Effects of atorvastatin on systemic inflammatory response after coronary bypass surgery Effects of Antiadhesion preparation on free fibrinogen and fibrin degrading products in abdominal exudates of rabbits postoperatively. Effectiveness of auto-crosslinked hyaluronic acid gel in the prevention of intrauterine adhesions after hysteroscopic surgery: a prospective, randomized, controlled study. REDUCTION OF SYSTEMIC AND CARDIAC ADHESION MOLECULE EXPRESSION AFTER OFF‐PUMP VERSUS CONVENTIONAL CORONARY ARTERY BYPASS GRAFTING Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study. High, but not moderate frequency and duration of exercise training induces downregulation of the expression of inflammatory and atherogenic adhesion molecules Preoperative administration of steroids: influence on adhesion molecules and cytokines after cardiopulmonary bypass. Effects of Intraperitoneal Administration of Simvastatin in Prevention of Postoperative Intra-abdominal Adhesion Formation in Animal Model of Rat. Can statins reduce the inflammatory response to cardiopulmonary bypass? A clinical study. Statins improve surgical ablation outcomes for atrial fibrillation in patients undergoing concomitant cardiac surgery. Clinical assessment of a novel antiadhesion barrier gel: prospective, randomized, multicenter, clinical trial of ADCON-L to inhibit postoperative peridural fibrosis and related symptoms after lumbar discectomy. Statin therapy is associated with improved survival after endovascular and open aneurysm repair. Post-operative adhesions after laparoscopic electrosurgical treatment for polycystic ovarian syndrome with the application of Interceed to one ovary: a prospective randomized controlled study. Prevention of Postoperative Abdominal Adhesions by a Novel, Glycerol/Sodium Hyaluronate/Carboxymethylcellulose-Based Bioresorbable Membrane: A Prospective, Randomized, Evaluator-Blinded Multicenter Study Preoperative statin use and infection after cardiac surgery: a cohort study. Ultrasound detection of visceral adhesion after intraperitoneal ventral hernia treatment: A comparative study of protected versus unprotected meshes A randomized, controlled pilot study of the safety and efficacy of 4% icodextrin solution in the reduction of adhesions following laparoscopic gynaecological surgery.
Objectives : Systemic inflammatory response occurs frequently after coronary artery bypass surgery , and it is strongly correlated with the risk of postoperative morbidity and mortality . Recent studies demonstrate that treatment with statin is associated with a significant and marked decrease in inflammation-associated variables such as the C-reactive protein , cytokines , and adhesion molecules . Therefore , we investigated the effects of preoperative atorvastatin treatment on systemic inflammatory response and perioperative morbidity after cardiopulmonary bypass . Design : Double-blinded , placebo-controlled , r and omized study . Setting : University hospital . Patients : Forty patients were r and omized to treatment with atorvastatin ( 20 mg/day , group A , n = 20 ) or placebo ( group B , n = 20 ) 3 wks before surgery . Interventions : Three-week treatment by atorvastatin 20 mg/day . Measurement and Main Results : Postoperative serum levels of both interleukin-6 and interleukin-8 increased significantly over baseline , but the peak levels observed 4 hrs postoperatively were significantly lower in the atorvastatin group . In the same fashion , CD11b expression on neutrophils was significantly lower in the statin group at 4 and 24 hrs postoperatively . Finally , neutrophil-endothelial adhesion was significantly reduced in the statin patients compared with controls . The operation time , blood loss , need for inotropic support , intubation time , and length of intensive care unit or hospital stay did not differ significantly between the two groups . The systemic inflammatory response syndrome score on postoperative days 1 and 2 was comparable in both groups . Conclusions : Pretreatment with atorvastatin significantly reduces cytokine release and neutrophil adhesion to the venous endothelium in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass AIM To observe effects of ACOL on fibrinogen ( FIB ) , fibrin degrading products ( FDP ) and changes of FIB and FDP concentration in rabbits with intro-abdominal exu date s during 7 d after major abdominal surgery . METHODS Sixty New Zeal and rabbits were r and omly divided into 4 groups : ACOL group , the control group , DCT group and the normal group . After being modeled , except the normal group , the other 3 groups were treated with different ways for a week ; the intro-abdominal exu