ŞERİFE ŞAFAK, ESRA KARACA, R. Gözde ÖZALP

CERRAHİ ADEZYONUN ÖNLENMESİ İÇİN YENİ BİR YAKLAŞIM: NANOLİFLİ CERRAHİ ADEZYON BARİYERLERİ

Adezyonlar; seröz zarı ile çevrili olan organların, yaralanmalarını takiben aralarında meydana gelen anormal birleşmelerdir. Karın içi operasyonları, karın zarı iltihabı, çikolata kisti, radyasyon ve kanser gibi nedenlerle organlar birbirlerine ya da karın duvarına yapışabilirler. Adezyonlar; bağırsak tıkanıklıklarının yanı sıra kronik karın ağrısına ve kısırlığa da neden olmaktadır. Adezyon oluşumu ve komplikasyonlarının tedavisi ise, ciddi iş gücü ve ekonomik kayıplara yol açmaktadır. Karın içi yapışıklıkların azaltılması veya önlenmesi için çalışmalar devam etmekte ve ortaya konan ürünler milyon dolarlık sağlık pazarı oluşturmaktadır. Nanolifli yüzeyler, sahip oldukları geniş spesifik yüzey alanı ve nano gözenekli yapısı sayesinde; oksijen ve hava geçirgenliği sağlarken, bakterilere karşı bariyer özelliği sergilemektedir. Bu nedenle, son yıllarda biyomedikal alanda özellikle tercih edilmektedir. Bu çalışmada; cerrahi uygulamalarda adezyonun önemi ortaya konulmuş ve nanolifli yüzeylerin adezyon bariyeri olarak kullanım potansiyeli tartışılmıştır.

A NEW APPROACH FOR THE PREVENTION OF SURGICAL ADHESION: NANOFIBROUS SURGICAL ADHESION BARRIERS

Adhesions are the abnormal sticking of organs which are covered by serous membranes after injuries. Abdominal organs can stick together or to the peritoneal cavity due to abdominal operations, peritonitis, endometriosis, radiation and cancer. Adhesions can also cause intestinal obstruction, chronic abdominal pain and infertility. Occurrence of adhesion and treatment of its complications are causing economic loss and loss of serious work power. Attempts to decrease or prevent the peritoneal adhesions are studied and curing materials make a million dollar market. Nanofibrous mats, thanks to their large specific surface area and nano porous structure; have oxygen and air permeability, but exhibit barrier properties against bacteria. For this reason, they are especially preferred in the biomedical field in recent years. In this study, the importance of adhesion in surgical applications was put forward and the usage potential of nanofiber surfaces as adhesion barriers were discussed.

PDF

___

1. Lower, A.M., Hawthorn, R.J., O'Brien, F., Buchan, S., Crowe, A.M., (2000), The Impact of Adhesions on Hospital Readmissions Over Ten Years After 8849 Open Gynaecological Operations: An Assessment from the Surgical and Clinical Adhesions Research Study, BJOG: An International Journal of Obstetrics & Gynaecology, 107, 7, 855-862.
2. Akçıl, A.M., (2008), Tavşan Mediasteninde Cerrahi Sonrası Adhezyonu Engellemek İçin Sodyum Hyalüranat ve Karboksimetilselüloz Membran (Seprafilm®) İle Doku Arası Bariyer Oluşturulması, Uzmanlık Tezi, İstanbul Üniversitesi, İstanbul.
3. Altunel, Y., (2011), Sıçanlarda Karın Duvarı Fıtıkları Tedavisinde Farklı İki Polipropilen Meş ve Kitin Kaplı Formlarının Karşılaştırması, Uzmanlık Tezi, Uludağ Üniversitesi, Bursa.
4. Cheong, Y.C., Laird, S.M., Li, T.C., Shelton, J.B., Ledger, W.L., Cooke, I.D., (2001), Peritoneal Healing and Adhesion Formation/Reformation, Human Reproduction Update, 7, 6, 556- 566.
5. Barmparas, G., Branco, B.C., Schnüriger, B., Lam, L., Inaba, K., Demetriades, D., (2010), The Incidence and Risk Factors of PostLaparotomy Adhesive Small Bowel Obstruction, Journal of Gastrointestinal Surgery, 14, 10, 1619-1628.
