Prevention of peritoneal adhesions: A promising role for gene therapy

World J Gastroenterol. 2011 December 14; 17(46): 5049–5058.
Published online 2011 December 14. doi: 10.3748/wjg.v17.i46.5049 PMCID: PMC3235588

Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
Prevention of peritoneal adhesions: A promising role for gene therapy
Hussein M Atta
Hussein M Atta, Department of Surgery, Faculty of Medicine, Minia University, El-Minia 61519, Egypt
Author contributions: Atta HM solely contributed to this paper.
Correspondence to: Hussein M Atta, MD, PhD, Professor, Department of Surgery, Faculty of Medicine, Minia University, Misr-Aswan Road, El-Minia 61519, Egypt. attahm@ems.org.egTelephone: +20-1-001407222 Fax: +20-2-22917077
Received May 15, 2011; Revised July 14, 2011; Accepted July 21, 2011.

Abstract:

Adhesions are the most frequent complication of abdominopelvic surgery, yet the extent of the problem, and its serious consequences, has not been adequately recognized. Adhesions evolved as a life-saving mechanism to limit the spread of intraperitoneal inflammatory conditions. Three different pathophysiological mechanisms can independently trigger adhesion formation. Mesothelial cell injury and loss during operations, tissue hypoxia and inflammation each promotes adhesion formation separately, and potentiate the effect of each other. Studies have repeatedly demonstrated that interruption of a single pathway does not completely prevent adhesion formation. This review summarizes the pathogenesis of adhesion formation and the results of single gene therapy interventions. It explores the promising role of combinatorial gene therapy and vector modifications for the prevention of adhesion formation in order to stimulate new ideas and encourage rapid advancements in this field.

Keywords: Peritoneal adhesions, Tissue plasminogen activator, Gene therapy, Plasminogen activator inhibitor, Tissue inhibitor of metalloproteinase, Transforming growth factor β

Full article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3235588/?tool=pubmed

Severe inflammatory reaction induced by peritoneal trauma is the key driving mechanism of postoperative adhesion formation

CO2 insufflation however, led to moderate inflammation and less adhesion formation.


http://7thspace.com/headlines/399719/severe_inflammatory_reaction_induced
_by_peritoneal_trauma_is_the_key_driving_mechanism_of_postoperative_adhesion_formation_.html


Many factors have been put forward as a driving mechanism of surgery-triggered adhesion formation (AF). In this study, we underline the key role of specific surgical trauma related with open surgery (OS) and laparoscopic (LS) conditions in postoperative AF and we aimed to study peritoneal tissue inflammatory reaction (TIR), remodelling specific complications of open surgery (OS) versus LS and subsequently evaluating AF induced by these conditions.

Methods: A prospective randomized study was done in 80 anaesthetised female Wistar rats divided equally into 2 groups.

Specific traumatic OS conditions were induced by midline incision line (MLI) extension and tissue drying and specific LS conditions were remodelled by CO2 insufflation. TIR was evaluated at the 24th, 72nd, 120th and 168th hour by scoring scale.

Statistical analysis was performed by the non parametric t test and two-way ANOVA using Bonferroni post-tests.

Results: More pronounced residual TIR was registered after OS than after LS. There were no significant TIR interactions though highly significant differences were observed between the OS and LS groups (p<0.0001) with regard to surgical and time factors. The TIR change differences between the OS and LS groups were pronounced with postoperative time p<0.05 at the 24th and 72nd; p<0.01 - 120th and p<0.001 - 168th hrs. Adhesion free wounds were observed in 20.0 and 31.0% of cases after creation of OS and LS conditions respectively; with no significant differences between these values (p>0.05).

However larger adhesion size (41.6733.63) was observed after OS in comparison with LS (20.3116.38). The upper-lower 95% confidential limits ranged from 60.29 to 23.04 and from 29.04 to 11.59 respectively after OS and LS groups with significant differences (p=0.03).

Analogous changes were observed in adhesion severity values. Subsequently, severe TIR parameters were followed by larger sizes of severe postoperative adhesions in the OS group than those observed in the LS group.

Conclusions: MIL extension and tissue drying seem to be the key factors in the pathogenesis of adhesion formation, triggering severe inflammatory reactions of the peritoneal tissue surrounding the MIL resulting in local and systemic consequences.

CO2 insufflation however, led to moderate inflammation and less adhesion formation.

Author: Sergei PismenskyZhomart KalzhanovMarina EliseevaIoannis KosmasOspan Mynbaev
Credits/Source: BMC Surgery 2011, 11:30

Idiopathic encapsulating peritonitis: Report of two cases.

Surg Today. 2011 Dec;41(12):1644-8. Epub 2011 Oct 4.
Idiopathic encapsulating peritonitis: Report of two cases.
Da Luz MM, Barral SM, Barral CM, Bechara Cde S, Lacerda-Filho A.
SourceDivision of Coloproctology and Small Bowel, Alfa Institute of Gastroenterology, Federal University of Minas Gerais Hospital, Av. Alfredo Balena 110 - 2° andar, Belo Horizonte, MG 30130-100, Brazil.

Abstract
This report presents two cases of young males who developed the rare idiopathic form of sclerosing encapsulating peritonitis (SEP) presented as partial bowel obstruction, both diagnosed during surgical treatment, with satisfactory outcomes. Sclerosing encapsulating peritonitis is a rare and enigmatic condition, characterized by intraperitoneal fibrosclerosis, which causes intestinal obstruction. It is a chronic entity with a poorly elucidated pathophysiology, leading to the constitution of a thick white nacreous fibrosis membrane that wraps the bowel in a concertina-like fashion with some adhesions configuring an intra-abdominal cocoon. Sclerosing encapsulating peritonitis is reported in a wide variety of patients, including those who have undergone peritoneal dialysis, young adolescent girls, cirrhotic patients after peritoneal-venous shunting, and patients treated with β-blockers. Nevertheless, the etiology of SEP remains obscure. This entity presents many difficulties in preoperative diagnosis because of its peculiar characteristics. Recognition of the SEP results in proper management and prevents unnecessary bowel resection. Regardless of cause, the treatment of the obstruction is surgical, with dissection of the encasing membrane from the intestine and separation of adherent loops of small bowel until they are laid free and returned to their normal configuration. The prognosis after appropriate surgical therapy is good, but depends on coexisting diseases.

PMID:21969199[PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/21969199

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MedSun Reports



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