date s of rabbits in the 4 groups were drawn for FIB and FDP measurement once daily during 7 d after major abdominal surgery . RESULTS FIB and FDP in the intro-abdominal exu date s altered in a regular way and ACOL could change the concentration of FIB and FDP in the intra-abdominal exu date s after major abdominal surgery . CONCLUSION ACOL can prevent intestinal adhesion by reducing the concentration of FIB and raising that of FDP in the intro-abdominal exu date s after major abdominal surgery BACKGROUND A prospect i ve , r and omized , controlled study was performed to assess the efficacy of auto-crosslinked hyaluronic acid ( ACP ) gel to prevent the development of de-novo intrauterine adhesions following hysteroscopic surgery . METHODS One hundred and thirty-two patients with a single surgically remediable intrauterine lesion ( myomas , polyps and uterine septa , subgroups I-III ) completed the study . Patients were r and omized to two different groups : group A underwent hysteroscopic surgery plus intrauterine application of ACP gel ( 10 ml ) while group B underwent hysteroscopic surgery alone ( control group ) . The rate of adhesion formation and the adhesion score was calculated for each group and subgroup 3 months after surgery . RESULTS Group A showed a significant reduction in the development of de-novo intrauterine adhesions at 3 months follow-up in comparison with the control group . Furthermore , the staging of adhesions showed a significant decrease in adhesion severity in patients treated with ACP gel . CONCLUSIONS ACP gel significantly reduces the incidence and severity of de-novo formation of intrauterine adhesions after hysteroscopic surgery ABSTRACT Cardiopulmonary bypass ( CPB ) and operative trauma are associated with increased expression of pro‐ inflammatory mediators . We determined the relative contribution of CPB on activation of cytokines and adhesion molecules in patients undergoing coronary revascularization by comparing them with patients receiving off‐pump coronary artery bypass grafting ( OPCAB ) . Twenty‐six patients were assigned to either the OPCAB procedure using a suction device and regular sternotomy ( n = 13 ) , or were treated conventionally using extracorporeal circulation , blood cardioplegia , and hypothermic arrest ( 29 ° C‐31 ° C ; n = 13 ) . Systemic levels of TNF‐&agr ; and the soluble adhesion molecules P‐selectin and intracellular adhesion molecule 1 ( ICAM‐1 ) were assayed . Immunohistochemistry was used to account for cardiac‐specific expression of adhesion molecules in interventricular endomyocardial sections . Both systemic and endomyocardial expres‐ sion of adhesion molecules were lower in the OPCAB group . Coronary revascularization with CPB result ed in a significant higher expression of TNF‐&agr ; , which was associated with P‐selectin and ICAM‐1 expression . This was accompanied with higher catecholamine requirement in the CPB group in the early postoperative period . Despite comparable surgical trauma , the OPCAB procedure without the use of CPB and cardioplegic arrest significantly reduces systemic and cardiac adhesion molecule expression and catecholamine requirement . Since the clinical course in the early postoperative period was comparable , larger trials are required to select the appropria te patient who benefits most from one or the other treatment regime BACKGROUND Postoperative abdominal adhesions are associated with numerous complications , including small bowel obstruction , difficult and dangerous reoperations , and infertility . A sodium hyaluronate and carboxymethylcellulose bioresorbable membrane ( HA membrane ) was developed to reduce formation of postoperative adhesions . The objectives of our prospect i ve study were to assess the incidence of adhesions that recurred after a st and ardized major abdominal operation using direct laparoscopic peritoneal imaging and to determine the safety and effectiveness of HA membrane in preventing postoperative adhesions . STUDY DESIGN Eleven centers enrolled 183 patients with ulcerative colitis or familial polyposis who were scheduled for colectomy and ileal pouch-anal anastomosis with diverting-loop ileostomy .  