De novo adhesions with extraperitoneal endosurgical para-aortic lymphadenectomy versus transperitoneal laparoscopic para-aortic lymphadenectomy: a randomized experimental study.
OBJECTIVE
The objective of this study was to compare the risk of adhesion formation and the site of postoperative adhesions after transperitoneal versus extraperitoneal laparoscopic para-aortic lymphadenectomy.


METHODS
A prospective study was conducted on 66 pigs, randomly allocated to 2 groups of 33 animals that underwent transperitoneal versus extraperitoneal laparoscopic para-aortic lymphadenectomy.


RESULTS
No statistically significant difference was observed between the 2 techniques in terms of operating time, number of lymph nodes removed, and intraoperative and postoperative morbidity. More lymphoceles were observed in the extraperitoneal laparoscopy group (P =.0002). The overall adhesion rates were 76% in the transperitoneal group and 43.33% in the extraperitoneal group (P =.04). The adhesion score specific to the operative site was lower in the extraperitoneal group (P =.0005). A stereolocalization study showed that almost all adhesions after transperitoneal laparoscopy were situated in the para-aortic external irradiation field, whereas adhesions after extraperitoneal laparoscopy were predominantly situated outside this field.


CONCLUSIONS
Extraperitoneal laparoscopy generates significantly fewer adhesions in the para-aortic irradiation field.
Occelli
B
B
Division of Gynecologic Oncology, Hôpital Jeanne de Flandre, 59037 Lille Cedex, France.
Narducci
F
F
Lanvin
D
D
Querleu
D
D
Coste
E
E
Castelain
B
B
Gibon
D
D
LeBlanc
E
E
D000818:Animals; D001011:Aorta; D005260:Female; D010535:Laparoscopy / Q000009:adverse effects*; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000379:methods*; D010537:Peritoneum; D011446:Prospective Studies; D013552:Swine; D000267:Tissue Adhesions / Q000453:epidemiology* / Q000209:etiology