title: Postoperative adhesions after application of topical hemostatic agents: outcomes in a rat partial nephrectomy model.
abstract: OBJECTIVE
  To compare 3 kinds of topical hemostatic agents in terms of adhesive strength, control of hemorrhage, and postoperative intra-abdominal adhesions in an experimental partial nephrectomy (PN) model.
  
  
  METHODS
  A total of 27 Wistar rats were divided into 5 groups. PN was performed in 6 rats (control group) with the conventional technique, in which the lower pole of the kidney was excised and sutured after hilar control. In 5 rats, oxidized cellulose was placed over the excised part of the kidney following conventional technique. In 6 rats, the hemostatic plant extract was used without hilar control. In 5 rats, the hemostatic agent chitosan was used without hilar control. As a sham group, 5 rats underwent a laparotomy and handling of the renal pedicle without the removal of renal pole. On the tenth day after the operation, the degree of adhesions to the operated kidney were evaluated. Histopathological evaluation was also performed by a blinded pathologist.
  
  
  RESULTS
  Mean warm ischemia times for control and oxidized cellulose groups were 4.85 ± 0.75 and 4.28 ± 1.28 minutes, respectively (P = .662). Wound healing was excellent in all groups except in 1 rat in the chitosan group. Chitosan was associated with significantly higher intestinal and peritoneal adhesion scores, although histopathologically comparable scores were revealed.
  
  
  CONCLUSIONS
  In our rat model, chitosan and the hemostatic plant extract were as effective as conventional suturing in achieving hemostasis even without hilar control. Warm ischemia was eliminated and PN time was significantly decreased. The use of oxidized cellulose was not associated with higher scores of adhesion, suppuration, or hematoma.
authors.affiliation: Department of Urology, Karaelmas University School of Medicine, Zonguldak, Turkey. h_tokgoz@hotmail.com
authors.forename: Hüsnü
authors.initials: H
authors.lastname: Tokgöz
authors.forename: Sibel
authors.initials: S
authors.lastname: Bektaş
authors.forename: Volkan
authors.initials: V
authors.lastname: Hancı
authors.forename: Bülent
authors.initials: B
authors.lastname: Erol
authors.forename: Bülent
authors.initials: B
authors.lastname: Akduman
authors.forename: Kemal
authors.initials: K
authors.lastname: Karakaya
authors.forename: Sedat
authors.initials: S
authors.lastname: Hakimolu
authors.forename: Necmettin
authors.initials: N
authors.lastname: Aydın Mungan
mesh_terms: D000287:Administration, Topical; D000818:Animals; D002482:Cellulose / Q000737:chemistry; D048271:Chitosan / Q000737:chemistry; D006406:Hematoma; D006487:Hemostasis; D006489:Hemostatic Techniques / Q000009:adverse effects; D006490:Hemostatics / Q000008:administration & dosage / Q000009:adverse effects*; D007511:Ischemia / Q000473:pathology; D007668:Kidney / Q000473:pathology; D008297:Male; D009392:Nephrectomy; D010100:Oxygen / Q000737:chemistry; D010936:Plant Extracts / Q000378:metabolism; D011183:Postoperative Complications; D051381:Rats; D017208:Rats, Wistar; D000267:Tissue Adhesions; D014945:Wound Healing
chemical_list: D006490:Hemostatics; D010936:Plant Extracts; D002482:Cellulose; D048271:Chitosan; D010100:Oxygen