Before abdominal closure , patients were r and omly assigned to receive or not receive HA membrane placed under the midline incision . At ileostomy closure eight to 12 weeks later , laparoscopy was used to evaluate the incidence , extent , and severity of adhesion formation to the midline incision . RESULTS Data were analyzed for 175 assessable patients . While only five ( 6 percent ) of 90 control patients had no adhesions , 43 ( 51 percent ) of 85 patients receiving HA membrane were free of adhesions ( p < 0.00000000001 ) . The mean percent of the incision length involved was 63 percent in the control group , significantly greater than the 23 percent observed in patients who received HA membrane ( p < 0.001 ) . Dense adhesions were observed in 52 ( 58 percent ) of the 90 control patients , but in only 13 ( 15 percent ) of the 85 receiving HA membrane ( P < 0.0001 ) . Comparison of the incidence of specific adverse events between the groups did not identify a difference ( P > 0.05 ) . CONCLUSIONS This study represents the first controlled , prospect i ve evaluation of postoperative abdominal adhesion formation and prevention after general abdominal surgery using st and ardized , direct peritoneal visualization . In this study , HA membrane was safe and significantly reduced the incidence , extent , and severity of postoperative abdominal adhesions Background Lifestyle changes which include daily exercise training have been shown to slow the progression of coronary artery disease . We design ed a study to examine the effects of a multifactorial intervention on atherogenic adhesion molecules on the surface of monocytes in patients with coronary artery disease . Methods We r and omized 39 patients with coronary artery disease to ( i ) an intervention program which consisted of 4 weeks of daily 6 × 15 min ergometer training at submaximal intensity in addition to a 1 h/week group exercise session , followed by 5 months of home-based ergometer training of 30 min/day again in addition to a 1 h/week group exercise session or ( ii ) conventional therapy .  All patients received a statin .  Monocyte-bound cellular adhesion molecules LFA-1 ( CD11a ) , MAC-1 ( CD11b ) , VLA-4 ( CD49d ) and L-selectin ( CD62L ) were assessed by fluorescence activated cell sorting analysis . Results After 4 weeks the multifactorial intervention led to a significant improvement of maximal work capacity , lipid profile , body mass index , blood pressure , fasting glucose and hemoglobin A1c . This was associated with a reduced expression of MAC-1 and VLA-4 . After 5 months of a home-based intervention the beneficial effects of the cardiovascular risk profile were still apparent , whereas the effects on the expression of adhesion molecules were blunted . Conclusion In patients treated with statins , 4 weeks of high frequency and long duration exercise training led to a diminished expression of atherogenic adhesion molecules MAC-1 und VLA-4 . After 5 months of home-based exercise training of moderate frequency and duration , these effects were blunted . Our data suggest that our patients in cardiac rehabilitation programs might further benefit from the antiatherogenic effects of an even higher amount of exercise training BACKGROUND Cardiopulmonary bypass ( CPB ) is associated with tissue damage mediated by adhesion molecules and cytokines . Prebypass steroid administration may modulate the inflammatory response , result ing in improved postoperative recovery . METHODS Fifty patients undergoing elective coronary operations under normothermic CPB were r and omized into two groups : group A ( n = 24 ) received intravenous methylprednisolone ( 10 mg/kg ) 4 hours preoperatively , and group B ( n = 26 ) served as controls . Cytokines ( tumor necrosis factor-alpha [ TNF-alpha ] , interleukin-2R [ IL-2R ] , IL-6 , IL-8 ) , soluble adhesion molecules ( sE-selectin , sICAM-1 ) , C-reactive protein , and leukocytes were measured before steroid application , then 24 and 48 hours , and 6 days postoperatively . Adhesion molecules were measured by enzyme-linked immunosorbent assay , cytokines by chemiluminescent immunoassay . Postoperatively , hemodynamic measurements , inotropic agent requirements , blood loss , duration of mechanical ventilation , and intensive care unit stay were compared . RESULTS Aortic cross-clamp and CPB time was similar in both groups . Prednisolone administration reduced postoperative levels of IL-6 ( 611 versus 92.7 pg/mL ; p = 0.003 ) , TNF-alpha ( 24.4 versus 11.0 pg/L , p = 0.02 ) , and E-selectin ( 327 versus 107 ng/mL , p = 0.02 ) . Postoperative recovery did not differ between groups . CONCLUSIONS Preoperative administration of methylprednisolone blunted the increase of IL-6 , TNF-alpha , and E-selectin levels after CPB but had no measurable effect on postoperative recovery OBJECTIVE To determine the preventive effects of local administration of simvastatin for postoperative intra-abdominal adhesion formation in animal model of rat . METHODS In this experimental study , 32 Wistar albino rats as the animal model of intra-abdominal adhesion formation were included . Adhesions were induced in all