Abstract
Amaç: Postoperatif peritoneal adezyonlar (PPA) abdominal cerrahi sonrası ağrı, intestinal obstrüksiyon ve infertiliteye neden olabilir. Bugüne kadar kanıtlanmış bir patogenezi veya kesin tedavisi yoktur. Karın içi girişimlerde en önemli noktalardan biri barsak florası ve enfeksiyona etkisidir. Florada bulunan veya sıklıkla hastane florası olarak eklenen farklı mikroorganizmaların inflamatuar süreçlere ve PPA oluşumuna neden olabileceği düşünülmüştür. Karın içi enfeksiyonların PPA'ya neden olduğunu gösteren birçok çalışma vardır, ancak farklı bakteri suşlarının PPA oluşumu üzerindeki etkisini karşılaştıran bir çalışma yoktur. Bu nedenle çalışmayı intraabdominal enfeksiyonlarda en sık izole edilen mikroorganizmalar ve hastane florası kullanılarak tasarladık. Farklı bakteri suşlarının (Klebsiella spp, E. coli spp, anaerob) sıçanlarda PPA oluşumu ve adezyon derecesi üzerine etkisini araştırmayı amaçladık.
Materyal Metod: Denekler on iki rattan oluşan 5 gruba ayrıldı. Gruplar; E.coli, Klebsiella, Bacteriodes fragilis, Sham ve Kontrol grupları olarak adlandırıldı. Sıçanlar 14. günde sakrifiye edildi ve relaparotomi uygulandı. Sonuçlar daha önce belirlenen sınıflamalara göre makroskobik ve mikroskobik olarak değerlendirildi.
Bulgular: Bakteriyel enfeksiyonlu gruplar sham ve kontrol grupları ile karşılaştırıldığında, PPA'da hem mikroskobik hem de makroskobik olarak anlamlı artış gözlendi.
Sonuç: Deneysel olarak oluşturulan adezyon modelinde mikroorganizmaların PPA oluşumunda aktif rol oynadığı bulunmuştur. Ancak bakteri suşları arasında PPA oluşumu üzerinde anlamlı bir fark yoktu.
References
- 1. Tanphiphat, C, Chittmittrapap S., Prasopsunti K., Adhesive small bowel obstruction. A review of 321 cases in a Thai hospital. Am J Surg, 1987. 154(3): 283-7.
- 2. DeCherney, A.H. and G.S. diZerega, Clinical problem of intraperitoneal postsurgical adhesion formation following general surgery and the use of adhesion prevention barriers. Surg Clin North Am, 1997. 77(3): 671-88. 3. Alican, F., İnce Barsak. Cerrahi Dersleri. Vol. 2. 1998, İstanbul: Avrupa Tıp Kitapçılık.
- 4. Tang J, Xiang Z, Bernards MT, Chen S. Peritoneal adhesions: Occurrence, prevention and experimental models. Acta Biomater. 2020 Oct 15;116:84-104.
- 5. Nair SK, Bhat IK, Aurora AL. Role of proteolytic enzyme in the prevention of postoperative intraperitoneal adhesions. Arch Surg 1974;108:849–853.
- 6. Zuhlke HV, Lorenz EM, Straub EM, Savvas V. Pathophysiology and classification of adhesions. Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir 1990:1009–1016.
- 7. Ten Broek, R.P.G,, KrielenP, Di SaverioS, Coccolini F, Biffl WL, Ansaloni L, et all. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg, 2018. 13: 24.
- 8. Conze, J, Junge K, Klinge U, Weiss C, Polivoda M, Oettinger AP, et al., Intraabdominal adhesion formation of polypropylene mesh. Influence of coverage of omentum and polyglactin. Surg Endosc, 2005. 19(6): 798-803.
- 9. Guvenal, T, Cetin A, Ozdemir H, Yanar O, Kaya T, Prevention of postoperative adhesion formation in rat uterine horn model by nimesulide: a selective COX-2 inhibitor. Hum Reprod, 2001. 16(8): 1732-5.
- 10. Bothin, C, Okada M, Midtvedt T, Perbeck L.The intestinal flora influences adhesion formation around surgical anastomoses. Br J Surg, 2001. 88(1): 143-5.
