Pelvic Surgery Ad Hoc Organizing Committee Dr. Gere S. diZerega Dr. Alan H. DeCherney Dr. Michael P. Diamond Dr. Randall C. Dunn Dr. Eugene P. Goldberg Dr. John A. Rock Dr. Togus Tulandi Springer Science+Business Media, LLC Gere S. diZerega, M.D. Alan H. DeCherney, M.D. Michael P. Diamond, M.D. Randall C. Dunn, M.D. Eugene P. Goldberg, Ph.D. Arthur F. Haney, M.D. John A. Rock, M.D. Togus Tulandi, M.D. Kathleen E. Rodgers, Ph.D. Editors Pelvic Surgery Adhesion Formation and Prevention With 52 Figures Springer GGeerree SS.. ddiiZZeerreeggaa DDeeppaarrttrmneenntt ooff OObbsstteettrriiccss aanndd GGyynneeccoollooggyy LLiivviinnggssttoonn LLaabboorraattoorriieess UUnniivveerrssiittyy ooff SSoouutthheerrnn CCaalliiffoorrnniiaa LLooss AAnnggeelleess,, CCAA 9900003333,, UUSSAA LLiibbrraarryy ooff CCoonnggrreessss CCaattaallooggiinngg--iinn--PPuubblliiccaattiioonn DDaattaa PPeellvviicc ssuurrggeerryy:: aaddhheessiioonn ffoornmnaattiioonn aanndd pprreevveennttiioonn // [[eeddiitteedd bbyy]] GGeerree SS.. ddiiZZeerreeggaa.. pp.. ccmm.. PPrroocceeeeddiinnggss ooff tthhee 33rrdd IInntteerrnnaattiioonnaall CCoonnggrreessss oonn PPeellvviicc SSuurrggeerryy && AAddhheessiioonn PPrreevveennttiioonn,, hheelldd iinn SSaann DDiieeggoo,, CCaalliiff,. ,f rforomm FFeebb.. 2299 t oto MMaarrcchh 22,, 11999966.. IInnccl\uuddeess bbiibblliiooggrraapphhiiccaall rreeffeerreenncceess aanndd iinnddeexx.. 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TTyyppeesseett bbyy KKPP CCoommppaannyy,, BBrrooookkllyynn, , NNYY, , aanndd A Aggnneeww's's, ,I nIncc.,. ,G Graranndd R Raappidids,s ,M MII. . 99 88 77 66 55 443322 IISSBBNN 997788--11--44661122--77331166--55 Preface Recent years have seen important advances in the technology and techniques available to surgeons performing gynecologic surgery as well as reconstructive pelvic procedures. These developments took place in a wide variety of clinical settings from regional teaching centers to private clinical facilities. In 1996, the leading investigators from around the world gathered to discuss the present status of pelvic surgery and adhesion prevention with a look toward the future of patient care. This volume contains the proceedings of that meeting: the Third Interna tional Congress on Pelvic Surgery and Adhesion Prevention. Each chapter in cludes the material presented at the congress as well as a timely update of the authors' latest research and clinical thinking. Presentation integrating basic and clinical science provide the basis for con sidering peritoneal repair after surgery including the interaction of growth factors and other biochemical messengers. Research has increased the understanding of mesothelial reepithelialization and has led to new surgical technologies to reduce adhesion fonnation. A state-of-the-art review of emerging surgical adjuvants for adhesion prevention is provided, including discussion of barriers, gels, and poly mers as well as "designer" drugs effective at modifying the peritoneal response to injury. Assessment of clinical outcome in a wide variety of gynecologic surgical procedures brings into focus the benefits available as a result of these new tech nologies. Specific recommendations are provided for adjuvant use in ovarian, tubal, and uterine surgery, as well as a review of the clinical experiences that substantiate these recommendations. Perspectives are provided by leading pelvic reconstruction surgeons as to how alterations in surgical procedures can enhance the quality of outcome today with a view toward future progress tomorrow. Acknowledgments The editors would like to acknowledge the diligent efforts of Ms. Leticia Corona and Mr. Alexander DeCherney during the preparation of this book. GERE mZEREGA v Contents Preface .................... " .... .. .. ............... ......... v Contributors ................................................. xi I. Postsurgical Peritoneal Repair 1. Cellular Events in Peritoneal Repair: A Review 3 ANDREW T. RAFTERY 2. Biochemical Messengers in Postsurgical Repair and Adhesion Formation ................................... 