the animals via abrasion of the peritoneal and intestinal surface during laparotomy . Afterwards , the rats were r and omly assigned to receive simvastatin ( 30 mg/kg body weight ) as a single intraperitoneal dose at the time of laparotomy ( n=16 ) or normal saline in same volume at the same time ( n=16 ) . At the day 21 , animals were euthanized and the adhesions were quantified clinical ly ( via repeated laparotomy ) and pathologically and compared between the two groups . RESULTS The baseline characteristics of the animals were comparable between two study groups . Clinical ly , in simvastatin group , 10 rats ( 62.5 % ) did not develop any adhesion and 6 ( 37.5 % ) had first- grade adhesion ; whereas in the control group , 11 ( 68.8 % ) rats had first- and 5 ( 31.2 % ) had second- grade adhesions ( p<0.001 ) . Pathologically , in simvastatin group , 6 rats ( 37.5 % ) had first- grade adhesion , while in control group , 11 rats ( 68.8 % ) had first- and 5 ( 31.2 % ) had second- grade adhesions ( p<0.001 ) . CONCLUSION Our findings suggest that intraperitoneal administration of simvastatin is an effective method for prevention of postoperative intra-abdominal adhesion formation in animal model of rat OBJECTIVE In addition to lowering lipid levels , statins might reduce leukocyte-endothelial cell interactions . Therefore , we assessed whether this effect could limit the inflammatory response to cardiopulmonary bypass ( CPB ) in cardiac surgical patients . METHODS Twenty patients undergoing valve or coronary operations with tepid ( 34 degrees C ) CPB were r and omized to receive an oral dose of atorvastatin ( 40 mg the evening before and 40 mg the morning of surgery ) or to serve as controls . Pre- and post-CPB blood sample s were assayed for neutrophil CD11b surface adhesion molecule and oxidative burst . Plasma levels of interleukins 6 and 8 , P-selectin , soluble intercellular adhesion molecule-1 , and lactoferrin were measured by enzyme-linked immunosorbent assay ( ELISA ) . In addition , right atrial biopsies were taken before and at the end of CPB , and processed for the expression of the transcription nuclear factor-kappa B ( NF-kappaB ) . RESULTS The two groups did not differ with regard to pre- and intraoperative data . Except for P-selectin , postbypass values of all markers significantly increased over baseline values , but atorvastatin therapy failed to attenuate the magnitude of this increase . In the two groups , the expression of NF-kappaB significantly ( p = 0.004 ) increased over baseline without group effect . Postoperative clinical outcomes did not differ either between the two groups . CONCLUSION These data show that acute preoperative statin therapy fails to limit the inflammatory response to CPB ; however , the data also document a major upregulation of NF-kappaB during cardiac operations , thereby providing a sound rationale for interventions targeted at inactivating this key component of the inflammatory cascade Ablation outcomes were investigated in patients with and without statin pretreatment before cardiac surgery with concomitant surgical ablation for atrial fibrillation ( AF ) . A prospect i ve cohort study was performed containing 149 patients ( n=73 statin group vs. n=76 control group ) undergoing on-pump cardiac procedures with surgical ablation for paroxysmal or persistent AF . Measured outcomes were freedom from AF in the intensive care unit , discharge and at three and six months follow-up and perioperative markers of inflammation ( white blood cell count , C-reactive protein ) . Independent predictors for freedom from AF were assessed . Groups did not differ with respect to EuroSCORE , New York Heart Association class , left atrial size , anti-arrhythmic drug therapy or aortic cross-clamp time . Statin therapy had no impact on postoperative inflammatory markers . Freedom from AF was more frequent in the statin group at discharge ( P=0.07 ) and after three and six months ( P<0.05 ) . Subgroup analysis showed that statin pretreatment was associated with higher rates of freedom from AF for paroxysmal AF at three and six months and for persistent AF after six months ( P<0.05 ) . Importantly , statin-pretreatment was independently predictive for freedom from AF at discharge [ odds ratio ( OR ) : 3.21 ; 95 % confidence interval ( CI ) : 1.2 - 8.55 ; P=0.02 ] and at three months ( OR : 2.91 ; 95 % CI : 1.14 - 7.45 ; P=0.026 ) . Statin therapy prior to ablation surgery improves postoperative freedom from AF for paroxysmal and persistent AF in cardiac surgery patients A prospect i ve , multicenter , r and omized , double-blind , controlled study of ADCON-L Anti-Adhesion Barrier