Clin Exp Otorhinolaryngol.  2016 Jun;9(2):143-149. 10.21053/ceo.2015.00591.

Effect of a Chitosan Gel on Hemostasis and Prevention of Adhesion After Endoscopic Sinus Surgery

• Chung YJ
• An SY
• Yeon JY
• Shim WS
• Mo JH

• KMID: 2165057
• DOI: http://doi.org/10.21053/ceo.2015.00591

Abstract

OBJECTIVES
Postoperative bleeding and adhesion formation are the two most common complications after endoscopic sinus surgery (ESS). The former sometimes can be life threatening and the latter is the most common reason requiring revision surgery. This study was designed to evaluate the effect of newly developed chitosan gel (8% carboxymethyl chitosan, Surgi shield) on hemostasis and wound healing after ESS.
METHODS
A prospective, randomized, double-blind controlled trial was conducted in 33 patients undergoing symmetric ESS. At the conclusion of the operation, Surgi shield was randomly applied on one side of the nasal cavity, with the opposite side acting as control and the bleeding quantity of the surgical field was evaluated every 2 minutes. And then, Merocel was placed in the ethmoidectomized areas of the both sides. Five milliliters of Surgi shield was applied to the Merocel of intervention side and saline was applied to the other side. Merocel in both nasal cavities was removed and 5 mL of Surgi shield was applied again to the intervention side on the second day after surgery. The nasal cavity was examined using a nasal endoscope and the degree of adhesion, crusting, mucosal edema, infection, and granulations were graded at 1, 2, and 4 weeks after surgery.
RESULTS
Complete hemostasis was rapidly achieved in the Surgi shield applied side compared with the control side at 2, 4, 6, 8, and 10 minutes after application of Surgi shield (P#x0003d;0.007, P#x0003d;0.004, P<0.001, P#x0003d;0.001, and P<0.001, respectively). There were significantly less adhesions on the Surgi shield applied side at postoperative 1, 2, and 4 weeks (P#x0003d;0.001, P<0.001, and P<0.001, respectively). The degree of mucosal edema, infection, crusting, or granulation formation assessed by the endoscopic features in the Surgi shield applied side was not significantly different from that of the control side (P>0.05). No adverse effects were noted in the patient series.
CONCLUSION
Surgi shield containing chitosan can be used safely to achieve rapid hemostasis immediately after ESS and to prevent adhesion formation.

Keyword

Chitosan; Endoscopy; Wound Healing; Hemostasis; Adverse Effects

MeSH Terms

Chitosan*
Edema
Endoscopes
Endoscopy
Hemorrhage
Hemostasis*
Humans
Nasal Cavity
Prospective Studies
Wound Healing
Chitosan

Figure

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  Fig. 1. Surgi shield (D. med, Seoul, Korea) contained in a syringe.

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  Fig. 2. Mean value of Boezaart scores after completion of surgery. Hemostasis was more rapidly achieved on the Surgi shield (chitosan; D. med, Seoul, Korea) applied side (solid line) than on the control side (dotted line) from 2 minutes after application of Surgi shield (P<0.05).

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