Preventing intra-abdominal adhesions with a sodium hyaluronate carboxymethylcellulose membrane enabled visualization of hepatic microcirculation Hai.

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Presentation transcript:

Preventing intra-abdominal adhesions with a sodium hyaluronate carboxymethylcellulose membrane enabled visualization of hepatic microcirculation Hai Huang, Meihong Deng, Hao Jin, Olaf Dirsch, Uta Dahmen International Journal of Surgery Volume 11, Issue 9, Pages 935-943 (November 2013) DOI: 10.1016/j.ijsu.2013.06.842 Copyright © 2013 Terms and Conditions

Fig. 1 Comparison of postoperative macroscopic results in the S-group and the Non-S-group. (A) Normal liver surface. (B) Immediately after RMHV-L. (C) A thin white “fibrin-like” membrane (arrow) was found on the surface of the right median lobe at POW1. No adhesions were found between median lobe and diaphragm. Small lacerations occurred after blunt separation (arrow). (D) Moderate adhesions were found between diaphragm and right median lobe in Non-S-group at POW1. (E) The fibrin-like membrane was thicker and more visible at POW4. (F) Severe adhesions were found between diaphragm and median lobe (arrow) in Non-S-group at POW4. Sharp dissection was needed for adhesiolysis. RMHV-L: Right median hepatic vein ligation. POW: postoperative week. International Journal of Surgery 2013 11, 935-943DOI: (10.1016/j.ijsu.2013.06.842) Copyright © 2013 Terms and Conditions

Fig. 2 Comparison of OPS video quality in the S-group and the Non-S-group. (A) and (B) Normal sinusoidal structure. (C) and (D) After adhesiolysis, floating and moving erythrocytes within the visual field due to laceration (triangles) in the group without Seprafilm™ placement (Non-S-group) at POW1 and POW4 respectively. (E) and (F) The video quality was disturbed as well but appeared different due to the fibrin-like membrane at POW1 and POW4. Visualization of sinusoidal blood flow in some area was diffused and blurred (arrows). International Journal of Surgery 2013 11, 935-943DOI: (10.1016/j.ijsu.2013.06.842) Copyright © 2013 Terms and Conditions

Fig. 3 Time of OPS videos acquisition in both S-group and Non-S-group compared with normal control. (*: P < 0.05 S-group compared with C-group). International Journal of Surgery 2013 11, 935-943DOI: (10.1016/j.ijsu.2013.06.842) Copyright © 2013 Terms and Conditions

Fig. 4 Histological finding of Non-S-group (A and B) and S-group (C to D) at POW1 and POW4. (C and D) Multiple phagocytic cells were embedded in amorphous material with mesothelial cells and fibrin (arrow). Cells containing this amorphous material (arrow) were also observed in sinusoids close to the peritoneum. International Journal of Surgery 2013 11, 935-943DOI: (10.1016/j.ijsu.2013.06.842) Copyright © 2013 Terms and Conditions

Fig. 5 Hematoxylin-Eosin staining of the spleen in Non-S-group and S-group at POW1 and POW4. No Histiocytic cells containing amorphous material were found in non-S-group (A and B) whereas multiple histiocytic cells (arrows) containing amorphous material were found in the red pulp in spleen samples at both time points in S-group (C and D) (400×). International Journal of Surgery 2013 11, 935-943DOI: (10.1016/j.ijsu.2013.06.842) Copyright © 2013 Terms and Conditions

Fig. 6 White blood cell counting in both S-group and Non-S-group compared with normal control. Leucocytosis indicative of systemic inflammation did not develop at any postoperative time point in both groups. International Journal of Surgery 2013 11, 935-943DOI: (10.1016/j.ijsu.2013.06.842) Copyright © 2013 Terms and Conditions

Fig. 7 Immunohistochemical staining of CD68 in Non-S-group and S-group at POW1 and POW4. In S-group, formation of a “membrane-like”-thickening of the peritoneal surface of the liver, which was heavily infiltrated with CD68 positive staining cells, was observed (marked with brackets C and D) (100×). International Journal of Surgery 2013 11, 935-943DOI: (10.1016/j.ijsu.2013.06.842) Copyright © 2013 Terms and Conditions