cellulase and Postoperative-Complications

Postoperative adhesion is a frequent problem in patients undergoing surgery. In particular, gastrectomy is associated with a high risk of bowel obstruction. However, there are few reports of small bowel obstruction (SBO) after gastrectomy in the English-language literature. We reviewed the literature to assess the effectiveness of various techniques for preventing adhesion in patients treated with gastrectomy. We assumed that strategies used to prevent postoperative adhesion associated with colorectal surgery, cholecystectomy, appendectomy and gynecologic procedures are similar to those used in gastrectomy. We therefore reviewed reports on the prevention of postoperative SBO in any abdominal surgical procedure, focusing especially on gastrectomy. General intraoperative preventive techniques, such as the use of starch-free gloves, saline irrigation at a temperature below 37 °C and laparoscopic techniques whenever possible, may reduce the incidence of SBO in patients with gastric cancer who undergo gastrectomy. If preserving the omentum is unrelated to the survival rate of patients with gastric cancer, this technique should be recommended for preventing postoperative SBO. The use of hyaluronic acid/carboxymethylcellulose bioabsorbable membranes should also be considered in patients undergoing gastrectomy. However, demonstrating the advantages of bioabsorbable membranes would require larger randomized studies with a longer follow-up period.

Topics: Biocompatible Materials; Cellulase; Gastrectomy; Gloves, Surgical; Humans; Hyaluronic Acid; Intestinal Obstruction; Intestine, Small; Intraoperative Care; Laparoscopy; Membranes, Artificial; Omentum; Postoperative Complications; Sodium Chloride; Starch; Stomach Neoplasms; Temperature; Therapeutic Irrigation

To determine if a hyaluronic acid/carboxymethylcellulose (HA/CMC) sinus dressing reduces the rate of postoperative scarring.. In a randomized, matched-controlled, single-blinded study, following the completion of surgery, an HA/CMC dressing was randomly assigned to one side with the opposite unpacked side serving as a control.. Fifty-three patients underwent surgery for chronic rhinosinusitis (CRS; 39 patients) or CRS with nasal polyposis (14 patients). At the 8-week follow-up, there was no difference in synechiae on the HA/CMC side compared to the control (p = 0.09). HA/CMC-treated sinuses, however, demonstrated fewer synechiae in the first 2 weeks postoperatively compared to the control (p = 0.01), and were associated with significantly less nasal congestion at the 4-week (p = 0.02) and 8-week follow-up visits (0.03).. There was no long-term difference in the rate of synechiae in the HA/CMC-treated sinus compared to the control. However, less severe nasal congestion and synechiae in the initial postoperative period may reduce the need for aggressive sinus debridement.

Topics: Adult; Aged; Aged, 80 and over; Bandages; Cellulase; Chronic Disease; Debridement; Endoscopy; Female; Humans; Hyaluronic Acid; Male; Middle Aged; Nasal Cavity; Postoperative Complications; Prospective Studies; Sinusitis; Treatment Outcome; Young Adult

This study assessed and compared the efficacy of two types of bioresorbable membranes in the prevention of postoperative adhesion under clean contaminated and bacterial peritonitis conditions using a cecal ligation and puncture model in rats.. Wistar albino rats (n = 72) were divided into six groups. Bacterial peritonitis was induced using a cecal ligation and puncture model in groups 2, 4, and 6. Groups 1, 3, and 5 served as controls for clean contaminated procedures in the absence of bacterial peritonitis. Groups 1 and 2 were the untreated clean contaminated and bacterial peritonitis groups and served as controls for the effect of the bioresorbable membranes in each condition. In groups 3 and 4, a 1.5 x 3 cm USP glycerol/sodium hyaluronate/carboxymethylcellulose membrane was wrapped around the cecal resection area and a 2 x 4 cm membrane was left under the incision. The oxidized regenerated cellulose membrane was similarly applied in groups 5 and 6. Four weeks later, the adhesions were evaluated. In addition, fibrosis and inflammation were observed histopathologically.. Adhesion development (P = .008), fibrosis (P = .008), and inflammation (P = .0001) differed among the groups. Both materials increased adhesion formation in the bacterial peritonitis condition. Increased fibrotic activity was detected in all material-applied groups under both conditions. In addition, more inflammation was detected in the groups that received the application of a material, especially in the presence of bacterial peritonitis.. Neither material prevented adhesions in clean contaminated conditions. Moreover, they increased adhesion formation in bacterial peritonitis.

Topics: Abdomen; Animals; Bacterial Infections; Biocompatible Materials; Cellulase; Cellulose, Oxidized; Fibrosis; Glycerol; Hyaluronic Acid; Inflammation; Laparotomy; Male; Membranes, Artificial; Peritonitis; Postoperative Complications; Rats; Rats, Wistar; Tissue Adhesions

Gastric bezoars may occur in the normal stomach as a result of ingestion of various objects which do not pass through the pylorus. Most gastric bezoars occur as a complication of previous gastric surgery in which there is a loss of normal pyloric function, hypoperistalsis, and low gastric acidity. They may also occur as a complication of cimetidine therapy. Symptoms include epigastric fullness, regurgitation, nausea and vomiting, and epigastric pain. A simple treatment utilizing an ordinary Teledyne Water Pik jet stream through a gastroscope is described to break up a large phytobezoar. This method is probably the treatment of choice and should be used more widely.

Topics: Adult; Bezoars; Cellulase; Female; Gastric Lavage; Gastroscopy; Humans; Papain; Postoperative Complications; Stomach

Phytobezoars are plant fibre concretions occurring in the stomach as a complication following some types of gastric surgery. Symptoms include distension, pain and vomiting. Ulceration, gastric bleeding and even perforation can occur. If untreated, they result in a significant mortality. Dissolution of the phytobezoar can be achieved without operative intervention. Enzymes and especially cellulase help to break up the mass and it can then be aspirated or allowed to pass on. Five patients with phytobezoars were thus treated and the cellulase method was confirmed to be simple, safe and effective.

Topics: Adult; Aged; Bezoars; Cellulase; Gastrectomy; Humans; Male; Middle Aged; Plants; Postoperative Complications; Time Factors

Topics: Aged; Bezoars; Cellulase; Female; Gastrectomy; Humans; Male; Middle Aged; Postoperative Complications

Topics: Bezoars; Cellulase; Duodenal Ulcer; Glycoside Hydrolases; Humans; Male; Middle Aged; Postoperative Complications; Vegetables