrraaddee MMaarrkkss aanndd MMeerrcchhaannddiissee MMaarrkkss AAcctt,, mmaayy aaccccoorrddiinnggllyy bbee uusseedd ffrreeeellyy bbyy aannyyoonnee..
WWhhiillee tthhee aaddvviiccee aanndd iinnffoorrmmaattiioonn iinn tthhiiss bbooookk aarree bbeelliieevveedd t too bbee ttrruuee aanndd aaccccuurraatete aatt tthhee ddaattee ooff g gooiinngg
ttoo pprreessss,, nneeiitthheerr tthhee aauutthhoorrss nnoorr tthhee eeddiittoorrss nnoorr tthhee ppuubblliisshheerr ccaann aacccceepptt aannyy lleeggaall rreessppoonnssiibbiilliittyy ffoorr aannyy
eerrrroorrss oorr oommiissssiioonnss tthhaatt mmaayy bbee mmaaddee.. TThhee ppuubblliisshheerr mmaakkeess nnoo wwaarrrraannttyy,, eexxpprreessss oorr iimmpplliieedd,, wwiitthh
rreessppeecctt ttoo tthhee mmaatteerriiaall ccoonnttaaiinneedd hheerreeiinn..
PPrroodduuccttiioonn ccoooorrddiinnaatteedd bbyy CChheerrnnooww EEddiittoorriiaall SSeerrvviicceess,, IInncc..,, aanndd mmaannaaggeedd bbyy NNaattaalliiee JJoohhnnssoonn;;
mmaannuuffaaccttuurriinngg ssuuppeerrvviisseedd bbyy JJoohhaannnnaa TTsscchheebbuullll..
TTyyppeesseett bbyy KKPP CCoommppaannyy,, BBrrooookkllyynn, , NNYY, , aanndd A Aggnneeww's's, ,I nIncc.,. ,G Graranndd R Raappidids,s ,M MII. .
99 88 77 66 55 443322
IISSBBNN 997788--11--44661122--77331166--55
Preface
Recent years have seen important advances in the technology and techniques
available to surgeons performing gynecologic surgery as well as reconstructive
pelvic procedures. These developments took place in a wide variety of clinical
settings from regional teaching centers to private clinical facilities. In 1996, the
leading investigators from around the world gathered to discuss the present status
of pelvic surgery and adhesion prevention with a look toward the future of patient
care. This volume contains the proceedings of that meeting: the Third Interna
tional Congress on Pelvic Surgery and Adhesion Prevention. Each chapter in
cludes the material presented at the congress as well as a timely update of the
authors' latest research and clinical thinking.
Presentation integrating basic and clinical science provide the basis for con
sidering peritoneal repair after surgery including the interaction of growth factors
and other biochemical messengers. Research has increased the understanding of
mesothelial reepithelialization and has led to new surgical technologies to reduce
adhesion fonnation. A state-of-the-art review of emerging surgical adjuvants for
adhesion prevention is provided, including discussion of barriers, gels, and poly
mers as well as "designer" drugs effective at modifying the peritoneal response to
injury. Assessment of clinical outcome in a wide variety of gynecologic surgical
procedures brings into focus the benefits available as a result of these new tech
nologies. Specific recommendations are provided for adjuvant use in ovarian,
tubal, and uterine surgery, as well as a review of the clinical experiences that
substantiate these recommendations. Perspectives are provided by leading pelvic
reconstruction surgeons as to how alterations in surgical procedures can enhance
the quality of outcome today with a view toward future progress tomorrow.
Acknowledgments
The editors would like to acknowledge the diligent efforts of Ms. Leticia Corona
and Mr. Alexander DeCherney during the preparation of this book.
