title: Comparison of adhesion reformation after laparoscopic and conventional adhesiolysis in an animal model.
abstract: 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.
authors.affiliation: Department of Surgery, Technical University, Pauwelsstrasse 30, D-52074 Aachen, Germany. andreas.tittel@post.rwth-aachen.de
authors.forename: A
authors.initials: A
authors.lastname: Tittel
authors.forename: K H
authors.initials: KH
authors.lastname: Treutner
authors.forename: S
authors.initials: S
authors.lastname: Titkova
authors.forename: A
authors.initials: A
authors.lastname: Ottinger
authors.forename: V
authors.initials: V
authors.lastname: Schumpelick
mesh_terms: 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*