Zavada N.V., Volkov O.E., Ryabtseva S.N., Shved I.A.
Small intestinal rupture stitching up with everted mechanical suture covered with amniotic membrane as a method for adhesions prevention in the abdominal cavity (the experimental study)
Belarusian Medical Academy of Post-Graduate Education, Minsk, Republic of Belarus
Vestnik VGMU. 2017;16(3):29-37.
Objectives. In an experiment to evaluate adhesions prevention effect of everted mechanical suture covered with an amniotic membrane for intestinal rupture.
Material and methods. Rabbit intestinal rupture model by hydrodynamic strike was used to perform this study. After small intestine damage modelling, all animals were divided into 3 groups: group 1 (HS) - small intestine damage was sutured with single continuous hand-wound stiches 6-0 (Schmiden’s stich), which was covered by single-row Lembert stitches, subgroup 2 (ST) - with mechanical suture in the transverse direction by the linear stapler device, then it was covered by single-row serous Lembert stitches, subgroup 3 (ST + AM) - an everted mechanical seam was applied in the transverse direction, which was covered with a patch of cryopreserved amniotic membrane. The experimental animals were crucified after intestinal rupture suturing on the 7th, the 14th and the 30th days.
Results. The following morphological changes were assessed: inflammatory reaction severity, connective tissue scar formation, fibrous adhesions tendency. When we used an everted mechanical seam covered with a cryopreserved amniotic membrane patch, we found out the statistically significantly lower fibrous scar thickness in the bowel wall defect area and a less pronounced fibrous adhesions formation outside the damage zones. It was also found out that on using manual suture fibrosis was more pronounced with the largest scar formation in comparison with the other groups.
Conclusions. The proposed method enables the reduction of the abdominal adhesions formation intensity.
Key words: small intestine damage, amniotic membrane, everted mechanical suture, fibrosis.
1. Zavada NV, Volkov OE. Diagnostics and treatment of injuries of a small and large intestine at the isolated and combined injury of a stomach. Ekstren Meditsina. 2014;(3):80-98. (In Russ.)
2. Stupin VA, Mudarisov RR, Aliev SR, Gafina AA, Dzhabbarova AD. Prophylaxis of an adhesive desease of an abdominal cavity in the early postoperative period. Meditsina. 2014;(1):114-9. (In Russ.)
3. Zaporozhets AA. The causes of commissures of a peritoneum after primary aseptic digestive tract operations and a method of their prophylaxis. Vestn Khirurgii im II Grekova. 2011;170(2):14-30. (In Russ.)
4. Totchiev GF. Adhesive disease: physiological aspects, mechanisms of prevention. Effektiv Farmakoterapiia. 2013;(28):18-20. (In Russ.)
5. Mutsaers SE. Mesothelial cells: their structure, function and role in serosal repair. Respirology. 2002 Sep;7(3):171-91.
6. Mutsaers SE. The mesothelial cell. Int J Biochem Cell Biol. 2004 Jan;36(1):9-16.
7. diZerega GS, Cortese S, Rodgers KE, Block KM, Falcone SJ, Juarez TG, et al. A Modern Biomaterial for Adhesion Prevention. J Biomed Mater Res B Appl Biomater. 2007 Apr;81(1):239-50. doi: http://dx.doi.org/10.1002/jbm.b.30659
8. Itala E. Atlas of abdominal surgery. In 3 t. T 1 Abdominal surgery. Moscow, RF: Med lit; 2009. 448 р. (In Russ.)
9. Holmdahl L, Falkenberg M, Ivarsson M-L, Risberg B. Plasminogen activators and inhibitors in peritoneal tissue. APMIS. 1997 Jan;105(1-6):25-30. doi: http://dx.doi.org/10.1111/j.1699-0463.1997.tb00535.x
10. Jones PA, Werb Z. Degradation of connective tissue matrices by macrophages. II. Influence of matrix composition on proteolysis of glycoproteins, elastin, and collagen by macrophages in culture. J Exp Med. 1980 Dec;152(6):1527-36.
11. Raftery AT. Effect of peritoneal trauma on peritoneal fibrinolytic activity and intraperitoneal adhesion formation. An experimental study in the rat. Eur Surg Res. 1981;13(6):397-401.
12. Scott-Coombes D, Whawell S, Vipond MN, Thompson J. Human intraperitoneal fibrinolytic response to elective surgery. Br J Surg. 1995 Mar;82(3):414-7.
13. Shal'kov YuL. Commissural syndrome. Moscow, RF: Binom; 2011. 240 р.(In Russ.)
14. van Baal JO, Van de Vijver KK, Nieuwland R, van Noorden CJ, van Driel WJ, Sturk A, et al. The histophysiology and pathophysiology of the peritoneum. Tissue Cell. 2017 Feb;49(1):95-105. doi: http://dx.doi.org/10.1016/j.tice.2016.11.004
15. de Araújo LA, Mrué F, Neves RA, Alves MM, da Silva-Júnior NJ, Silva MS, et al. Effects of topical treatment with euphorbia tirucalli latex on the survival and intestinal adhesions in rats with experimental peritonitis. Arq Bras Cir Dig. 2015 Nov-Dec;28(4):243-6. doi: http://dx.doi.org/10.1590/S0102-6720201500040006
16. Ozbalci GS, Sulaimanov M, Hazinedaroğlu SM, Törüner A. The Effects of Hydrophilic Polyethylene Glycol-Based Adhesion Barrier Use to Prevent Intra-abdominal Adhesions in Intra-abdominal Sepsis Model. Indian J Surg. 2015 Dec;77(Suppl 2):398-402. doi: http://dx.doi.org/10.1007/s12262-013-0852-1
17. Volenko AV, Faller AP, Shurkalin BK, Gorskiy VA, Leonenko IV, Andreev SS, i dr. Possible, results and prospects of strengthening of intestinal sutures fibrin-collagen substance «tachocomb». Khirurgiia Zhurn im NI Pirogova. 2004;(2):53-5. (In Russ.)