6. Sümer, A., (2005), Prolen Mesh Kullanımı Sonrası Oluşan Adezyonlara Oxidized Regenerated Cellulose, Polietilenglikol ve Hylan Gf-20'nin Etkileri, Uzmanlık Tezi, Sağlık Bakanlığı Haydarpaşa Numune Eğitim ve Araştırma Hastanesi, İstanbul.
7. Şahiner, İ.T., (2011), Simvastatin Yüklü Polipropilen Yama İle Onarılan Karın Duvarı Defektlerinde Batın İçi Yapışıklıkların Karşılaştırılması, Uzmanlık Tezi, Kırıkkale Üniversitesi, Kırıkkale.
8. Yeğenoğlu, A., (2006), Postoperatif İntraperitoneal Adezyonların Önlenmesinde Heparin, Seprafilm, Heparin ve Seprafilm'in Etkinliklerinin Karşılaştırılması, Uzmanlık Tezi, Sağlık Bakanlığı Dr. Lütfi Kırdar Eğitim Araştırma Hastanesi, İstanbul.
9. Ensari, N., (2008), Polilaktik Asit Biyoabsorbabl Adezyon Bariyer Filminin Kobaylardaki Nörotoksik Etkisinin Araştırılması Amacıyla Orta Kulağa Uygulanması, Uzmanlık Tezi, Gazi Üniversitesi, Ankara.
10. Günaydın, M., Güvenç, D., Yıldız, L., Aksoy, A., Tander, B., Bıçakcı, Ü., Ayyıldız, H.S., Sünter, A.T., Bernay, F., (2012), Karın İçi Yapışıklığı Önlemek İçin Kullanılan Maddelerin Karşılaştırılması: Sıçanlarda Deneysel Bir Çalışma, Journal of Medical Sciences, 32, 2, 337-345.
11. Clear Passage. Post Surgical Pain, http://www.clearpassage.com/ what-we-treat/chronic-pain/post-surgical-pain/, 11 Ekim 2016.
12. DeCherney, A.H., (1997), Clinical Problem of Intraperıtoneal Postsurgical Adhesion Formatıon Following General Urgery and the Use of Adhesion Prevention Barriers, Surgical Clinics of North America, 77, 3, 671-688.
13. Dizerega, G.S., (1996), Biochemical Events In Peritoneal Tissue Repair, The European Journal of Surgery. Supplement= Acta Chirurgica. Supplement, 577, 10-16.
14. Erdoğu, T. Ekstraperitoneal (Periton Zarı Dışından) daVinci Robotik Cerrahi, http://www.uroloji-laparoskopi.com/index.php? goto=ekstra_peritoneal, 10 Ağustos 2016.
15. Sammour, T., Kahokehr, A., Soop, M., Hill, A.G., (2010), Peritoneal Damage: The Inflammatory Response and Clinical Implications of the Neuro-Immuno-Humoral Axis, World Journal of Surgery, 34, 4, 704-720.
16. Campeau, J.D., (2001), Peritoneal Repair and Post-Surgical Adhesion Formation, Human Reproduction Update, 7, 6, 547-555.
17. Aguilera, J.F., Lugo, R.E., Luna, A.W., (2014), Stercoral Perforation of the Colon: Case Report and Literature Review, Medwave, 15, 2, 6108-6108.
18. Agresta, F., Piazza, A., Michelet, I., Bedin, N., Sartori, C.A., (2000), Small Bowel Obstruction, Surgical Endoscopy, 14, 2, 154- 156.
19. Holmdahl, L., Eriksson, E., Al-Jabreen, M., Risberg, B., (1996), Fibrinolysis in Human Peritoneum During Operation, Surgery, 119, 6, 701-705.
20. Rodgers, K.E., Dizerega, G.S., (1993), Function of Peritoneal Exudate Cells After Abdominal Surgery, Journal of Investigative Surgery, 6, 1, 9-23.
21. Abdominal Adhesions. Abdominal Adhesions Causes, Symptoms, Prevention, Diagnosed and Treatment, http://abdominaladhesions.blogspot.com.tr/, 2 Eylül 2016.
22. Raftery, A.T., (1981), Effect of Peritoneal Trauma on Peritoneal Fibrinolytic Activity and Intraperitoneal Adhesion Formation, European Surgical Research, 13, 6, 397-401.
