J Int Med Res (1976) 4 , 360
Prevention of Peritoneal Adhesions with Aprotinin (Trasylol) R A H Mooney, MA, M B , F R C S (Ed), FRCSI, Surgeon, Kildare, Ireland
Curragh Military
Hospital,
Co.
An objective asse.isment of intraperitoneal Trasylol in the prevention of abdominal adhesions in 20 patients has shown that Trasylol resulted in a marked reduction in adhesions in 16 patients who underwent 'second look' procedures. No side-effects were noted and all wounds healed without complications.
Introduction Intraperitoneal adhesions are today an increasing problem in abdominal surgery and constitute a serious cause of morbidity and mortality following abdominal operations. Adhesions are responsible for 9 0 % of early post-operative intestinal obstruction and in newborn infants operated on for mechonium ileus and intestinal atresia, 2 5 % need a second operation for peritoneal adhesions (Coletti & Bossart 1960). It v/as observed that adhesions accounted for only 7 % of cases of intestinal obstruction compared with 4 9 % due to strangulated hernia (Vick 1932). The same situation applies today in primitive communities where abdom inal operations are comparatively rare, whereas, in the more advanced countries adhesions are becoming more common as a cause of intestinal obstruction whilst hernias are a much less common cause. In a ten year review of 555 cases of small bowel obstruction at The Royal Victoria Hospital, Belfast, 1971 (34%) were due to adhesions, of these 27 cases (14%) died, (Crockard 1971). In a study of 2,295 case records of obstructions of the small intestine.
it was found that no fewer than 1,477 obstructions (64%) were due to intra abdominal adhesions, of these 8 6 % had previous operations, 3 8 % appendicectomies and 2 8 % gynaecological procedures (Raf 1969). The exact incidence of clinically important adhesions is difficult to assess because of the number of patients who after abdominal surgery do not develop frank obstruction, but complain of vague non-specific symptoms which may or may not be due to adhesions. Prophylaxis against adhesions has been approached from a number of aspects: (1) Prevention of fibrin deposition by anti coagulants. (2) Removal of fibrin by fibrinolytic agents such as streptokinase. (3) Preventing the fibrin-coated intestinal walls from coming in contact with each other by means of dextran solutions and silicone. (4) Preventing fibroplastic proliferation with steroids and cytotoxic agents. Trasylol, a proteinase inhibitor
derived
RAH
361
Mooney
if
It
0,
IL cd
α
1.1 LI" 1§
II
II
Is
Prevention of Peritoneal Adhesions with Aprotinin (Trasylol) R A H Mooney, MA, M B , F R C S (Ed), FRCSI, Surgeon, Kildare, Ireland
Curragh Military
Hospital,
Co.
An objective asse.isment of intraperitoneal Trasylol in the prevention of abdominal adhesions in 20 patients has shown that Trasylol resulted in a marked reduction in adhesions in 16 patients who underwent 'second look' procedures. No side-effects were noted and all wounds healed without complications.
Introduction Intraperitoneal adhesions are today an increasing problem in abdominal surgery and constitute a serious cause of morbidity and mortality following abdominal operations. Adhesions are responsible for 9 0 % of early post-operative intestinal obstruction and in newborn infants operated on for mechonium ileus and intestinal atresia, 2 5 % need a second operation for peritoneal adhesions (Coletti & Bossart 1960). It v/as observed that adhesions accounted for only 7 % of cases of intestinal obstruction compared with 4 9 % due to strangulated hernia (Vick 1932). The same situation applies today in primitive communities where abdom inal operations are comparatively rare, whereas, in the more advanced countries adhesions are becoming more common as a cause of intestinal obstruction whilst hernias are a much less common cause. In a ten year review of 555 cases of small bowel obstruction at The Royal Victoria Hospital, Belfast, 1971 (34%) were due to adhesions, of these 27 cases (14%) died, (Crockard 1971). In a study of 2,295 case records of obstructions of the small intestine.
it was found that no fewer than 1,477 obstructions (64%) were due to intra abdominal adhesions, of these 8 6 % had previous operations, 3 8 % appendicectomies and 2 8 % gynaecological procedures (Raf 1969). The exact incidence of clinically important adhesions is difficult to assess because of the number of patients who after abdominal surgery do not develop frank obstruction, but complain of vague non-specific symptoms which may or may not be due to adhesions. Prophylaxis against adhesions has been approached from a number of aspects: (1) Prevention of fibrin deposition by anti coagulants. (2) Removal of fibrin by fibrinolytic agents such as streptokinase. (3) Preventing the fibrin-coated intestinal walls from coming in contact with each other by means of dextran solutions and silicone. (4) Preventing fibroplastic proliferation with steroids and cytotoxic agents. Trasylol, a proteinase inhibitor
derived
RAH
361
Mooney
if
It
0,
IL cd
α
1.1 LI" 1§
II
II
Is
