Efficacy of Seprafilm~ graft with adhesiolysis in experimentally induced lid adhesion in rabbits

AIM:To evaluate the efficacy of Seprafilm transplantation following adhesiolysis for preventing postoperative readhesion and improving surgical outcomes. METHODS:Primary blepharoplasty was carried out on both eyelids of 18 albino rabbits. After 2 weeks, a new skin incision was made, and adhesiolysis was performed on both eyelids. The rabbits were categorized into two groups, one with adhesiolysis alone in the left eyelid (control group), and the other with adhesiolysis with a Seprafilm graft in the right eyelid (Seprafilm group). The degrees of inflammation and fibrosis were examined with hematoxylin-eosin (HE) and Masson’s trichrome stains. Expression of α-smooth muscle actin (α-SMA) was also immunohistochemically examined. RESULTS:Eyelid examination immediately after the operation revealed mild swelling and hemorrhage in both groups, but these symptoms resolved after 1 week-2 weeks, and eyelid shape had recovered completely in both groups. Microscopic assessments demonstrated that the Seprafilm group showed less inflammation and fibrosis than the control group. The Seprafilm group also exhibited fewer α-SMA-positive cells than the control group. CONCLUSION:Based on these findings, we conclude that Seprafilm graft with adhesiolysis is an effective method for preventing postoperative readhesions after eyelid surgery.

Disturbed passage of jejunal limb near esophageal hiatus after overlapped esophagojejunostomy following laparoscopic total gastrectomy

BACKGROUND Overlapped esophagojejunostomy(OEJ) is a secure purely laparoscopic reconstruction after laparoscopic total gastrectomy(LTG). However, long-term surgical results have not been documented well.AIM In this paper, we report unusual patients who manifested jejunal limb stricture near the esophageal hiatus without anastomotic stenosis during long-term observation after surgery.METHODS From April 2009 until May 2020, we retrospectively reviewed 211 patients underwent LTG following by OEJ for gastric carcinoma and took a standard surveillance program. We aimed to characterize a novel complicated disorder observed in these patients to assist treatment and prevention.RESULTS Five patients(2.4%) had unusual jejunal limb stricture after LTG and OEJ,occurring at a mean of 10 mo after initial radical LTG. All five patients had disturbed oral intake and marked weight loss, and two had aspiration pneumonia.Various diagnostic modalities and intraoperative findings in each patient revealed an intact anastomosis, bent or tortuous jejunal limb resulting from loose fibrous adhesions on the left crus at the esophageal hiatus and no cancer recurrence. All five patients were successfully treated by reoperation for adhesiolysis, division of the left crus and rearrangement of the jejunal limb.CONCLUSION Disturbed passage through the jejunal limb near the hiatus can occur after some types of OEJ following LTG. We speculate that it may result from a short remnant esophagus, excessive mobilization of the jejunal limb that permits bending or tortuosity and adhesions on the left crus at the hiatus. Prevention for this complication is possible during the original LTG procedure.

Contribution of Laparoscopy in the Management of Female Infertility in Low Resource Countries: A Review of 208 Cases at the YaoundéGeneral Hospital, Cameroon

Background: Infertility is a global problem, but the highest prevalence is in low resource countries, particularly in sub-Saharan Africa where tubal damage following pelvic infection is the commonest cause. Objectives: This study aimed to assess contribution of laparoscopy as a diagnostic and therapeutic tool in infertile women in our setting. Methods: A descriptive review of complete medical records of 208 women who underwent laparoscopy at the Gynaecology Unit of Yaoundé General Hospital from December 2007 to December 2012. Results: Two hundred and eight women were enrolled in this study. Mean age was 32.6 ± 11.25 years. Infertility was secondary in 71.6% of cases;125 (60.1%) women were married and 116 (55.8%) had a positive serology of Chlamydia trachomatis infection. The most frequent findings during diagnostic laparoscopy were: pelvic adhesions (83.7%), hydrosalpinx (21.6%), pyosalpinx (4.8%), perihepatic adhesions (25.5%), uterine fibromas (22.6%), pelvic endometriosis (13%) and ovarian abnormalities (10.1%). The surgical procedures during laparoscopy were: adhesiolysis (79.7%), tuboplasty (35.0%), salpingectomy (8.2%), ovarian cystectomy (5.8%) and myomectomy (1.9%). Three (1.4%) cases of uterine perforation and 1 (0.5%) case of laparoscopy conversion to laparotomy were observed. Conclusion: Diagnostic laparoscopy revealed that tubal lesions and pelvic adhesions were still the major causes of female infertility in developing countries. Adhesiolysis and tuboplasty were the most frequently performed surgical procedures during laparoscopy. Therefore, training in endoscopic surgery should be regarded as an important issue in developing countries.

Theco-thecal bypass technique elucidating a novel procedure and perspective on treatment of post-arachnoiditis syringomyelia:A case report

BACKGROUND Post-arachnoiditis syringomyelia is a condition in which there is an intraspinal cerebrospinal fluid(CSF)blockade due to arachnoidal adhesions and bands.Although many of the techniques currently in use,namely,the theco-peritoneal,syringo-pleural,syringo-peritoneal,and syringo-subarachnoid shunts,are effective,the results are often variable.CASE SUMMARY A 36-year-old man with a past history of pulmonary tuberculosis,presented with progressive paraesthesia in the feet and progressive paraparesis along with constipation,difficulty in micturition,and decreased libido.He was bedridden a month before presentation.Magnetic resonance imaging revealed a dorsal multiloculated syrinx from D3-D10 vertebral levels.He underwent a D1-2 to D11 theco-thecal shunt bilaterally to abolish the CSF gradient across the level of the syrinx.There was no direct surgical handling of the spinal cord involved.At the 15-mo follow up,the patient had significant improvement in his symptoms and function.CONCLUSION We present a novel technique aimed at correcting the primary cause of a postarachnoiditis syrinx,the subarachnoid cerebrospinal flow obstruction or block,which we believe is simple and effective,involves minimal handling of the normal neural structures,and attempts to restore the physiology of CSF flow across the obstruction,with favorable clinical results.

Viable cryopreserved umbilical tissue (vCUT) reduces post-operative adhesions in a rabbit abdominal adhesion model

Post-operative adhesions,a common complication of surgery,cause pain,impair organ functionality,and often require additional surgical interventions.Control of inflammation,protection of injured tissue,and rapid tissue repair are critical for adhesion prevention.Adhesion barriers are biomaterials used to prevent adhesions by physical separation of opposing injured tissues.Current adhesion barriers have poor anti-inflammatory and tissue regenerative properties.Umbilical cord tissue(UT),a part of the placenta,is inherently soft,conforming,biocompatible,and biodegradable,with antimicrobial,anti-inflammatory,and antifibrotic properties,making it an attractive alternative to currently available adhesion barriers.While use of fresh tissue is preferable,availability and short storage time limit its clinical use.A viable cryopreserved UT(vCUT)“point of care”allograft has recently become available.vCUT retains the extracellular matrix,growth factors,and native viable cells with the added advantage of a long shelf life at−80℃.In this study,vCUT's anti-adhesion property was evaluated in a rabbit abdominal adhesion model.The cecum was abraded on two opposing sides,and vCUT was sutured to the abdominal wall on the treatment side;whereas the contralateral side of the abdomen served as an internal untreated control.Gross and histological evaluation was performed at 7,28,and 67 days post-surgery.No adhesions were detectable on the vCUT treated side at all time points.Histological scores for adhesion,inflammation,and fibrosis were lower on the vCUT treated side as compared to the control side.In conclusion,the data supports the use of vCUT as an adhesion barrier in surgical procedures.