The judgement of adhesion formation following laparoscopic and conventional cholecystectomy in an animal model.
BACKGROUND
The development of postoperative adhesions remains an almost inevitable consequence of visceral and gynaecologic surgery, appearing in 50-95% of all patients. Although decreased adhesion formation is one of the accepted advantages of laparoscopic surgery, only a small number of prospective studies have been done to support this claim.


OBJECTIVE
To evaluate the extent of postoperative adhesion formation after laparoscopic and open cholecystectomy.


METHODS
60 experimental laparoscopic cholecystectomies (LC) were performed by qualified surgeons in dogs with the aim to acquire the laparoscopic technique. To assess the relation between the complications during the operation (bleeding, injury to the liver substance or gallbladder perforation) and the formation of adhesions, the surviving animals were divided into 4 groups according to the complications occurred. The assessment of the results was made by second--look laparoscopy 4 weeks following LC using the adhesion index. As a control group open cholecystectomy was then performed in 5 dogs without intraoperative complications.


RESULTS
No adhesion formation was observed in the groups where no intraoperative complications occurred. In all the cases where bleeding or injury to the liver bed occurred adhesion formation occurred. No adhesion formation was observed in case of gallbladder perforation. In all the animals of the control group adhesion formation was observed.


CONCLUSIONS
It seems that LC has a reduced rate of adhesion formation when compared with the open technique. Complications such as bleeding or injury to the liver substance during LC can enhance adhesion formation. No adhesion formation can be mentioned in relation with gallbladder perforation when the laparoscopic technique is applied.
Gamal
E M
EM
Department of Surgery, Haynal Imre University for Health Sciences, Budapest, Hungary.
Metzger
P
P
Mikó
I
I
Szabó
G
G
Bráth
E
E
Kiss
J
J
Furka
I
I
D000276:Adjuvants, Immunologic / Q000008:administration & dosage; D000818:Animals; D002483:Cellulose, Oxidized / Q000008:administration & dosage; D002763:Cholecystectomy / Q000009:adverse effects; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D004285:Dogs; D006820:Hyaluronic Acid / Q000008:administration & dosage; D007552:Isotonic Solutions / Q000008:administration & dosage; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D011446:Prospective Studies; D000077325:Ringer's Lactate; D000267:Tissue Adhesions / Q000209:etiology* / Q000517:prevention & control
D000276:Adjuvants, Immunologic; D002483:Cellulose, Oxidized; C060002:INTERCEED; D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D006820:Hyaluronic Acid