The influence of intraoperative complications on adhesion formation during laparoscopic and conventional cholecystectomy in an animal model.
BACKGROUND
The aim of this study was to evaluate the extent of postoperative adhesion formation after laparoscopic and open cholecystectomy.


METHODS
Qualified surgeons performed 60 experimental laparoscopic cholecystectomies (LC) in dogs with the aim to acquire the laparoscopic technique. To assess the relation between the complications during the operation (bleeding, laceration of the liver bed, or gallbladder perforation) and the formation of adhesions, surviving animals were divided into four groups according to the type of complication occurred. Assessment of the results was made by second-look laparoscopy 4 weeks after LC using the adhesion index (AI; score range, 0-4). The animals then were killed so the extent of adhesion formation could be measured. As a control, open cholecystectomy was performed in 15 dogs without intraoperative complications. The Mann-Whitney rank-sum test and Dunn's method were used for statistical analysis.


RESULTS
No adhesion formation or intraoperative complications were registered in the laparoscopic group I. In all the cases wherein bleeding or laceration of the liver bed occurred and was managed with electrocoagulation, adhesions formed. Adhesion formation in these groups was significantly higher than in "ideal LC" or cases of gallbladder perforation alone (p < 0.01). All the animals in the control group developed significantly more adhesions than those in the experimental group (p < 0.05).


CONCLUSIONS
It seems that LC has a lower rate of adhesion formation than the conventional open technique. Complications such as bleeding or laceration of the liver bed during LC can enhance adhesion formation. No adhesion formation can be mentioned in relation to gallbladder perforation during LC.
Gamal
E M
EM
Department of Surgery, Faculty of Health Sciences, Semmelweis University Budapest, 1135 Budapest, Szabolcs u. 35, Hungary. gamal@mail.hiete.hu
Metzger
P
P
Szabó
G
G
Bráth
E
E
Petõ
K
K
Oláh
A
A
Kiss
J
J
Furka
I
I
Mikó
I
I
D000818:Animals; D016063:Blood Loss, Surgical; D002763:Cholecystectomy / Q000009:adverse effects*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D004285:Dogs; D005260:Female; D005704:Gallbladder / Q000293:injuries; D007431:Intraoperative Complications; D022125:Lacerations / Q000209:etiology; D008099:Liver / Q000293:injuries; D011446:Prospective Studies; D000267:Tissue Adhesions / Q000209:etiology*