title: Adhesion formation in intubated rabbits increases with high insufflation pressure during endoscopic surgery.
abstract: The aim of the study was to test the hypothesis that the increase in adhesion formation by CO(2) pneumoperitoneum is caused by mesothelial hypoxaemia. Therefore the effect of the intra-abdominal pressure together with the flow rate upon adhesion formation was evaluated in rabbits following laser and bipolar lesions during endoscopic surgery using humidified CO(2) at 35 +/- 1 degrees C. The intra-abdominal pressure and flow rate were 5 mmHg and 1 l/min in group 1 (n = 5), 5 mmHg and 10 l/min in group 2 (n = 4), 20 mmHg and 1 l/min in group 3 (n = 5) and 20 mmHg and 10 l/min in group 4 (n = 4) respectively. A rapid and reliable intubation method for rabbits was developed to permit high insufflation pressure. By two-way analysis of variance, total adhesion scores following a laser lesion increased with flow rate (P = 0.0003) and insufflation pressure (P = 0.002). Total adhesion scores of bipolar lesions increased with pressure (P = 0.02) but not with flow rate (P = 0.1). The total adhesion scores of laser and bipolar lesions together increased with flow rate (P = 0.005) and with insufflation pressure (P = 0.004). There was no statistical interaction between flow rate and insufflation pressure. In conclusion, the insufflation pressure in endoscopic surgery with CO(2) pneumoperitoneum is a co-factor in adhesion formation, together with desiccation.
authors.affiliation: Centre for Surgical Technologies, Catholic University of Leuven, Belgium.
authors.forename: N
authors.initials: N
authors.lastname: Yesildaglar
authors.forename: P R
authors.initials: PR
authors.lastname: Koninckx
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D002245:Carbon Dioxide; D005260:Female; D000860:Hypoxia / Q000209:etiology; D007440:Intubation; D010535:Laparoscopy / Q000009:adverse effects*; D010532:Peritoneal Diseases / Q000209:etiology / Q000473:pathology*; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects* / Q000379:methods; D011817:Rabbits; D000267:Tissue Adhesions / Q000209:etiology
chemical_list: D002245:Carbon Dioxide