The impact of conventional and laparoscopic colon resection (CO2 or helium) on intraperitoneal adhesion formation in a rat peritonitis model.
BACKGROUND
Although postoperative intra-abdominal adhesion formation has been shown to be less with laparoscopic procedures than with open surgery, the extent of intraperitoneal adhesion formation after open and laparoscopic colon resection in patients with intra-abdominal infection remains unclear.


METHODS
A standardized fecal inoculum was intraperitoneally applied in 72 rats to induce peritonitis. The rats were randomized into four groups. The three experimental groups underwent laparoscopic resection of the cecum with carbon dioxide (n = 20) or helium (n = 20) insufflation at a pressure of 8 mmHg, or conventional open cecum resection (n = 20). In the control group, no further manipulations were performed after induction of the peritonitis (n = 12). Blood samples were taken during the perioperative course to determine the plasma levels of tumor necrosis factor-alpha (TNF-alpha) and interleukin-10 (IL-10). The number of intraperitoneal adhesions and the bacterial species of peritoneal swabs were determined in each animal.


RESULTS
The adhesions were increased in all operation groups as compared with the control group. The number of adhesions was significantly greater after conventional resection than after laparoscopic approaches (p < 0.01). The overall adhesion score was significantly lower in the helium group (p < 0.05) than in the two other operation groups. There was no difference between the laparotomy and carbon dioxide groups. Whereas postoperative TNF-alpha plasma levels were decreased, IL-10 levels were significantly greater in the helium group than in the other three groups.


CONCLUSIONS
Intraperitoneal infection is reducing the benefit of laparoscopic surgery regarding postoperative adhesions. Although laparoscopic resection showed an advantage in the number of adhesions with both gases, the total adhesion score was lowest in the helium group.
Jacobi
C A
CA
Department of General, Visceral, Vascular, and Thoracic Surgery, Charite, Humboldt-University of Berlin, Schumann Strasse 20/21, D-10098 Berlin, Germany. christoph.jacobi@charite.de
Sterzel
A
A
Braumann
C
C
Halle
E
E
Stösslein
R
R
Krähenbühl
L
L
Müller
J M
JM
D000818:Animals; D002245:Carbon Dioxide / Q000008:administration & dosage; D002432:Cecum / Q000601:surgery; D003082:Colectomy / Q000379:methods*; D004195:Disease Models, Animal; D006371:Helium / Q000008:administration & dosage; D007327:Insufflation; D016753:Interleukin-10 / Q000097:blood; D010535:Laparoscopy / Q000379:methods*; D010538:Peritonitis / Q000097:blood / Q000150:complications*; D011183:Postoperative Complications / Q000209:etiology*; D051381:Rats; D000267:Tissue Adhesions / Q000097:blood / Q000209:etiology; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D002245:Carbon Dioxide; D006371:Helium