Carbon dioxide pneumoperitoneum prevents intraperitoneal adhesions after laparotomy in rats

Miyano, Go; Yamataka, Atsuyuki; Doi, Takashi; Okawada, Manabu; Takano, Yoichi; Kobayashi, Hiroyuki; Lane, Geoffrey J.; Miyano, Takeshi

doi:10.1016/j.jpedsurg.2005.12.048

Cited by 12 publications

(8 citation statements)

References 7 publications

(7 reference statements)

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“…From this, a large body of literature has sprung studying the pathophysiologic mechanisms of CO 2 -pneumoperitoneum induced systemic alterations such as respiratory, cardiovascular and blood gas, acid base parameters changes, as well as local disturbances in the peritoneal cavity such as decreased peritoneal pH and blood circulatory deteriorations with mesothelial hypoxemia during laparoscopic surgery [24-29]. The discussion has polarised: some claim these changes have a crucial impact on postsurgical complications such as adhesion formation and port-site cancer metastasis [30-34] others say these changes have no or little impact on postsurgical complications [16,17,28,29]. …”

Section: Discussionmentioning

confidence: 99%

Severe inflammatory reaction induced by peritoneal trauma is the key driving mechanism of postoperative adhesion formation

et al. 2011

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BackgroundMany factors have been put forward as a driving mechanism of surgery-triggered adhesion formation (AF). In this study, we underline the key role of specific surgical trauma related with open surgery (OS) and laparoscopic (LS) conditions in postoperative AF and we aimed to study peritoneal tissue inflammatory reaction (TIR), remodelling specific complications of open surgery (OS) versus LS and subsequently evaluating AF induced by these conditions.MethodsA prospective randomized study was done in 80 anaesthetised female Wistar rats divided equally into 2 groups. Specific traumatic OS conditions were induced by midline incision line (MIL) extension and tissue drying and specific LS conditions were remodelled by intraperitoneal CO2 insufflation at the 10 cm of water. TIR was evaluated at the 24th, 72nd, 120th and 168th hour by scoring scale. Statistical analysis was performed by the non-parametric t test and two-way ANOVA using Bonferroni post-tests.ResultsMore pronounced residual TIR was registered after OS than after LS. There were no significant TIR interactions though highly significant differences were observed between the OS and LS groups (p < 0.0001) with regard to surgical and time factors. The TIR change differences between the OS and LS groups were pronounced with postoperative time p < 0.05 at the 24th and 72nd; p < 0.01 - 120th and p < 0.001 - 168th hrs. Adhesion free wounds were observed in 20.0 and 31.0% of cases after creation of OS and LS conditions respectively; with no significant differences between these values (p > 0.05). However larger adhesion size (41.67 ± 33.63) was observed after OS in comparison with LS (20.31 ± 16.38). The upper-lower 95% confidential limits ranged from 60.29 to 23.04 and from 29.04 to 11.59 respectively after OS and LS groups with significant differences (p = 0.03). Analogous changes were observed in adhesion severity values. Subsequently, severe TIR parameters were followed by larger sizes of severe postoperative adhesions in the OS group than those observed in the LS group.ConclusionsMIL extension and tissue drying seem to be the key factors in the pathogenesis of adhesion formation, triggering severe inflammatory reactions of the peritoneal tissue surrounding the MIL resulting in local and systemic consequences. CO2 insufflation however, led to moderate inflammation and less adhesion formation.

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Section: Discussionmentioning

confidence: 99%

Severe inflammatory reaction induced by peritoneal trauma is the key driving mechanism of postoperative adhesion formation

et al. 2011

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“…1,13 An inhibitory effect of the CO 2 pneumoperitoneum on adhesion formation may explain this shift in the etiology of bowel obstructions. 14 Recently, Kavic reviewed other potential reasons why laparoscopic surgery may decrease adhesion rates including a decrease in the size of surgical wounds, reduced intraabdominal contact with foreign bodies, 15 maintenance of tissue in a humid environment, less tissue trauma and hemorrhage, pneumoperitoneum to separate tissue surfaces, and the ability to visualize the entire abdominal cavity and evaluate inflammatory changes. 16 In his review, he reported that the majority of studies indicate that laparoscopy may reduce postoperative adhesion formation relative to laparotomy.…”

Section: Discussionmentioning

confidence: 99%

Failure of Mesenteric Defect Closure After Roux-en-Y Gastric Bypass

Hope

Sing

Chen

et al. 2010

JSLS

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“…Some efficacy in humans without negative side effects (n ¼ 34) [195] Some efficacy in rat and rabbit models [196][197][198][199][200] Reduced size, strength, and number of adhesions [196] More effective than hyaluronic acid in rat model [196] No effect on bowel anastomosis healing [197] Some efficacy in rats [204] Caused no abnormal histopathology in rats [204] Would not work in open procedures Heated-humidified CO 2 (during laparoscopy)…”

Section: Surgical and Noninvasive Strategiesmentioning

confidence: 99%