Effect of adding more than 3% oxygen to carbon dioxide pneumoperitoneum on adhesion formation in a laparoscopic mouse model

Effect of reactive oxygen species scavengers, antiinflammatory drugs, and calcium-channel blockers on carbon dioxide pneumoperitoneum-enhanced adhesions in a laparoscopic mouse model

“…This also led to new concepts of adhesion prevention such as the addition of 3% oxygen to the pneumoperitoneum [76,77], the use of anti-VEGF-R1 antibodies [48], using anti-PiGF antibodies [72], and lowering of body temperature [74]. In this model, we demonstrated that avoidance of desiccation prevented adhesion formation [75], whereas the addition of more than 3% oxygen to the pneumoperitoneum increased adhesions [77]. This led to the hypothesis that ROS could be another cofactor in adhesion formation [78].…”

Prevention of adhesion in laparoscopic gynaecological surgery

“…17 In a rodent model, hypoxiainduced adhesion formation was decreased by adding 3% oxygen to the carbon dioxide pneumoperitoneum. 18 Laparoscopy was long regarded as less adhesiogenic than laparotomy due to its less invasive nature. Research as noted above, offers an explanation why this hypothesis must be rejected, because the laparoscopic environment itself unfavourably influences adhesion formation.…”

Angiogenic factors in peritoneal adhesion formation

“…However, the roles of all these molecules, specifically in the peritoneal biology and in the adhesion formation process, remain speculative to a large extent. Recently a specific adhesion phenotype has been reported, describing the substantial differences between the adhesion peritoneum and the apparently normal adjacent peritoneum [57], an observation that may be crucial for prevention of adhesion reformation (type 2 adhesions).…”

“…CO 2 pneumoperitoneum for laparoscopy and air for laparotomy, to fully understand the intrinsic mechanisms involved. These observations should not be underestimated since environment-related factors such as hypoxia , hyperoxia [58,59], desiccation and hypothermia [60,61] could modulate every stage of the adhesion formation process in different ways. Indeed, we have initially postulated that the CO 2 pneumoperitoneum induces peritoneal hypoxia by compressing the capillary flow at the time of insufflation, which could enhance the formation of adhesions.…”