11 KATHLEEN E. RODGERS 3. Comparative Tissue Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 GREGORY S. SCHULTZ 4. Response of Fetal Tissue to Wounding 37 TIMOTHY M. CROMBLEHOLME 5. Postsurgical Intraperitoneal Tissue Repair: Implication of TGF-13 ..................................... 51 NASSER CHEGINI II. Developing Technology for Adhesion Prevention 6. Animal Adhesion Models: Design, Variables, and Relevance 65 MICHAEL P. DIAMOND 7. Experimental Prevention of Peritoneal Adhesions in General Surgery ....................................... 71 KARL H. TREUTNER, PETER BERTRAM, AND VOLKER SCHUMPELICK 8. Tissue Protective Solutions and Films for Adhesion Prevention 79 EUGENE P. GOLDBERG vii viii Contents 9. Peritoneal Fibrinolysis and Adhesion Formation. . . . . . . . . . . . . . . . 93 JEREMY N. THOMPSON, DAVID M. SCOTT-COOMBES, AND SIMON A. WHAWELL 10. Peritoneal Conditioning: The Role of the Supply of Natural Membrane Lipids ........................................ 103 STIG BENGMARK III. Outcome Measures 11. Clinical Trial Design for Evaluation of Treatments Purported to Prevent Postsurgical Adhesions ............................. 117 ARTHUR F. HANEY 12. Adhesions and Infertility .................................. 126 RICCARDO MARANA, MARIO RIZZI, AND LUDOVICO MUZII 13. Laparoscopic Ovarian Surgery and Adhesions ................. 136 MICHEL CANIS, MAURICE ANTOINE BRUHAT, GERARD MAGE, JEAN Luc POULY, ARNAUD WATTIEZ, AND HUBERT MANHES 14. Infertility and Ectopic Pregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . .. 144 PER LUNDORFF 15. Clinical Significance of Adhesions in Patients with Chronic Pelvic Pain .................................. 150 ERICA A. BAKKUM AND A.A.W. PETERS 16. Bowel Obstruction Related to Prior Gynecologic Surgery 160 JODY BLANCO IV. Adjuvants for Clinical Use 17. Prognostic Factors of Distal Tubal Occlusion .................. 167 JACQUES DONNEZ, ROLAND POLET, AND MICHELE NISOLLE 18. Reconstruction of the Ovary with Endometrioma: A Problem of Adhesions .................................. 181 Ivo A. BROSENS AND PATRICK PuTTEMANS 19. Use of Adhesion Prevention Barriers in Pelvic Reconstructive and Gynecologic Surgery ..................................... 188 GERE S. mZEREGA Contents ix 20. Prevention of Postoperative Adhesions on the Human Oviduct and of Sactosalpinges ........................................ 210 BERTIL LARSSON 21. Laparoscopic Myomectomy, Laparoscopy-Assisted Myomectomy, and Postmyomectomy Adhesions. . .. . . . .. . . . . . . . . . . . . . .. . . .. 214 TOGUS TuLANDI 22. Adhesion Prevention: The Role of Fibrin Glue . . . . . . . . . . . . . . . .. 222 MATTHIAS KORELL 23. Clinical Use of Oxidized Regenerated Cellulose for the Prevention of Adhesion Formation After Laparoscopic Myomectomy. . . . . . .. 231 GIAN BENEDETTO MELlS, S. AJOSSA, S. GUERRIERO, AND V. MAIS Advances in Gynecologic Surgery (Abstracts) 1. Adhesion Formation and Changes in Local Fibrinolytic Activity (LFA) of the Uterine Hom Tissue (UHF) After Various Types of Operations ............................................ 239 O.A. MYINBAYEV, L.V. ADAMIAN, K.1. RUBLEVA, L.V. LUTOVA, M.A. KARABASOVA, AND G.V. ANDREBENKO 2. Gyaluronidase Electrophoresis Effect on Postoperative Adhesions Formations ......................... 240 v.1. KULAKOV, L.V. ADAMIAN, O.A. MYINBAYEV, AND V.M. STRUGALSKLI 3. Prevention of Postsurgical Adhesion Formation with Polyactive, A Degradable Barrier ..................................... 