[How do intraoperative complications effect adhesion formation after laparoscopic cholecystectomy: a comparative animal study].
BACKGROUND
The aim of this study was to evaluate the extent of postoperative formation of adhesions following laparoscopic and open cholecystectomy.


METHODS
60 experimental laparoscopic cholecystectomies (LC) were performed in dogs by qualified surgeons to learn laparoscopic technique. To assess the relationship between complications occurred during the operation (bleeding, laceration of the liver bed or gallbladder perforation) and the formation of adhesions surviving animals were divided into 4 groups according to the type of complication. We assessed the results during second-look laparoscopy 4 weeks following LC using the adhesion index (AI: 0-4 score). Animals were then sacrificed to measure the extent of adhesions. As a control group open cholecystectomy was performed in 15 dogs without intraoperative complications. Mann-Whitney Rank Sum test and Dunn's Method were used for statistical analysis.


RESULTS
No adhesions were observed in the laparoscopic group without intraoperative complications. In all dogs with bleeding or laceration of the liver bed maintained by electrocoagulation, adhesions developed. Formation of adhesion in these groups was significantly higher than in "ideal LC" or in case of gallbladder perforation (P < 0.01). All animals in the control group developed significantly more adhesions compared to the experimental group (p < 0.05).


CONCLUSIONS
LC produces less adhesion compared to conventional open technique. Complications such as bleeding or laceration of the liver bed during LC can increase the formation of adhesions. No formation of adhesions can be related to gallbladder perforation during LC.
Gamal
E M
EM
Semmelweis Egyetem Egészségtudományi Kar Sebészeti Klinika, 1135 Budapest, Szabolcs u. 35. gamal@mail.hiete.hu
Metzger
P
P
Szabó
G
G
Bráth
E
E
Seli
A
A
Ender
F
F
Polányi
C
C
Furka
I
I
Mikó
I
I
D000818:Animals; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D004285:Dogs; D007431:Intraoperative Complications; D000267:Tissue Adhesions / Q000209:etiology*