GERE mZEREGA
v
Contents
Preface .................... " .... .. .. ............... ......... v
Contributors ................................................. xi
I. Postsurgical Peritoneal Repair
1. Cellular Events in Peritoneal Repair: A Review 3
ANDREW T. RAFTERY
2. Biochemical Messengers in Postsurgical Repair
and Adhesion Formation ................................... 11
KATHLEEN E. RODGERS
3. Comparative Tissue Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
GREGORY S. SCHULTZ
4. Response of Fetal Tissue to Wounding 37
TIMOTHY M. CROMBLEHOLME
5. Postsurgical Intraperitoneal Tissue Repair:
Implication of TGF-13 ..................................... 51
NASSER CHEGINI
II. Developing Technology for Adhesion Prevention
6. Animal Adhesion Models: Design, Variables, and Relevance 65
MICHAEL P. DIAMOND
7. Experimental Prevention of Peritoneal Adhesions
in General Surgery ....................................... 71
KARL H. TREUTNER, PETER BERTRAM, AND VOLKER SCHUMPELICK
8. Tissue Protective Solutions and Films for Adhesion Prevention 79
EUGENE P. GOLDBERG
vii
viii Contents
9. Peritoneal Fibrinolysis and Adhesion Formation. . . . . . . . . . . . . . . . 93
JEREMY N. THOMPSON, DAVID M. SCOTT-COOMBES, AND
SIMON A. WHAWELL
10. Peritoneal Conditioning: The Role of the Supply of Natural
Membrane Lipids ........................................ 103
STIG BENGMARK
III. Outcome Measures
11. Clinical Trial Design for Evaluation of Treatments Purported to
Prevent Postsurgical Adhesions ............................. 117
ARTHUR F. HANEY
12. Adhesions and Infertility .................................. 126
RICCARDO MARANA, MARIO RIZZI, AND LUDOVICO MUZII
13. Laparoscopic Ovarian Surgery and Adhesions ................. 136
MICHEL CANIS, MAURICE ANTOINE BRUHAT, GERARD MAGE,
JEAN Luc POULY, ARNAUD WATTIEZ, AND HUBERT MANHES
14. Infertility and Ectopic Pregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . .. 144
PER LUNDORFF
15. Clinical Significance of Adhesions in Patients
with Chronic Pelvic Pain .................................. 150
ERICA A. BAKKUM AND A.A.W. PETERS
16. Bowel Obstruction Related to Prior Gynecologic Surgery 160
JODY BLANCO
IV. Adjuvants for Clinical Use
17. Prognostic Factors of Distal Tubal Occlusion .................. 167
JACQUES DONNEZ, ROLAND POLET, AND MICHELE NISOLLE
18. Reconstruction of the Ovary with Endometrioma:
A Problem of Adhesions .................................. 181
Ivo A. BROSENS AND PATRICK PuTTEMANS
19. Use of Adhesion Prevention Barriers in Pelvic Reconstructive and
Gynecologic Surgery ..................................... 188
GERE S. mZEREGA
Contents ix
20. Prevention of Postoperative Adhesions on the Human Oviduct and
of Sactosalpinges ........................................ 210
BERTIL LARSSON
21. Laparoscopic Myomectomy, Laparoscopy-Assisted Myomectomy,
and Postmyomectomy Adhesions. . .. . . . .. . . . . . . . . . . . . . .. . . .. 214
TOGUS TuLANDI
22. Adhesion Prevention: The Role of Fibrin Glue . . . . . . . . . . . . . . . .. 222
MATTHIAS KORELL
23. Clinical Use of Oxidized Regenerated Cellulose for the Prevention
of Adhesion Formation After Laparoscopic Myomectomy. . . . . . .. 231
GIAN BENEDETTO MELlS, S. AJOSSA, S. GUERRIERO, AND V. MAIS
Advances in Gynecologic Surgery (Abstracts)
1. Adhesion Formation and Changes in Local Fibrinolytic Activity
(LFA) of the Uterine Hom Tissue (UHF) After Various Types
of Operations ............................................ 239
O.A. MYINBAYEV, L.V. ADAMIAN, K.1. RUBLEVA, L.V. LUTOVA,
M.A. KARABASOVA, AND G.V. ANDREBENKO
2. Gyaluronidase Electrophoresis Effect on
Postoperative Adhesions Formations ......................... 240
v.1. KULAKOV, L.V. ADAMIAN, O.A. MYINBAYEV, AND
V.M. STRUGALSKLI
3. Prevention of Postsurgical Adhesion Formation with Polyactive,
A Degradable Barrier ..................................... 241