241 ERICA A. BAKKUM AND TRUDY TRIMBOS-KEMPER 4. An Evaluation of Operator Variability in a Rat Cecal Abrasion Model for the Formation of Abdominal Models ................ 242 L.S. BURGESS, R.L. ROSE, J.e. COLT, K.e. SKINNER, AND JAMES W. BURNS 5. The Evaluation of an Injectable Bioresorbable Gel on Adhesion Reduction in Two Animal Models ........................... 244 L.S. BURGESS, R.L. ROSE, MJ. COLT, K.C. SKINNER, AND JAMES W. BURNS 6. Seprafilm (HAL-F) Reduces Postoperative Adhesions: Initial Results of a Multicenter Gynecologic Clinical Study ............ 245 MICHAEL P. DIAMOND AND THE SEPRAFILM ADHESION STUDY GROUP x Contents 7. Comparative Post Operative Adhesion Fonnation Following Laparoscopic Cholecystectomy in the Porcine Model Using Electrosurgery, Laser, and Ultrasonically Activated Scalpel. . . . . .. 246 ROGER FERLAND AND JOSEPH AMARAL 8. Pelvic Inflammatory Pseudotumor with Central Infectious Abscess: A Case Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 247 CHIH-PING HAN, YEU-SHENG TYAN, SYH-SHEN CHEN, GOW-CHING GER, AND SHAW-YEU JENG 9. Plasminogen-Activator Inhibitor-l (PAl-I) Remains Elevated After Surgery and Is Not Correlated with Postoperative Adhesion Score . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 248 RICHARD E. LEACH, EBERHARDT MAMMEN, JAMES W. BURNS, ELIZABETH DAWE, MICHELLE SMITH-BARBOUR, AND MICHAEL P. DIAMOND 10. Mannan Activation of Peritoneal Macrophages: A Method of Identifying a Cell Population Associated with Adhesions Due to Infection ......................................... 249 D.E. OTT, R.E. GARNER, AND A.N. WALKER 11. Pollutants Resulting from Intraabdominal Tissue Combustion . . . .. 251 D.E. OTT 12. Tissue Combustion SmokelPlume Absorption via the Peritoneum at Laparoscopy .......................... 253 D.E. OTT 13. Vesicovaginal Fistular Repair: A New Technique to Avoid Recurrence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 255 SAFWAT TOSSON 14. Review of Randomized Studies of Pharmacologic Adjuvant Used During Infertility Surgery to Prevent Postoperative Adhesion Fonnation ...................................... 256 ANDREW WATSON, PATRICK VANDERKERCKHOVE, AND R.J. LILFORD 15. Comments on the Third International Congress on Pelvic Surgery and Adhesion Prevention: Summary ......................... 258 ALAN H. DECHERNEY Index.. ................................ ................. .... 261 Contributors L.V. ADAMIAN, M.D., Scientific Center for Obstetrics and Gynecology and Per inatology, Russian Academy of Medical Sciences, 117811 Moscow, Russia S. AJOSSA, M.D., Department of Obstetrics and Gynecology, University of Cagliari, Ospedale San Giovanni di Dio, 09124 Cagliara, Italy JOSEPH AMARAL, M.D., F.A.C.S., Department of Surgery, Brown University, Providence, RI 02903, USA G.V. ANDREBENKO, M.D., Faculty of Biology, Laboratory of Fermentative Fibrinolysis, Moscow University, Moscow, Russia ERICA A. BAKKUM, M.D., Ph.D., Department of Gynecology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands, and Department of Gynecol ogy, Groene Hart Hospital, 2803 HH Gouda, The Netherlands STIG BENMARK, M.D., Ph.D., Ideon Research Center, Lund University, S-223 70 Lund, Sweden PETER BERTRAM, M.D., Department of Surgery, Rhenish-Westphalian Technical University, Aachen, Germany JODY BLANCO, M.D., Department of Obstetrics and Gynecology, Columbia Pres byterian Medical Center, New York, NY 10032, USA Ivo A. BROSENS, M.D., Leuven Institute for Fertility and Embryology, B-300 Leuven, Belgium MAURICE ANTOINE BRUHAT, M.D., Department of Obstetrics and Gynecology and Reproductive Medicine, Polyclinique de I'Hotel Dieu, Centre Hospitalier Regional et Universitaire de Clermont Ferrand, Clermont Ferrand, France L.S. BURGESS, M.D., Genzyme Corporation, Cambridge, MA 02139, USA xi