- 11. Cahill, R.A., J.H. Wang, H.P. Redmond, Enteric bacteria and their antigens may stimulate postoperative peritoneal adhesion formation. Surgery, 2007. 141(3): 403-10.
Abstract
Aim: Postoperative peritoneal adhesions (PPA) cause pain, intestinal obstruction and infertility after abdominal surgery and to date there is no shown pathogenesis or definitive treatment. One of the most important points in intraabdominal interventions is bowel flora and its effect on infection. It was thought that different microorganisms found in flora or frequently added as hospital flora might cause inflammatory processes and cause PPA formation. There are a lot of studies showing intraabdominal infections cause PPA but there is no study comparing the effect of different bacterial strains on PPA formation. That is why we designed this study using the most common microorganisms isolated in intraabdominal infections and hospital flora. In this study, we aimed to investigate the effect of different bacterial strains (Klebsiella spp, E. coli spp, anaerobe) on the formation and degree of PPA in adhesion formation in rats.
Methods: In this study, rats were divided into 5 groups, consisting of twelve rats. Groups were classified as; E. coli, Klebsiella, Bacteriodes fragilis, Sham and Control groups. The rats were sacrificed on the fourteenth day and relaparotomy was performed. The results were evaluated macroscopically and microscopically according to the previously determined classifications.
Results: When bacterial infected groups were compared with sham and control groups, both microscopic and macroscopically significant increase in PPA was observed.
Conclusion: In the experimentally generated adhesion model, microorganisms have been found to play an active role in PPA formation. But there was no significant difference between bacterial strains on PPA formation.
References
- 1. Tanphiphat, C, Chittmittrapap S., Prasopsunti K., Adhesive small bowel obstruction. A review of 321 cases in a Thai hospital. Am J Surg, 1987. 154(3): 283-7.
- 2. DeCherney, A.H. and G.S. diZerega, Clinical problem of intraperitoneal postsurgical adhesion formation following general surgery and the use of adhesion prevention barriers. Surg Clin North Am, 1997. 77(3): 671-88. 3. Alican, F., İnce Barsak. Cerrahi Dersleri. Vol. 2. 1998, İstanbul: Avrupa Tıp Kitapçılık.
- 4. Tang J, Xiang Z, Bernards MT, Chen S. Peritoneal adhesions: Occurrence, prevention and experimental models. Acta Biomater. 2020 Oct 15;116:84-104.
- 5. Nair SK, Bhat IK, Aurora AL. Role of proteolytic enzyme in the prevention of postoperative intraperitoneal adhesions. Arch Surg 1974;108:849–853.
- 6. Zuhlke HV, Lorenz EM, Straub EM, Savvas V. Pathophysiology and classification of adhesions. Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir 1990:1009–1016.
- 7. Ten Broek, R.P.G,, KrielenP, Di SaverioS, Coccolini F, Biffl WL, Ansaloni L, et all. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg, 2018. 13: 24.
- 8. Conze, J, Junge K, Klinge U, Weiss C, Polivoda M, Oettinger AP, et al., Intraabdominal adhesion formation of polypropylene mesh. Influence of coverage of omentum and polyglactin. Surg Endosc, 2005. 19(6): 798-803.
- 9. Guvenal, T, Cetin A, Ozdemir H, Yanar O, Kaya T, Prevention of postoperative adhesion formation in rat uterine horn model by nimesulide: a selective COX-2 inhibitor. Hum Reprod, 2001. 16(8): 1732-5.
- 10. Bothin, C, Okada M, Midtvedt T, Perbeck L.The intestinal flora influences adhesion formation around surgical anastomoses. Br J Surg, 2001. 88(1): 143-5.
- 11. Cahill, R.A., J.H. Wang, H.P. Redmond, Enteric bacteria and their antigens may stimulate postoperative peritoneal adhesion formation. Surgery, 2007. 141(3): 403-10.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Original Articles |
| Authors | |
| Publication Date | July 31, 2023 |
| Acceptance Date | May 25, 2023 |
| Published in Issue | Year 2023 Volume: 11 Issue: 2 |
