Kobaylarda Postoperatif Adezyonlarýn Önlenmesinde Hyaluronic Acid/Carboxymethylcellulose’un Etkisi

Ýt is well known that appropriate surgical techniçue alone will help decrease but not prevent intraabdominai adhesion for-mation. Ýt is necessary to use adjuvant therapy that falls into two main categories, drugs and barriers. This study was designed to determine the effectiveness of HA/CMC (Hyaluronic acid/Carboxymethylcellulose) as a barrier agent for preventing postoperative adhesions and also to determine whether it alters abdominal wound tensile strength. An adhesion forming State was created by traumatization of peritoneal and serozal surfaces and inocuiation of self biood on traumatized areas in 30 guinea pigs. HA/CMC was applied between the viscera and the abdominai wall before laparotomy clo-sure in the experimental group (n= 15). Three weeks after the operation the adhesion scores were obtained and the abdominai wall wound was evaiuated for tensile strength. Adhesion formation was significantly lower in the study group compared to the control group (U= 197, p< 0.05). There were no statistically significant difference for tensile strength betvveen the two groups (U=113, p> 0.05). HA/CMC has no adverse effect on wound tensile strength, while significantly lovvering adhesion formation. However, it does not totally prevent it. Future investigations on its insufficient States and causes will help in obtaining successfui results.

The Effect of Hyaluronic Acid/Carboxymethylcellulose in the Prevention of Postoperative Adhesion in Guinea Pigs

Uygun cerrahi tekniðin tek baþýna adezyon oluþumunu azaltmaya yardýmcý olabileceði fakat adezyon oluþumunu tümden engellemeye yetmeyeceði iyi bilinmektedir, ilaçlar ve bariyerler olmak üzere 2 ana grupta toplanan yardýmcý yöntem kullanýmý gereklidir. Bizim bu deneysel çalýþmadaki amacýmýz, hem genel cerrahi hem de jinekoloji kliniklerinde giderek daha yaygýn kullanýlmaya baþlanan, bariyer materyali HA-CMC'nin, adezyon oluþumunu engellemedeki etkinliðini, yara gerilim kuvveti üzerine olumsuz etkisinin olup olmadýðýný belirlemektir. Laparotomi sýrasýnda peritoneal ve serozal hasar ile kan kullanýlarak adezyojenik ortam oluþturulan 30 kobayýn yarýsýna, batýn kapatýlmadan önce HA-CMC yerleþtirildi. 3 haftanýn sonunda yüksek doz eter anestezisi ile deneklerin hayatlarý sonlandý-rýldýktan sonra adezyon skorlamasý ve yara gerilim kuvveti ölçümleri yapýldý. Adezyon oluþumu, çalýþma grubunda kontrol grubuna göre anlamlý ölçüde daha azdý (U= 197, p< 0.05). Gruplar arasýnda, yara gerilim kuvvetlen yönünden istatistiksel anlamlý fark gözlenmedi (U= 113, p> 0.05). HA-CMC, yara gerilim kuvveti üzerine olumsuz etki yapmadan adezyon oluþumunu anlamlý derecede azaltmýþ fakat tamamen önleyememiþtir. Yetersiz kaldýðý durumlarýn irdelenmesi, daha baþarýlý sonuçlarýn alýnmasýna yardýmcý olacaktýr.