Gel ( a medical device by Gliatech Inc , Clevel and , OH ) was conducted in 298 patients undergoing first-time lumbar discectomy to evaluate the safety and effectiveness of ADCON-L in preventing postoperative peridural fibrosis and in improving patient clinical outcome . After lumbar discectomy , patients were r and omized to receive either ADCON-L gel or nothing ( control group ) at the conclusion of the surgical procedure . Six months after surgery , peridural scar was evaluated by magnetic resonance imaging , and postoperative pain and straight-leg-raise angle were assessed . No statistically significant differences between the ADCON-L and control groups were observed in terms of adverse events or wound healing characteristics .  ADCON-L gel was shown to be safe and to significantly inhibit peridural scar compared with the control group ( P = 0.002 ) . That peridural scarring was reduced with ADCON-L gel was further supported by direct visualization of scar tissue at reoperation in both groups . ADCON-L-treated patients had better clinical outcomes than did control patients . The incidence of activity-related pain was significantly reduced ( P = 0.013 ) , straight-leg-raise examination scores were significantly improved ( P = 0.024 on the operative side and P = 0.015 on the nonoperative side ) , and ADCON-L reduced low back pain when it was most severe ( P = 0.047 ) and at the end of the day ( P = 0.044 ) BACKGROUND The relationship between numerous risk factors and perioperative mortality after cardiovascular surgery has been studied extensively . While improved perioperative survival and fewer cardiovascular events have been related to statin therapy , its effect on long-term survival after aneurysm repair remains to be eluci date d. The aim of this study is to determine the effect of statin therapy on long-term survival after open and endovascular aneurysm repair and to identify other cardiovascular and patient-related risk factors in this respect . METHODS A post-hoc analysis of a r and omized trial comparing open and endovascular abdominal aortic aneurysm repair was performed . In this multicenter trial , 351 patients were r and omly assigned to undergo either open abdominal aortic aneurysm repair or endovascular repair . Patients who were on lipid-lowering medication at their inclusion in the trial ( n = 135 ) were compared with those who were not ( n = 216 ) . RESULTS During 6 years of follow-up , 118 ( 33.6 % ) patients died after r and omization . Statin therapy , baseline characteristics , Society for Vascular Surgery/International Society for Cardiovascular Surgery risk factors , aneurysm size , re interventions , antiplatelet or anticoagulant agents , and β-blockers were used to identify prognostic factors influencing survival . After identification of significant factors in a Kaplan-Meier analysis , a multivariable Cox regression analysis was applied . Statin therapy at inclusion in the trial was independently associated with better overall survival after open or endovascular aneurysm repair ( hazard ratio [ HR ] , 0.5 ; 95 % confidence interval [ CI ] , 0.3 - 0.8 ; P = .004 ) . Statins were especially associated with fewer cardiovascular deaths ( HR , 0.4 ; 95 % CI , 0.2 - 0.9 ; P = .025 ) . Several risk factors were associated with poor survival after open and endovascular aneurysm repair : age > 70 ( HR , 3.4 ; 95 % CI , 2.2 - 5.0 ; P < .001 ) , a history of cardiac disease at baseline ( HR , 1.9 ; 95 % CI , 1.3 - 2.8 ; P = .001 ) , and moderate/severe tobacco use ( HR , 1.7 ; 95 % CI , 1.2 - 2.5 ; P = .004 ) . Gender , aneurysm size , the need for reintervention , pulmonary disease , renal disease , carotid disease , hypertension , diabetes mellitus , antiplatelet or anticoagulant agents , and β-blockers were not significantly associated with impaired long-term survival ( P > .05 ) . CONCLUSIONS Despite the limitations of a post-hoc analysis of a prospect ively maintained trial , we conclude that statin therapy at the beginning of the trial is independently associated with improved long-term survival after open or endovascular aneurysm repair , while age above 70 years , a history of cardiovascular disease , and tobacco use are associated with decreased long-term survival In this prospect i ve , r and omized , controlled clinical study , 21 women underwent a second-look laparoscopy 2 - 11 weeks after st and ardized laparoscopic electrosurgical treatment for polycystic ovarian syndrome ( PCOS ) . Following bilateral ovarian treatment , one ovary was r and omly chosen to have Interceed applied to its surface using a specially design ed applicator , with the other ovary serving as a