23. Milligan, D.W., Raftery, A.T., (1974), Observations on the Pathogenesis of Peritoneal Adhesions: A Light and Electron Microscopical Study, British Journal of Surgery, 61, 4, 274-280.
24. Holmdahl, L., Eriksson, E., Eriksson, B.I., Risberg, B., (1998), Depression of Peritoneal Fibrinolysis During Operation is a Local Response to Trauma, Surgery, 123, 5, 539-544.
25. Ellis, H., (1971), The Cause and Prevention of Postoperative Intraperitoneal Adhesions, Surgery Gynecology and Obstetrics, 133, 3, 497-511.
26 Vipond, M.N., Whawell, S.A., Dudley, H.A.F., Thompson, J.N., (1990), Peritoneal Fibrinolytic Activity and Intra-Abdominal Adhesions, The Lancet, 335, 8698, 1120-1122.
27. Thompson, J.N., Paterson-Brown, S., Harbourne, T., Whawell, S.A., Kalodiki, E., Dudley, H.A.F., (1989), Reduced Human Peritoneal Plasminogen Activating Activity: Possible Mechanism of Adhesion Formation, British Journal of Surgery, 76, 4, 382-384.
28. Montesano, R., Orci, L., (1988), Transforming Growth Factor Beta Stimulates Collagen-Matrix Contraction by Fibroblasts: Implications for Wound Healing, Proceedings of the National Academy of Sciences, 85, 13, 4894-4897.
29. McBride, W.H., Mason, K., Withers, H.R., Davis, C., (1989), Effect of Interleukin 1, Inflammation, and Surgery on The Incidence of Adhesion Formation and Death After Abdominal Irradiation in Mice, Cancer Research, 49, 1, 169-173.
30. Luijendijk, R.W., de Lange, D.C., Wauters, C.C.A.P., Hop, W.C.J., Duron, J.J., Pailler, J.L., Jeekel, J., (1996), Foreign Material in Postoperative Adhesions, Annals of Surgery, 223, 3, 242-248.
31. Malçık, H., (2009), Proanthocyanidinin Ratlarda Deneysel Olarak Oluşturulan İntraabdominal Adezyonların Gelişimi Üzerine Etkisi, Uzmanlık Tezi, Sağlık Bakanlığı Taksim Eğitim ve Araştırma Hastanesi, İstanbul.
32. Leber, G.E., Garb, J.L., Alexander, A.I., Reed, W.P., (1998), LongTerm Complications Associated with Prosthetic Repair of Incisional Hernias, Archives of Surgery, 133, 4, 378-382.
33. Risberg, B.O., (1996), Adhesions: Preventive Strategies, The European Journal of Surgery. Supplement= Acta Chirurgica. Supplement, 577, 32-39.
34. Schnüriger, B., Barmparas, G., Branco, B.C., Lustenberger, T., Inaba, K., Demetriades, D., (2011), Prevention of Postoperative Peritoneal Adhesions: A Review of The Literature, The American Journal of Surgery, 201, 1, 111-121.
35. Dizerega, G.S. (1994), Contemporary Adhesion Prevention, Fertility and Sterility, 61, 2, 219-235.
36. Pijlman, B.M., Dörr, P.J., Brommer, E.J.P., Vemer, H.M., (1994), Prevention of Adhesions, European Journal of Obstetrics and Gynecology and Reproductive Biology, 53, 3, 155-163.
37. Grosfeld, J.L., Berman, I.R., Schiller, M., Morse, T.S., (1973), Excessive Morbidity Resulting From The Prevention of Intestinal Adhesions with Steroids and Antihistamines, Journal of Pediatric Surgery, 8, 2, 221-226.
38. Bateman, B.G., Nunley Jr, W.C., Kitchin 3rd, J.D., (1982), Prevention of Postoperative Peritoneal Adhesions with Ibuprofen, Fertility and Sterility, 38, 1, 107-108.
39. Treutner, K.H., Bertram, P., Lerch, M.M., Klimaszewski, M., Petrovic-Källhom, S., Sobesky, J., Schumpelick, V., (1995), Prevention of Postoperative Adhesions by Single Intraperitoneal Medication, Journal of Surgical Research, 59, 6, 764-771.
40. Burns, J.W., Colt, M.J., Burgees, L.S., Skinner, K.C., (1996), Preclinical Evaluation of Seprafilm Bioresorbable Membrane, The European Journal of Surgery. Supplement= Acta Chirurgica. Supplement, 577, 40-48.
