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

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

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.

Anahtar Kelimeler:

Key words: Anti-adhesive barriers, thyroidectomy, adhesion

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

Keywords:

Key words: Anti-adhesive barriers, thyroidectomy, adhesion,

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Auguste LJ, Attie NJ. Completion thyroidectomy for initially misdiagnosed thyroid cancer. Otolaryngol Clin N Am 1990; 23: 429-439.
Chao TC, Jeng LB, Lin JD, Chen MF. Completion thyroidectomy for differentiated thyroid carcinoma. Otolaryngol Head Neck Surg 1998; 118: 896-899. 3. Eroğlu A, Berberoğlu U, Buruk F, Yıldırım E. Completion thyroidectomy for differantiated thyroid carcinoma. J Surg Oncol 1995; 59: 261-266.
Pezzulo L,Delrio P, Losito NS, Caraco C, Mozzillo N. Postoperative complications after completion thyroidectomy for differentiated thyroid cancer. Eur J Surg Oncol 1997; 23: 215- 218. 5. Dralle H, Sekulla C, Lorenz K, Brauckhoff M, Machens A; German IONM Study Group. Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg 2008; 32: 1358-1366. 6. Sitreq-Serra A, Saucho JJ. Surgical management of recurrent and intrathoracic goiters. In Clark OH, Duk AY, editors, Textbook of Endocrine Surgery, WB. Saunders Comp., Philadephia, 1997; 262-274.
Muller PE, Jakoby R, Heinert G, Spelsberg F. Surgery for recurrent goitre: its complications and their risk factors. Eur J Surg 2001; 167: 816-821. 8. Pasieka JL, Thompson NW, McLeod MK, Burney RE, Macha M. The incidence of bilateral well-differentiated thyroid cancer found at completion thyroidectomy. World J Surg 1992; 16: 711- 716. 9. De Jong SA, Demeter JG, Lawrence AM, Paloyan E. Necessity and safety of completion thyroidectomy for differentiated thyroid carcinoma. Surgery 1992; 112: 734-739.
DeCherney AH, DiZerega GS. Clinical problem of intraperitoneal postsurgical adhesion formation following general surgery and the use of adhesion prevention barriers. Surg Clin North Am 1997; 77: 671-688.
Diamond MP. Reduction of adhesions after uterine myomectomy by Seprafilm membrane: a blinded, prospective, randomized, multicenter clinical study. Seprafilm Adhesion Study Group. Fertil Steril 1996; 66: 904-910.
Diamond MP. Reduction of de novo postsurgical adhesions by intraoperative precoating with Sepracoat solution: a prospective, randomized, blinded, placebo-controlled multicenter study. The Sepracoat Adhesion Study Group. Fertil Steril 1998; 69: 1067-1074.
Zeng Q, Yu Z., You J, Zhang Q. Efficiency and safety of seprafilm for preventing postoperative abdominal adhesions: systemic review and metaanalysis. World J Surg 2007; 31: 2125-2131.
Yigit O, Uslu Coskun B., Coskun H, Yilmaz B, Alkan S, Cinar U et al. Efficacy of antiadhesive barriers in secondary thyroidectomy: an experimental study. Laryngoscope 2004; 114: 1668-1673.
Elkins TE, Ling FW, Ahokas RA, Abdella TN, Homsey CA, Malinak LR. Adhesion prevention by of sodium carboxymethyl cellulose in the rat-II. Fertil Steril 1984; 41: 929-932.
Becker JM, Dayton MT, Fazio VW, Beck DE, Stryker SJ, Wexner SD et al. Prevention postoperative abdominal adhesions by sodium hyaluronate based bioabsorbable membrane: a prospective, randomized, double blind, multicenter study. J Am Coll Surg 1996; 183: 406-407.
Brady JM, Cutright DE, Miller RA, Barristone GC. Resorption rate, route, route of elimination and ultrastructure of the implant side of polylactic acid in the abdominal wall of the rat. J Biomed Mater Res 1973; 7: 155-166.
Hollinger JO, Battistone GC. Biodegradable bone repair materials. Synthetic polymers and ceramics. Clin Orthop Relat Res 1986; 207: 290-305.
Kulkarni RK, Pani KC, Neuman C, Leonard F. Polylactic acid for surgical implants. Arch Surg 1966; 93: 839-843.
Pistner H, Gutwald R, Ordung R, Reuther J, Mühling J. Poly(L- lactide): a long term degradation study in vivo. I. Biological results. Biomaterials 1993; 14: 671-677. 21. Welch
WC, Cornwall GB, Toth JM, Turner AS, Thomas KA,
Gerszten PC et al. Use of polylactide resorbable film as an
adhesion barrier. Orthopedics 2002; 25: 1121-1130.
Majuzi MK, Kalambahati K, Paear B. Prevention of adhesions with polyvinylpyrrolidone. Arch Surg 1964; 89: 1011.
Fewins J, Simpson CB, Miller FR. Complication of thyroid and parathyroid surgery. Otolaryngol Clin North Am 2003; 36: 189- 206.
Hooker GD, Taylor BM, Driman DK. Prevention of adhesion formation with use of sodium hyaluronate-based bioresorbable membrane in a rat model of ventral hernia repair with polypropylene mesh. Surgery 1999; 125: 211-216.
Alponat A, Lakshminarasappa SR, Yavuz N, Goh PM. Prevention of adhesions by Seprafilm, an absorbable adhesion barrier: an incisional hernia model in rats. Am Surg 1997; 63: 818-819.
Moreira H, Wexner SD, Yamaguchi T, Pikarsky AJ, Choi JS, Weiss EG et al. Use of bioresorbable membrane (sodium hyaluronate-carboxymethylcellulose) controlled bowel injuries in a rabbit model. Dis Colon Rectum 2000; 43: 182-187.
Chao TC, Jeng LB, Lin JD. Reoperative thyroid surgery. World J Surg 1997; 21: 644-647.
Tan MP, Agarwal G, Reeve TS, Barraclough BH, Delbridge LW. Impact of timing on completion thyroidectomy for thyroid cancer . Br J Surg 2002; 89: 802-804.