control . Peri-adnexal adhesions of significant extent and severity developed in 57 % of the women and 38 % of the adnexa . The incidence of adhesions on the Interceed-treated side was 43 % , while on the control side it was 33 % . In addition , the extent and severity of the adhesions appeared to be similar on the Interceed-treated and control side . However , larger numbers would be required to determine statistically the effects of Interceed on de-novo adhesion formation after laparoscopic electrosurgical treatment of PCOS , as described here INTRODUCTION Postoperative abdominal adhesions are associated with significant morbidity and mortality , placing a substantial burden on healthcare systems worldwide . Development of a bioresorbable membrane containing up to 23 percent glycerol and chemically modified sodium hyaluronate/carboxymethylcellulose offers ease of h and ling and has been shown to provide significant postoperative adhesion prevention in animals . This study was design ed to assess the safety of glycerol hyaluronate/carboxymethylcellulose and to evaluate its efficacy in reducing the incidence , extent , and severity of postoperative adhesion development in surgical patients . METHODS Twelve centers enrolled 120 patients with ulcerative colitis or familial polyposis who were scheduled for a restorative proctocolectomy and ileal pouch-anal anastomosis with diverting loop ileostomy . Before surgical closure , patients were r and omized to no antiadhesion treatment ( control ) or treatment with glycerol hyaluronate/carboxymethylcellulose membrane under the midline incision . At ileostomy closure , laparoscopy was used to evaluate the incidence , extent , and severity of adhesion formation to the midline incision . RESULTS Data were analyzed using the intent-to-treat population . Treatment with glycerol hyaluronate/carboxymethylcellulose result ed in 19 of 58 patients ( 33 percent ) with no adhesions compared with 6 of 60 adhesion-free patients ( 10 percent ) in the no treatment control group ( P = 0.002 ) . The mean extent of postoperative adhesions to the midline incision was significantly lower among patients treated with glycerol hyaluronate/carboxymethylcellulose compared with patients in the control group ( P < 0.001 ) . The severity of postoperative adhesions to the midline incision was significantly less with glycerol hyaluronate/carboxymethylcellulose than with control ( P < 0.001 ) . Adverse events were similar between treatment and no treatment control groups with the exception of abscess and incisional wound complications were more frequently observed with glycerol hyaluronate/carboxymethylcellulose . CONCLUSIONS Glycerol hyaluronate/carboxymethylcellulose was shown to effectively reduce adhesions to the midline incision and adhesions between the omentum and small bowel after abdominal surgery . Safety profiles for the treatment and no treatment control groups were similar with the exception of more infection complications associated with glycerol hyaluronate/carboxymethylcellulose use . Animal models did not predict these complications BACKGROUND It has been suggested that the routine use of statins preoperatively would reduce the risk of postoperative infection . We conducted this study to explore whether preoperative statin use was associated with infection after cardiac surgery ( recipients of which have a higher-than-average risk of postoperative infection ) . METHODS We performed secondary analysis of data collected in a prospect i ve cohort study of adults who underwent nontransplant cardiac surgery in a university hospital during the period January 1999 through December 2005 . Outcomes were ascertained in a blinded and independent fashion . RESULTS Of the 7733 patients , 2657 ( 34 % ) were taking statins preoperatively ; the proportion increased from 16 % during 1999 - 2000 to 53 % during 2003 - 2005 ( P < .001 , by test for trend ) . There was no association between preoperative statin use and postoperative infection : 214 statin users ( 8.1 % ) versus 425 statin nonusers ( 8.4 % ) developed an infection within 30 days after surgery . Factors associated with increased risk of infection after cardiac surgery included diabetes mellitus , heart failure , chronic obstructive pulmonary disease , increasing age , elevated baseline creatinine level , and longer duration of cardiopulmonary bypass but not statin use ( adjusted odds ratio , 1.08 ; 95 % confidence interval , 0.89 - 1.31 ) . CONCLUSIONS Preoperative statin use was not associated with a reduction in the rate of postoperative infection among patients who underwent cardiac surgery . This lack of apparent benefit for