Comparison of adhesion reformation after laparoscopic and conventional adhesiolysis in an animal model.
This study set out to compare adhesion reformation after conventional and laparoscopic adhesiolysis using two different laparoscopic dissection techniques. In a first operation, 36 rabbits underwent fixation of 6 cm2 of the cecum with the serosa removed to the lateral abdominal wall to induce standardized adhesions. After 4 weeks, adhesiolysis was performed laparoscopically (n = 12) or via laparotomy (n = 12) using sharp and blunt dissection. In a third group (n = 12), laparoscopic adhesiolysis was performed using monopolar electrocautery. Outcome was assessed by incidence, extent, and localization of adhesion reformation. After conventional adhesiolysis, all rabbits developed new adhesions relative to 79% after laparoscopic adhesiolysis. The extent of reformed adhesions (median) was greater after conventional adhesiolysis than laparoscopic adhesiolysis (2725 mm2 vs 230 mm2, P < 0.001). The latter did not differ significantly from laparoscopic adhesiolysis by electrocautery (310 mm2). There were small adhesions to 3 of 72 trocar wounds, but extensive adhesions to 33% of the abdominal incisions were found in the conventional group. In this standardized experimental setting, laparoscopic adhesiolysis is associated with a significantly reduced reformation of adhesions. Different laparoscopic dissection techniques have no significant influence on the extent of adhesion reformation.
Tittel
A
A
Department of Surgery, Technical University, Pauwelsstrasse 30, D-52074 Aachen, Germany. andreas.tittel@post.rwth-aachen.de
Treutner
K H
KH
Titkova
S
S
Ottinger
A
A
Schumpelick
V
V
D000005:Abdomen; D000818:Animals; D004564:Electrocoagulation; D010535:Laparoscopy / Q000379:methods*; D011817:Rabbits; D011897:Random Allocation; D012008:Recurrence; D018709:Statistics, Nonparametric; D000267:Tissue Adhesions / Q000601:surgery*