Sadık YILDIRIM, Adil BAYKAN, Gökhan ÇİPE, Hakan Mustafa KÖKSAL, Mustafa Celayir CELAYİR

Efficacy of hyaluronic acid - carboxymethyl cellulose membrane (Seprafilm®) and polylactic acid barrier film (Surgiwrap™) for the prevention of adhesions after thyroid surgery: An experimental model

Amaç: İlk tiroid ameliyatlarından sonra oluşan yapışıklık ikincil tiroid ameliyatlarındaki komplikasyonları arttırır. Bu nedenle yapışıklık önleyici bariyer kullanımı ikincil tiroid ameliyatlarındaki komplikasyon oranını azaltabilir. Bu çalışmada tiroid ameliyatları sonrası oluşan yapışıklıkları azaltmada hyalüronik asit-karbosimetil selülöz (HA-CMC, Seprafilm®) ve polilaktik asit bariyer filmin (PLA, Surgiwrap™) etkisi araştırılmıştır. Yöntem ve gereç: Randomize-kontrollü deneysel hayvan modeli kullanıldı. Kırksekiz erkek Wistar Albino türü sıçan çalışma grupları ve kontrol grubu olarak 3 eşit gruba ayrıldı. Tüm deneklere tiroid cerrahisi uygulandı. Çalışmagruplarında HA-CMC ve PLA tiroid cerrahisinden sonra tiroid loju ile strap kasları arasına yerleştirildi. Her gruptan 8 denek 7. gün, kalan denekler 28. gün sakrifiye edildi. Reoperasyon esnasında iki cerrah ayrı ayrı yapışıklıkları skorladı. Bunu takiben tiroid, çevre dokularla beraber çıkarılarak histopatolojik inceleme yapıldı. Bulgular: Cerrahi yapışıklık skoru kontrol grubuyla karşılaştırıldığında HA-CMC grubunda 7. ve 28. günde önemli oranda az bulunmuştur (7. gün P = 0,005 ve 28. gün P = 0,001). Kontrol grubuyla PLA grubu arasında ise anlamlı farklılık saptanmamıştır. Histopatolojik olarak 7. gündeki reoperasyonda hücresel yapışıklık belirteçleri çalışma gruplarında kontrol grubuna göre daha fazla saptanmıştır. 28. gündeki reoperasyonda ise HA-CMC ve kontrol grubunda benzer olup, PLA grubundan daha az bulunmuştur. Sonuç: İlk tiroid ameliyatlarından sonra HA-CMC kullanılması, yapışıklık oluşumunu ve böylece ikincil ameliyatlarda oluşabilecek komplikasyon oranını azaltabilir. Tiroid cerrahisinde bariyer ajanların kullanımı benzer klinik çalışmalarla desteklenmelidir.

Tiroid cerrahisi sonrası oluşan yapışıklıkları önlemede hyaluronik asit - karboksimetil selülöz film (Seprafilm®) ve polilaktik asit bariyer filmin (Surgiwrap™) etkisi: Deneysel model

Aim: Adhesions occurring after initial surgery increase complications in secondary thyroid operations. Therefore use of anti-adhesive barriers may reduce complication rates of secondary thyroid operations. In this study, we investigated the efficacy of hyaluronic acid-carboxymethyl cellulose membrane (HA-CMC, Seprafilm®) and polylactic acid barrier film (PLA, Surgiwrap™) in reducing adhesions after thyroid surgery. Materials and methods: A randomized-controlled experimental animal model was utilized. Forty-eight male Wistar Albino rats were randomly divided into 3 equal groups, forming study and control groups. Thyroid surgery was performed in all subjects. HA-CMC and PLA were applied between the thyroid zone and strap muscles after thyroid surgery in the HA-CMC and PLA study groups, respectively. Eight animals in each group were sacrificed and re-operated on day 7 and the rest on day 28. Two surgeons independently scored adhesion formation during the re-operation. Subsequently, thyroid and adjacent tissues were excised for histopathologic examination. Results: Surgical adhesion scores were significantly reduced in HA-CMC group compared to the control group both on day 7 and 28 re-operations (P = 0.005 and P = 0.001, respectively); however, no significant difference was observed between control and PLA groups. Histopathologically, on day 7 re-operations, cellular markers of adhesion were more prominent in both HA-CMC and PLA groups compared to the control group; however, on day 28 re-operations, adhesion markers were similar in HA-CMC and control subjects, whereas PLA subjects still had marked adhesion. Conclusion: Use of HA-CMC after primary thyroidectomy may reduce adhesion formation, and thereby the complication rate in secondary surgery. Similar studies are warranted to determine the clinical application of barrier agents in thyroid surgery.

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