Prevenzione delle aderenze dopo la chirurgia
Prevenzione delle Aderenze
Le ultime relazioni
Le aderenze postoperatorie rappresentano il problema clinico maggiore
Le aderenze postoperatorie occorrono in circa l’805 dei casi in seguito a chirurgia, e sono la causa di dolore cronico, di infertilità e di ostruzione intestinale. Sono responsabili del 30% circa dei casi dolore cronico nelle donne, del 30% dei casi di infertilità e del 100% dei casi di ostruzione intestinale in seguito a chirurgia.
A destra: la cavità peritoneale
In mezzo: le conseguenze cliniche
Durata della chirurgia e il grado della manipolazione, la capacità del chirurgo ( per questa ragione la poca esperienza del chirurgo causerà molte più aderenze).
Desiccation will occur systematically unless specific preventive measurements are taken.
A better gas mixture instead of CO2 that is very irritant
de lower temperatures are better during laparoscopy
If all factors are controlled by conditioning adhaesion formation is reduced by over 70%.
BELGIAN SOCIETY OF
2001 Molinas et al
R. Palmer Prize.
2001 Molinas et al
2002 ESHRE Molinas et al
2004 Binda et al
Ospan Mynbaev CO2 resorbtion
This work received a series of international prices
and a series of PhD’s were made
prevention of adhaesions :
then a barrier
prevention of adhaesions today : with the old model: Maximum 40-50% effective
Adept : FDA approved
effective ?: unclear
Ringers Lactate : cheap
effective in our mouse model
no clinical evidence
maximum 40-50% effective
no demonstrated effect upon
pain, infertility, reintervention
not FDA approved
prevention of adhaesions based upon the old model is done by using “barriers” of “Flotation agents” in order to keep the surgical surfaces separated for a few days. All available products have an effectivity of 40 tot 50% at best and this for specific (simple) interventions performed by esperts. In addition, the variability of results is high.
Therefore effectivity has not been demonstrated for any product for a clinical endpoint as infertility, or pain or reintervention. These products are marketed as devices. Only for Adept safety has been extgensively demonstrated . This is the only product approved by the FDA today. Adept can be associated with vulvar oedema
The future of prevention of adhaesions : first conditioning of the peritoneal cavity
We do expect that in the very near future we will be able to perform surgery without adhaesions by peritoneal conditioning. This was described first ascombination therapy.
= > 90% adhaesion reduction
Developed clinically in cooperation with eSaturnus NV
Other advantages of Conditioning of the peritoneal cavity
less postoperative pain , estimated at a 60% decrease.
Less CO2 resorbtion is a major advantage for laparoscopic surgery of longer duration especially in more obese patients
Less tumor metastasis, if confirmed in the human, the importance is obvious in reducing mortality