Comparison of adhesion reformation after laparoscopic and conventional adhesiolysis in an animal model

Abstract.

This study set out to compare adhesion reformation after conventional and laparoscopic adhesiolysis using two different laparoscopic dissection techniques. In a first operation, 36 rabbits underwent fixation of 6 cm² of the cecum with the serosa removed to the lateral abdominal wall to induce standardized adhesions. After 4 weeks, adhesiolysis was performed laparoscopically (n=12) or via laparotomy (n=12) using sharp and blunt dissection. In a third group (n=12), laparoscopic adhesiolysis was performed using monopolar electrocautery. Outcome was assessed by incidence, extent, and localization of adhesion reformation. After conventional adhesiolysis, all rabbits developed new adhesions relative to 79% after laparoscopic adhesiolysis. The extent of reformed adhesions (median) was greater after conventional adhesiolysis than laparoscopic adhesiolysis (2725 mm² vs 230 mm², P<0.001). The latter did not differ significantly from laparoscopic adhesiolysis by electrocautery (310 mm²). There were small adhesions to 3 of 72 trocar wounds, but extensive adhesions to 33% of the abdominal incisions were found in the conventional group. In this standardized experimental setting, laparoscopic adhesiolysis is associated with a significantly reduced reformation of adhesions. Different laparoscopic dissection techniques have no significant influence on the extent of adhesion reformation.