high-risk patients argues against the routine use of statins as a preoperative strategy for lower-risk patients and supports calls for r and omized trials to define whether preoperative statin use influences postoperative rates of infection Abstract  Intraperitoneal ( IP ) ventral hernia repair  has been proposed with the advantages of reducing dissection , operative time , and postoperative pain . The IP position of the mesh is suspected of increasing the risk of visceral adhesion and inducing complications . To overcome these drawbacks , a mesh protected on one side by a hydrophilic resorbable film ( Parietex Composite ) has been vali date d [ 1 ] . Using a previously described ultrasound procedure [ 2 ] , the purpose of this study was to compare the rate of visceral adhesion after intraperitoneal placement of a polyester mesh versus this protected mesh .  Fifty-one patients who received a Parietex Composite mesh were prospect ively compared to a retrospective series of 22 consecutive asymptomatic patients who received a Mersilene mesh .  To objective ly assess visceral adhesion toward the abdominal wall , an ultrasound ( US ) specific examination was firstly vali date d and secondly used to evaluate the adhesion incidence in both groups . Both groups were equivalent in terms of inclusion criteria and body mass index ( BMI ) . Pre-operative US versus perioperative macroscopical findings determined the following parameters : sensitivity 83 % , accuracy 78 % , negative predictive value 81 % . Using this procedure , 77 % of the patients exhibited visceral adhesion to the mesh in the Mersilene group , against 18 % in the Parietex Composite group ( P<0.001 , chi-square ) . US examination represents a suitable tool to evaluate postoperative adhesions to the abdominal wall . Using this procedure , a significant reduction of visceral adhesion in the Parietex Composite group was shown BACKGROUND Adhesion-related readmissions are frequent sequelae to gynaecological surgery . Attempts to prevent adhesions by separating healing peritoneal surfaces include site-specific barriers and hydroflotation by instilled solutions . Rapid absorption limits the effectiveness of solutions such as Ringer 's lactated saline ( RLS ) . This pilot study assessed the safety , tolerability and preliminary effectiveness of a non-viscous , iso-osmolar solution of 4 % icodextrin , an alpha-1,4 glucose polymer with prolonged intraperitoneal residence , in reducing adhesions after laparoscopic gynaecological surgery . METHODS Women aged > or = 18 years , requiring laparoscopic adnexal surgery ( n = 62 ) , were entered into a r and omized , open-label , assessor-blinded , multicentre study to compare 4 % icodextrin with RLS . Treatments were coded in blocks of four with equal r and omization to each group , and pre-allocated to consecutively numbered patients . At least 100 ml per 30 min was used for intra-operative lavage , with 1 l instilled post-operatively . Per protocol analysis included all eligible patients ( n = 53 ) ; reformation analysis required one or more baseline adhesion ( n = 42 ) . Incidence , extent and severity of post-operative adhesions were assessed at second-look laparoscopy after 6 - 12 weeks . Procedures were video-taped for third party , blinded assessment . RESULTS Safety and tolerability ( laboratory variables , adverse events , clinical follow-up ) were good with no difference between treatments . A shift analysis of incidence-ranked adhesions ( n = 53 ) showed apparent improvements in more patients with icodextrin than RLS ( 37 versus 15 % ; not significant ) . Adhesion score reduction ( n = 42 ) was more frequent in icodextrin- than RLS-treated patients : incidence ( 52 versus 32 % ) , extent ( 52 versus 47 % ) , and severity ( 65 versus 37 % ) . Despite greater baseline adhesions , median reformation was less after icodextrin ( 24 % ) than RLS ( 60 % ) . The pilot study group sizes were not powered for statistical significance . CONCLUSIONS In this preliminary study , 4 % icodextrin lavage plus instillation was well tolerated and reduced adhesion formation and reformation following laparoscopic gynaecological surgery . A Phase III pivotal study is currently in progress
In conclusion , statins were effective in preventing postoperative adhesion , as assessed based on gross and microscopic adhesion scores in rats
Adhesion is a significant concern after surgery .
Many research ers studied the anti-adhesive effect of statin , of which results were inconsistent .
Thus , we purpose d to perform a systematic review and meta- analysis to evaluate the effect of statins on postoperative adhesion in an experimental study .