Open adhesiolysis is more effective in reducing adhesion reformation than laparoscopic adhesiolysis in an experimental model.
BACKGROUND
This study compared adhesion reformation after open and laparoscopic adhesiolysis in a rat model.


METHODS
Adhesions were induced by surgically creating ischaemic buttons on the peritoneal side wall. After 7 days the animals underwent laparoscopy with carbon dioxide insufflation or laparotomy to score and lyse adhesions. Peritoneal tissue and fluid were collected after 24 h in a subset of animals, and adhesion reformation was scored 7 days after lysis in the remainder. Tissue plasminogen activator (tPA), plasminogen activator inhibitor (PAI) 1, transforming growth factor (TGF) beta1 and tumour necrosis factor (TNF) alpha mRNA, and total fibrinolytic activity were assessed. The abdomen of non-operated animals was insufflated for 7, 15 or 30 min with carbon dioxide, after which tPA and PAI-1 mRNA and total fibrinolytic activity were measured.


RESULTS
Animals that underwent open adhesiolysis had 60 per cent fewer reformed adhesions than the laparoscopic adhesiolysis group (P < 0.001). There were no differences in tPA activity or tPA, PAI-1 and TNF-alpha mRNA between groups, but TGF-beta1 mRNA levels were significantly increased in the open group. Carbon dioxide insufflation did not affect peritoneal tPA activity.


CONCLUSIONS
Open adhesiolysis may be more beneficial in minimizing adhesion reformation in the management of adhesion-related complications.
Prushik
S G
SG
Department of Surgery, Boston University School of Medicine, 88 East Newton Street, Boston, Massachusetts 02118, USA.
Stucchi
A F
AF
Matteotti
R
R
Aarons
C B
CB
Reed
K L
KL
Gower
A C
AC
Becker
J M
JM
D000818:Animals; D002245:Carbon Dioxide / Q000494:pharmacology; D007327:Insufflation; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D056627:Peritoneal Fibrosis / Q000209:etiology / Q000378:metabolism; D017395:Plasminogen Activator Inhibitor 1 / Q000378:metabolism; D012333:RNA, Messenger / Q000378:metabolism; D051381:Rats; D017208:Rats, Wistar; D055502:Secondary Prevention; D000267:Tissue Adhesions / Q000517:prevention & control / Q000601:surgery*; D010959:Tissue Plasminogen Activator / Q000378:metabolism; D053773:Transforming Growth Factor beta1 / Q000378:metabolism; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D017395:Plasminogen Activator Inhibitor 1; D012333:RNA, Messenger; D053773:Transforming Growth Factor beta1; D014409:Tumor Necrosis Factor-alpha; D002245:Carbon Dioxide; D010959:Tissue Plasminogen Activator