Effect of upper abdomen tissue manipulation on adhesion formation between injured areas in a laparoscopic mouse model.
OBJECTIVE
These experiments were designed to examine the effect of manipulation during surgery as a cofactor in adhesion formation at trauma sites.


METHODS
Randomized, controlled trial. Canadian Task Force Classification-class 1.


METHODS
University laboratory research center.


METHODS
A standardized laparoscopic mouse model (Balb\c mice 9-10 weeks old) for adhesion formation after opposing bipolar lesions and 60 minutes of carbon-dioxide pneumoperitoneum. In this model adhesions are known to decrease after the addition of 3% of oxygen, dexamethasone, or both. In addition, adhesions decrease with experience (i.e., with a decreasing amount of manipulation during the learning curve).


METHODS
A factorial design was used to evaluate the effects of dexamethasone and of adding 3% of oxygen on manipulation-enhanced adhesion formation during a learning curve. Blocks of 4 animals were thus randomized as controls (carbon-dioxide pneumoperitoneum only) or received an additional 3% of oxygen, dexamethasone, or both. In a second experiment, the effects of manipulation on adhesion formation were quantified. In a third experiment we evaluated whether dexamethasone had a specific effect on manipulation-enhanced adhesion formation.


RESULTS
Qualitative and quantitative adhesion scoring 7 days after the intervention. The first experiment confirmed that adhesion formation decreased during the learning curve (p <.0001) and after the addition of dexamethasone whether assessed as the total adhesion score (p <.0001 and p =.0009, respectively) or a quantitative score (p <.0001 and p <.0001, respectively). The second experiment showed that adhesion formation increased by standardized touching and grasping of omentum and bowels (proportion score p =.0059 and p =.0003, respectively) and this effect increased with duration of touching (p =.0301). In the third experiment, dexamethasone was confirmed to decreased adhesion formation (p =.0001) but this effect was not specific for manipulation-enhanced adhesion formation.


CONCLUSIONS
Manipulation of intraperitoneal organs in the upper abdomen enhances adhesion formation at trauma sites, confirming that the peritoneal cavity is a cofactor in adhesion formation. Dexamethasone decreases adhesion formation but the effect is not specific for manipulation-enhanced adhesion formation.
Schonman
Ron
R
Department of Obstetrics and Gynecology at the University Hospital Gasthuisberg, Leuven, Belgium. ronschonman@gmail.com
Corona
Roberta
R
Bastidas
Adriana
A
De Cicco
Carlo
C
Koninckx
Philippe Robert
PR
D034861:Abdominal Wall / Q000601:surgery*; D000818:Animals; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002983:Clinical Competence; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods*; D051379:Mice; D008807:Mice, Inbred BALB C; D010100:Oxygen / Q000627:therapeutic use; D010529:Peritoneal Cavity / Q000601:surgery*; D010532:Peritoneal Diseases / Q000209:etiology* / Q000517:prevention & control; D011028:Pneumoperitoneum, Artificial; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone; D010100:Oxygen