ERICA A. BAKKUM AND TRUDY TRIMBOS-KEMPER
4. An Evaluation of Operator Variability in a Rat Cecal Abrasion
Model for the Formation of Abdominal Models ................ 242
L.S. BURGESS, R.L. ROSE, J.e. COLT, K.e. SKINNER,
AND JAMES W. BURNS
5. The Evaluation of an Injectable Bioresorbable Gel on Adhesion
Reduction in Two Animal Models ........................... 244
L.S. BURGESS, R.L. ROSE, MJ. COLT, K.C. SKINNER,
AND JAMES W. BURNS
6. Seprafilm (HAL-F) Reduces Postoperative Adhesions: Initial
Results of a Multicenter Gynecologic Clinical Study ............ 245
MICHAEL P. DIAMOND AND THE SEPRAFILM ADHESION STUDY GROUP
x Contents
7. Comparative Post Operative Adhesion Fonnation Following
Laparoscopic Cholecystectomy in the Porcine Model Using
Electrosurgery, Laser, and Ultrasonically Activated Scalpel. . . . . .. 246
ROGER FERLAND AND JOSEPH AMARAL
8. Pelvic Inflammatory Pseudotumor with Central Infectious Abscess:
A Case Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 247
CHIH-PING HAN, YEU-SHENG TYAN, SYH-SHEN CHEN,
GOW-CHING GER, AND SHAW-YEU JENG
9. Plasminogen-Activator Inhibitor-l (PAl-I) Remains Elevated
After Surgery and Is Not Correlated with Postoperative
Adhesion Score . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 248
RICHARD E. LEACH, EBERHARDT MAMMEN, JAMES W. BURNS,
ELIZABETH DAWE, MICHELLE SMITH-BARBOUR, AND
MICHAEL P. DIAMOND
10. Mannan Activation of Peritoneal Macrophages: A Method of
Identifying a Cell Population Associated with Adhesions
Due to Infection ......................................... 249
D.E. OTT, R.E. GARNER, AND A.N. WALKER
11. Pollutants Resulting from Intraabdominal Tissue Combustion . . . .. 251
D.E. OTT
12. Tissue Combustion SmokelPlume Absorption
via the Peritoneum at Laparoscopy .......................... 253
D.E. OTT
13. Vesicovaginal Fistular Repair: A New Technique
to Avoid Recurrence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 255
SAFWAT TOSSON
14. Review of Randomized Studies of Pharmacologic Adjuvant Used
During Infertility Surgery to Prevent Postoperative
Adhesion Fonnation ...................................... 256
ANDREW WATSON, PATRICK VANDERKERCKHOVE, AND
R.J. LILFORD
15. Comments on the Third International Congress on Pelvic Surgery
and Adhesion Prevention: Summary ......................... 258
ALAN H. DECHERNEY
Index.. ................................ ................. .... 261
Contributors
L.V. ADAMIAN, M.D., Scientific Center for Obstetrics and Gynecology and Per
inatology, Russian Academy of Medical Sciences, 117811 Moscow, Russia
S. AJOSSA, M.D., Department of Obstetrics and Gynecology, University of
Cagliari, Ospedale San Giovanni di Dio, 09124 Cagliara, Italy
JOSEPH AMARAL, M.D., F.A.C.S., Department of Surgery, Brown University,
Providence, RI 02903, USA
G.V. ANDREBENKO, M.D., Faculty of Biology, Laboratory of Fermentative
Fibrinolysis, Moscow University, Moscow, Russia
ERICA A. BAKKUM, M.D., Ph.D., Department of Gynecology, Leiden University
Medical Center, 2300 RC Leiden, The Netherlands, and Department of Gynecol
ogy, Groene Hart Hospital, 2803 HH Gouda, The Netherlands
STIG BENMARK, M.D., Ph.D., Ideon Research Center, Lund University, S-223 70
Lund, Sweden
PETER BERTRAM, M.D., Department of Surgery, Rhenish-Westphalian Technical
University, Aachen, Germany
JODY BLANCO, M.D., Department of Obstetrics and Gynecology, Columbia Pres
byterian Medical Center, New York, NY 10032, USA
Ivo A. BROSENS, M.D., Leuven Institute for Fertility and Embryology, B-300
Leuven, Belgium
MAURICE ANTOINE BRUHAT, M.D., Department of Obstetrics and Gynecology
and Reproductive Medicine, Polyclinique de I'Hotel Dieu, Centre Hospitalier
Regional et Universitaire de Clermont Ferrand, Clermont Ferrand, France
L.S. BURGESS, M.D., Genzyme Corporation, Cambridge, MA 02139, USA
xi