41. Hellebrekers, B.W.J., Trimbos-Kemper, G.C.M., Van Blitterswijk, C.A., Bakkum, E.A., Trimbos, J.B.M.Z., (2000), Effects of Five Different Barrier Materials on Postsurgical Adhesion Formation in The Rat, Human Reproduction, 15, 6, 1358-1363.
42. Sekiba, K., (1992), Use of Interceed (TC7) Absorbable Adhesion Barrier to Reduce Postoperative Adhesion Reformation in Infertility and Endometriosis Surgery, Obstetrics & Gynecology, 79, 4, 518-522.
43. Boyers, S.P., Diamond, M.P., DeCherney, A.H., (1988), Reduction of Postoperative Pelvic Adhesions in The Rabbit with Gore-Tex Surgical Membrane, Fertility and Sterility, 49, 6, 1066-1070.
44. Sawada, T., Nishizawa, H., Nishio, E., (2000), Postoperative Adhesion Prevention with an Oxidized Regenerated Cellulose Adhesion, International Journal of Reproductive Medicine, 45, 387- 389.
45. Ethicon. GYNECARE INTERCEED® Absorbable Adhesion Barrier, http://www.ethicon.com/healthcare-professionals/products/ uterine-pelvic/adhesion-prevention/gynecare-interceed-absorbableadhesion-barrier, 12 Ocak 2017.
46. Myomectomy Adhesion Multicenter Study Group., (1995), An Expanded Polytetrafluoroethylene Barrier (Gore-Tex Surgical Membrane) Reduces Post-Myomectomy Adhesion Formation, Fertility and Sterility, 63, 3, 491-493.
47. Gore-Tex. The Gore-Tex Membrane, http://www.gore-tex.com/enus/technology/gore-tex-membrane, 12 Ocak 2017.
48. Beck, D.E., Cohen, Z., Fleshman, J.W., Kaufman, H.S., van Goor, H., Wolff, B.G., (2003), A Prospective, Randomized, Multicenter, Controlled Study of the Safety of Seprafilm® Adhesion Barrier in Abdominopelvic Surgery of the Intestine, Diseases of the Colon and Rectum, 46, 10, 1310-1319.
49. Fazio, V.W., Cohen, Z., Fleshman, J.W., Van Goor, H., Bauer, J.J., Wolff, B.G., Monson, J.R., (2006), Reduction in Adhesive SmallBowel Obstruction by Seprafilm® Adhesion Barrier After Intestinal Resection, Diseases of the Colon and Rectum, 49, 1, 1- 11.
50. Diamond, M.P., Burns, E.L., Accomando, B., Mian, S., Holmdahl, L., (2012), Seprafilm® Adhesion Barrier:(2) A Review of the Clinical Literature on Intraabdominal Use, Gynecological Surgery, 9, 3, 247-257.
51. Mumert, M.L., Altay, T., Couldwell, W.T., (2012), Technique for Decompressive Craniectomy Using Seprafilm as a Dural Substitute and Anti-Adhesion Barrier, Journal of Clinical Neuroscience, 19, 3, 455-457.
52. Deitzel, J.M., Kleinmeyer, J., Harris, D.E.A., Tan, N.B., (2001), The Effect of Processing Variables on the Morphology of Electrospun Nanofibers and Textiles, Polymer, 42, 1, 261-272.
53. Supaphol, P., Suwantong, O., Sangsanoh, P., Srinivasan, S., Jayakumar, R., Nair, S.V., (2012), Electrospinning of Biocompatible Polymers and Their Potentials in Biomedical Applications, Advances in Polymer Science, 246, 213-240.
54. Bhat, G, Uppal, R., (2010), Nanofiber Nonwovens: Production Technologies, Properties, and Applications, Beltwide Cotton Conferences, 5-7 Şubat 2010, New Orleans-Louisiana. 55. Cengiz Çallıoğlu, F., (2013), Silindirli Elektro Lif Çekim Yöntemi ile Nano Lif Üretimi, Tekstil ve Mühendis, 20, 91, 35-49.
56. Greiner, A., Wendorff, J.H., (2007), Electrospinning: A Fascinating Method for the Preparation of Ultrathin Fibers, Angewandte Chemie, 46, 30, 5670-5703.
