Laparoscopy versus laparotomy: an evaluation of adhesion formation after pelvic and paraaortic lymphadenectomy in a porcine model.
OBJECTIVE
Our purpose was to determine whether there is a difference in adhesion formation after pelvic and paraaortic lymphadenectomy with transperitoneal laparoscopy compared with both extraperitoneal laparotomy and transperitoneal laparotomy in a porcine model.


METHODS
Ninety female hogs underwent pelvic and paraaortic lymphadenectomy: 40 with transperitoneal laparoscopy, 40 with extraperitoneal laparotomy, and 10 with transperitoneal laparotomy. Three weeks after the initial surgery, a laparotomy was performed to assess adhesion formation.


RESULTS
The transperitoneal laparotomy group had significantly higher adhesion formation, with a 100% (10 of 10) adhesion rate. In the transperitoneal laparoscopy group, 12 of 40 hogs (30%) had adhesions develop versus 8 of 38 (21%) in the extraperitoneal laparotomy group (p = not significant). Also no differences were found in the transperitoneal laparoscopy and extraperitoneal laparotomy groups when comparing adhesion thickness or the total surface area of adhesions. More anterior abdominal wall adhesions were noted in the extraperitoneal laparotomy group (5 of 38) than in the transperitoneal laparoscopy group (0 of 40, p = 0.02).


CONCLUSIONS
Pelvic and paraaortic lymphadenectomy performed with transperitoneal laparoscopy does not increase adhesion formation when compared with extraperitoneal laparotomy in a porcine model. The transperitoneal laparoscopy (and extraperitoneal laparotomy) approach also induces significantly fewer adhesions than transperitoneal laparotomy.
Chen
M D
MD
Department of Obstetrics and Gynecology, University of Minnesota, Minneapolis 55455, USA.
Teigen
G A
GA
Reynolds
H T
HT
Johnson
P R
PR
Fowler
J M
JM
D000818:Animals; D001011:Aorta; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007813:Laparotomy / Q000379:methods; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000379:methods*; D010388:Pelvis; D013552:Swine; D000267:Tissue Adhesions / Q000175:diagnosis / Q000209:etiology*