Abstract
Objective: Re-mediastinoscopy can be a difficult procedure due to fibrosis in the mediastinum. We have investigated the effect of an anti-adhesive barrier agent “hylan B gel” on the formation of adhesions after dissection in the superior mediastinum in a rat model. Methods: The study was conducted in 70 male Sprague-Dawley rats weighing 300 g. The strap muscles were divided by a midline cervical incision. The anterior and lateral aspects of the trachea were dissected to the level of the carina. Hylan B gel (Sepragel Sinus, Genzyme Company, Redgefield, NJ, USA) was used to create an anti-adhesive barrier. The rats who were subjected to surgery were sacrificed on postoperative days 14 and 28. All rats were previously divided into 5 groups: Sham group (n = 10); Group 1 (n = 15) surgery alone, sacrificed on day 14; Group 2 (n = 15) surgery and Sepragel, sacrificed on day 14; Group 3 (n = 15) surgery alone, sacrificed on day 28; Group 4 (n = 15) surgery and Sepragel, sacrificed on day 28. Histopathological analysis was performed to study the effect of the anti-adhesive agent. Scores were calculated based on collagen fibrosis, fibroblasts, granulation tissue, muscle alterations/inflammation, histiocytes, mononuclear giant cells, inflammation and vascular proliferation. Results: Collagen fibrosis and fibroblast scores, which represent adhesions, were significantly higher in Groups 1, 2, 3, 4 than in the Sham group (p < 0.01). The degree of adhesions on day 14 was found to be higher in Group 1 compared to Group 2 (p < 0.01). Adhesions on day 28 were higher in Group 3 compared to Group 4 (p < 0.01). There were no differences between groups with regard to foreign body reactions (p > 0.05). Conclusion: Adhesions causing technical difficulty during re-mediastinoscopy can be reduced by the application of anti-adhesive agents during the primary procedure.
Key words
thoracic surgery - anti‐adhesive agent - re‐mediastinoscopy - lung cancer
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MD Okan Solak
Department of Thoracic Surgery
Kocatepe University, School of Medicine
03200 Afyon
Turkey
Phone: + 90 50 52 58 15 80
Fax: + 90 27 22 17 20 29
Email: okanchest@yahoo.com