57. Ramakrishna, S., Fujihara, K., Teo, W.E., Lim, T.C., Ma, Z., (2005), An Introduction to Electrospinning and Nanofibers, World Scientific Publishing Co., Singapore.
58. Kotek, R., (2008), Recent Advances in Polymer Fibers, Polymer Reviews, 48, 2, 221-229.
59. Amiraliyan, N., Nouri, M., Kish, M.H., (2009), Effects of Some Electrospinning Parameters on Morphology of Natural Silk-Based Nanofibers, Journal of Applied Polymer Science, 113, 226-234.
60. Tucker, N., Stanger, J.J., Staiger, M.P., Razzaq, H., Hofman, K., (2012), The History of the Science and Technology of Electrospinning from 1600 to 1995, Journal of Engineered Fabrics and Fibers, 7, 63-73.
61. Valizadeh, A., Farkhani, S.M., (2014), Electrospinning and Electrospun Nanofibres, IET Nanobiotechnology, 8, 2, 83-92.
62. Cengiz, F., Krucinska, I., Gliscinska, E., Chrzanowski, M., Göktepe, F., (2009), Comparative Analysis of Various Electrospinning Methods of Nanofibre Formation, Fibres & Textiles in Eastern Europe, 17, 13-19.
63. Xie, L., Shao, Z.Q., Lu, S.Y., (2012), Preparation of AlNPs/CMCN Composite Nanofibers by Electrospinning, Applied Mechanics and Materials, 130, 1266-1269.
64. Jin, H.J., Park, J., Valluzzi, R., Cebe, P., Kaplan, D.L., (2004), Biomaterial Films of Bombyx Mori Silk Fibroin with Poly (ethylene oxide), Biomacromolecules, 5, 3, 711-717.
65. Kumar, A., (2010), Nanofibers, Intech, Croatia. 66. Adanur, S., Ascıoglu, B., (2007), Nanocomposite Fiber Based Web and Membrane Formation and Characterization, Journal of Industrial Textiles, 36, 311-327.
67. Şafak, Ş., (2016), Biyobozunur Polimerlerden Elektro Çekim Yöntemiyle Üretilen Nanolifli Yüzeylerin Cerrahi Adezyon Bariyeri Olarak Kullanımlarının Araştırılması, Doktora Tezi, Uludağ Üniversitesi, Bursa.
68. Zong, X., Li, S., Chen, E., Garlick, B., Kim, K.S., Fang, D., Chu, B., (2004), Prevention of Postsurgery-Induced Abdominal Adhesions by Electrospun Bioabsorbable Nanofibrous Poly (Lactide-Co-Glycolide)-Based Membranes, Annals of Surgery, 240, 5, 910-915.
69. Bölgen, N., Vargel, I., Korkusuz, P., Menceloğlu, Y.Z., Pişkin, E., (2007), In Vivo Performance of Antibiotic Embedded Electrospun PCL Membranes for Prevention of Abdominal Adhesions, Journal of Biomedical Materials Research Part B: Applied Biomaterials, 81, 2, 530-543.
70. Dinarvand, P., Hashemi, S.M., Seyedjafari, E., Shabani, I., Mohammadi-Sangcheshmeh, A., Farhadian, S., Soleimani, M., (2012), Function of Poly (lactic-co-glycolic acid) Nanofiber in Reduction of Adhesion Bands, Journal of Surgical Research, 172, 1, 1-9.
71. Chang, J.J., Lee, Y.H., Wu, M.H., Yang, M.C., Chien, C.T., (2012), Electrospun Anti-Adhesion Barrier Made of Chitosan Alginate for Reducing Peritoneal Adhesions, Carbohydrate Polymers, 88, 4, 1304-1312.
72. Shin, Y.C., Yang, W.J., Lee, J.H., Oh, J.W., Kim, T.W., Park, J.C., Han, D.W., (2014), PLGA Nanofiber Membranes Loaded with Epigallocatechin-3-O-Gallate are Beneficial to Prevention of Postsurgical Adhesions, International Journal of Nanomedicine, 9, 4067-4078.
73. Adegani, J.F., Seyedjafari, E., Gheibi, N., Soleimani, M., Sahmani, M., (2016), Prevention of Adhesion Bands by Ibuprofen-Loaded PLGA Nanofibers, Biotechnology Progress, 32, 4, 990-997.