To perform operative procedures in an optimized local atmosphere: can it reduce post-operative adhesion formation?
BACKGROUND
Adhesion formation is a major problem following abdominal surgery as it creates a considerable economic burden in addition to an increased risk for complications. In the present study, an effort was made to reduce post-operative adhesion formation by creating an artificial atmosphere within and around the abdominal cavity during an open surgical procedure.


METHODS
82 Wistar male rats (Clr:WI) (200 gr, 7 weeks) were randomized into two groups. The abdominal cavity of the control group was exposed to the normal atmosphere of the operating-theatre during surgery (21% O₂, 21 °C, 40-47% relative humidity (RH)), while the abdominal cavity of the study group was exposed to an artificial atmosphere during surgery (3-6% O₂, >75% CO₂, 95-100% RH, 37 °C). Adhesion induction consisted of a laparotomy along linea-alba, four lesions in the anterior abdominal-wall, blood from the tail vein dripped inside the abdominal cavity and exposure to the atmosphere around the wound by use of self-retaining retractors. In addition, a liquid-sample for quantitative bacteriologic cultivation and bacterial load (CFU/ml) calculation was taken just before closure. After 3 weeks the abdominal cavity was scored for the extent, tenacity and severity of adhesions before the rats were euthanized. The two-sample-Wilcoxon-rank-sum test was used in the analysis.


RESULTS
Highly significant differences in postoperative total adhesion score, extent-, severity- and tenacity-score were found (P < 0.01). No differences were found between the two groups regarding mean bacterial load (P > 0.05).


CONCLUSIONS
The rats exposed to the warmed and humidified artificial atmosphere consisting of more than 75% carbon dioxide and 3-4% oxygen during surgery had more severe and more post-operative adhesions compared to the rats that were exposed to the ambient air during surgery.
Norwegian University of Science and Technology (NTNU), Department of Cancer Research and Molecular Medicine, Trondheim, Norway. Electronic address: Arildwie@stud.ntnu.no.
Arild
A
de Vries
Ronald
R
Mårvik
Esther
E
Kuhry
D034841:Abdominal Cavity / Q000601:surgery*; D000818:Animals; D002245:Carbon Dioxide; D004195:Disease Models, Animal; D006813:Humidity; D008297:Male; D011897:Random Allocation; D051381:Rats; D017208:Rats, Wistar; D018709:Statistics, Nonparametric; D000267:Tissue Adhesions / Q000453:epidemiology / Q000503:physiopathology*
D002245:Carbon Dioxide
Adhesion formation; Adhesions; Carbon dioxide; Humidified; Peritoneum; Warmed