18. Gorskiy VA. Technical aspects of application of a biopolmer of "Takhokomb" at abdominal organs operations. Khirurgiia Zhurn im NI Pirogova. 2001;(5):43-6. (In Russ.)
19. Zhukovskaya II. Experience. Quality. Innovations: [about production of LLC Linteks] [Elektronnyi resurs]. 2015. Rezhim dostupa: http://federalbook.ru/files/Reestr/Company/FSZ/16/FSZ%2016-24.pdf. (In Russ.)
20. Kondratovich LM. The basis for understanding the formation of adhesions in the abdominal cavity. Intraoperative prevention of protivopolozhnymi barrier drugs (review of literature). Vestn Novykh Med Tekhnologii. 2014;21(3):169-72. (In Russ.)
21. Matveev HL, Arutyunyan DYu, Digaeva MA. The results of the application of 4% solution of Icodextrin for the prevention of adhesions after surgical and gynecological operations. Endoskop Khirurgiia. 2008;14(3):45-54. (In Russ.)
22. Butureanu SA, Butureanu TA. Pathophysiology of adhesions. Chirurgia (Bucur). 2014 May-Jun;109(3):293-8.
23. Wang P, Wang J, Zhang W, Li Y, Li J. Effect of the combination of fibrin glue and growth hormone on intestinal anastomoses in a pig model of traumatic shock associated with peritonitis. World J Surg. 2009 Mar;33(3):567-76. doi: http://dx.doi.org/10.1007/s00268-008-9889-x
24. Fletcher NM, Jiang ZL, Diamond MP, Abu-Soud HM, Saed GM. Hypoxia‐generated superoxide induces the development of the adhesion phenotype. Free Radic Biol Med. 2008 Aug;45(4):530-6. doi: http://dx.doi.org/10.1016/j.freeradbiomed.2008.05.002
25. Jablin MS, Dubey M, Zhernenkov M, Toomey R, Majewski J. Influence of lipid membrane rigidity on properties of supporting polymer. Biophys J. 2011 Jul;101(1):128-33. doi: http://dx.doi.org/10.1016/j.bpj.2011.05.054
26. Kamel RM. Prevention of postoperative peritoneal adhesions. Eur J Obstet Gynecol Reprod Biol. 2010 Jun;150(2):111-8. doi: http://dx.doi.org/10.1016/j.ejogrb.2010.02.003
27. Mamede AC, Carvalho MJ, Abrantes AM, Laranjo M, Maia CJ, Botelho MF. Amniotic membrane: from structure and functions to clinical applications. Cell Tissue Res. 2012 Aug;349(2):447-58. doi: http://dx.doi.org/10.1007/s00441-012-1424-6
28. Fairbairn NG, Randolph MA, Redmond RW. The clinical applications of human amnion in plastic surgery. J Plast Reconstr Aesthet Surg. 2014 May;67(5):662-75. doi: http://dx.doi.org/10.1016/j.bjps.2014.01.031
29. Manuelpillai U, Moodley Y, Borlongan CV, Parolini O. Amniotic membrane and amniotic cells: Potential therapeutic tools to combat tissue inflammation and fibrosis? Placenta. 2011 Oct;32 Suppl 4:S320-5. doi: http://dx.doi.org/10.1016/j.placenta.2011.04.010
30. Rennie K, Gruslin A, Hengstschläger M, Pei D, Cai J, Nikaido T, et al. Applications of amniotic membrane and fluid in stem cell biology and regenerative medicine. Stem Cells Int. 2012;2012:721538. doi: http://dx.doi.org/10.1155/2012/72153
31. Uludag M, Ozdilli K, Citgez B, Yetkin G, Ipcioglu OM, Ozcan O, et al. Covering the colon anastomoses with amniotic membrane prevents the negative effects of early intraperitoneal 5-FU administration on anastomotic healing. Int J Colorectal Dis. 2010 Feb;25(2):223-32. doi: http://dx.doi.org/10.1007/s00384-009-0833-9
Information about authors:
Zavada N.V. – Doctor of Medical Sciences, professor of the Chair of Emergency Surgery, Belarusian Medical Academy of Post-Graduate Education;
Volkov O.E. – postgraduate of the Chair of Emergency Surgery, Belarusian Medical Academy of Post --Graduate Education;
Ryabtseva S.N. – Candidate of Medical Sciences, research officer of the pathomorphologic team of the Scientific-Research Laboratory, Belarusian Medical Academy of Post-Graduate Education;
Shved I.A. – Doctor of Medical Sciences, professor, principal officer of the pathomorphologic team of the Scientific-Research Laboratory Belarusian Medical Academy of Post-Graduate Education.