Aim: The purpose of the study was to compare adhesions following laparoscopic and conventional operations. Methods: In 14 dogs cecal resection and a deserosation of the abdominal wall were performed laparoscopically (n = 7) or by laparotomy (n = 7). After 8 days all dogs were reexamined and the adhesions were quantified by computer-aided measurements. The significance of any differences were tested using Student’s t test. Results: The extent of adhesions after laparoscopy (630 ± 360 mm²) and after laparotomy (3,300 ± 1,007 mm²) differed significantly (p < 0.0001). Extensive adhesions to the abdominal incision and interenteric adhesions were found after conventional operations. Identical manipulations, such as cecal resection or deserosation of the lateral wall, led to the same frequency and extent of adhesions in both operation groups. Conclusion: Laparoscopic procedures are associated with significantly less adhesions in comparison to conventional operations. Therefore the risk of adhesion-related complications should be reduced after laparoscopic operations.

No 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.

This study aimed to compare new adhesion formation after laparoscopic and conventional adhesiolysis. In a first operation, 24 rabbits underwent fixation of deserosated cecum (6 cm2) to the lateral abdominal wall to induce standardized adhesions. After 4 weeks, adhesiolysis was performed by laparoscopy (n = 12) or laparotomy (n = 12). Outcome was assessed by the incidence, extent, and location of adhesion reformation. After conventional adhesiolysis, new adhesions developed in all the rabbits, as compared with 75% after laparoscopic adhesiolysis. The extent of newly formed adhesions was significantly reduced (p < 0.001) after laparoscopic adhesiolysis (368+/-115 mm2) as compared with conventional adhesiolysis (2434+/-245 mm2). There were no adhesions to trocar wounds, but adhesions to the abdominal incision were found in 33% of the conventional group. In a rabbit model comparing laparoscopic and conventional adhesiolysis in a standardized experimental setting, laparoscopic adhesiolysis is associated with a significantly reduced formation of new postoperative adhesions.

The definitive closure of the abdominal wall, i.e., a closure of the fascial layer and skin may not be favorable in the treatment of numerous surgical conditions, e.g., peritonitis, trauma, or mesenteric ischemia. In these cases, the abdominal wall is temporarily closed, and a laparostomy is created to facilitate re-exploration or to prevent abdominal compartment syndrome. Regarding the technique and material used for the temporary closure, no prospective randomized data exists, but mesh materials are commonly used. They provide drainage of infectious material, permit visual control of the underlying viscera, facilitate access to the abdominal wall, preserve the fascial margin, enable healing by secondary intention, and allow mobilization of the patient. In the case of decreasing intra-abdominal pressure, meshes can be trimmed to centralize the rectus muscle and to facilitate definitive closure. Non-absorbable meshes have been frequently reported to cause enteric fistulae and persistent infection necessitating mesh explantation. While these infectious complications appear to occur less frequently with the use of absorbable materials, these meshes will finally lead to an incisional hernia, requiring repair with non-absorbable mesh after a period of 6-12 months. Nevertheless, in the complex situation requiring a temporary abdominal wall closure, use of absorbable mesh material is common and represents the state of the art.

The colonic J-pouch reconstruction results in better functional outcome than side-to-end coloanal anastomosis. Our results show that pouch evacuation is passive and independent from pouch motility. The functional principle of the colonic J-pouch is not its reservoir function but a delay of colonic motility.

The purpose of this study was to observe electromyographic activity of stomach, small bowel, and colon during and early after identical laparoscopic and conventional operations to compare the operative trauma. In nine dogs a cholecystectomy was performed laparoscopically (n = 5) or by laparotomy (n = 4). Analysis of electromyographic activity focused on rhythm, frequency, and amplitudes of slow waves. Furthermore, oxygenation of blood and tissue, intestinal impedance, intraabdominal humidity, and temperature were documented to investigate their influence on slow waves. Open cholecystectomy caused an evident decrease of frequency and amplitude of colonic slow waves in comparison to laparoscopic cholecystectomy. Arrhythmic slow waves were observed only in the stomach during conventional cholecystectomy. Stomach and small intestine showed no significant difference of frequency and amplitude of slow waves in both operation groups. Intraabdominal humidity and intestinal impedance differed significantly in laparoscopy and laparotomy. Laparoscopic cholecystectomy proceeded with a minor abdominal trauma documented by smaller alterations of slow waves. This may be caused by reduced peritoneal desiccation.

Straight coloanal anastomoses provide better anastomotic microcirculation after rectal resections than colonic-J-pouch anal anastomoses or side-to-end anastomoses. However this effect does not seem to be decisive for the prevention of anastomotic leaks.