Experimental study of adhesion formation in open and laparoscopic fundoplication

Krähenbühl, L.; Schäfer, Markus; Kuzinkovas, Vytauras; Renzulli, Pietro; Baer, H. U.; Büchler, Markus W.

doi:10.1046/j.1365-2168.1998.00718.x

Cited by 63 publications

(42 citation statements)

References 21 publications

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“…83 observaram menor formação de aderências no grupo submetido à laparoscopia quando comparado à cirurgia convencional, de forma que no primeiro grupo as aderências eram predominantemente parietais e mais finas, enquanto que no segundo, eram predominantemente viscerais e mais espessas.…”

Section: Impacto Da Via De Acesso Na Prevenção De Aderênciasunclassified

Impacto da vídeocirurgia na prevenção de aderências

Araújo

Caravatto

Chang

et al. 2006

Rev bras. colo-proctol.

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Uma das vantagens aventadas da vídeo-cirurgia é a possibilidade de formar menos aderências pós-operatórias. As evidências deste efeito resultam de trabalhos clínicos e experimentais, mas o real impacto desta via de acesso neste sentido ainda não foi comprovado. O objetivo da presente revisão foi avaliar as evidências científicas disponíveis sobre o assunto. Material e Métodos: revisão da literatura pertinente. Resultados: As aderências pós-operatórias foram analisadas no sítio da operação e nas incisões praticadas, porém existem poucas informações sobre aderências em locais não operados. Aderências pós-operatórias são menos freqüentes ou intensas quando se considera a via de acesso por vídeo. A despeito deste dado experimental, os desfechos clínicos de menor dor pélvica, menor número de admissões ou reoperações por obstrução intestinal e menor ocorrência de infertilidade ainda não podem ser claramente atribuídos a esta via de acesso, especialmente quando se consideram as cirurgias laparoscópicas avançadas, uma vez que nesta situação existe equivalência de área cruenta nas duas vias de acesso, à exceção da área associada às incisões. Conclusões: A via de acesso por vídeo está associada a menor formação de aderências, mas não protege de complicações relacionadas à sua ocorrência. Técnica operatória adequada e o uso de barreiras provavelmente estão mais fortemente associadas à menor formação de aderências do que a via de acesso aberta empregada para a realização das operações abdominais e pélvicas.
Laparoscopic surgery seems to be associated with less adhesion formation and complications associated to surgical access when compared to laparotomy. Experimental and clinical evidence confirm this hypothesis but the impact of laparoscopy on adhesion formation and its complications remains undetermined. The present article aims at reviewing the evidence on this issue. Method: literature review. Results: Postoperative adhesions were evaluated at operation site and at surgical scars. Nevertheless, results on adhesion formation at sites distant from them are still unavailable. Adhesion formation was less common or reduced when laparoscopic access was compared to conventional surgery. Main adverse outcomes regarding adhesion formation are pelvic pain, infertility, and intestinal obstruction. There is little evidence of reduced incidence of these adverse outcomes after laparoscopic surgery when compared to conventional access and there may be none at all when major laparoscopic operations are considered. This finding may be due to a similar extent of dissection after conventional or advanced video operations with the exception of the adhesions related to the incisions. Conclusions: Laparoscopic surgery is associated to less adhesion formation but may not protect from adverse outcomes expected after abdominal operations. Adequate surgical technique and the use of commercially available adhesion barriers may be major determinants from adhesions formation and its consequences

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Section: Impacto Da Via De Acesso Na Prevenção De Aderênciasunclassified

Impacto da vídeocirurgia na prevenção de aderências

Araújo

Caravatto

Chang

et al. 2006

Rev bras. colo-proctol.

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“…If different types were present, the highest type was scored. The severity of adhesion formation was calculated by multiplying extent and type of the adhesions [10, 21]. Regrowth is defined as new (recurrent) adhesion formation at sites, where adhesions were present at first evaluation.…”

Section: Methodsmentioning

confidence: 99%

“…Indeed, clinical and experimental studies have shown fewer adhesions after laparoscopic operations as compared with the open technique [6, 7, 8, 9, 10, 11, 12, 13, 14, 15]. …”

Section: Introductionmentioning

confidence: 99%

Reduction, Regrowth, and de novo Formation of Abdominal Adhesions after Laparoscopic Adhesiolysis: A Prospective Analysis

Swank

Hop²,

Jeekel³

2004

Dig Surg

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Aim: A significant reduction of abdominal adhesions at second-look relaparoscopy after adhesiolysis in patients with chronic abdominal pain. Methods: 368 patients underwent laparoscopic adhesiolysis because of chronic abdominal pain. Regrowth and de novo abdominal adhesions were determined in a qualitative and quantitative way in 24 patients who underwent a second-look re-laparoscopy because of recurrent pain after a mean period of 16 months after the first laparoscopic adhesiolysis. Reduction of incidence, extent, type, and severity of abdominal adhesions between organs and abdominal wall and de novo adhesion formation were determined. Results: Incidence (40 vs. 26), extent, type, and severity of abdominal adhesions between organs and abdominal wall are significantly reduced after laparoscopic adhesiolysis. After adhesiolysis of adhesions between organs themselves, no significant reduction could be demonstrated (incidence 40 vs. 32). De novo adhesions were present in 5 (5/24) patients. Conclusion: Laparoscopic adhesiolysis results in a significant reduction of adhesions between organs and abdominal wall, despite the occurrence of de novo adhesions in about 20% of the patients.

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“…17,[19][20][21][22][23][24][25][26] In this study most patients (94.4%) have a history of laparotomy. However there are not significant differences in PAI score based on previous surgical access (open vs laparoscopic, P=0.352).…”

Section: Figure 1 Peritoneal Adhesion Index (Pai)mentioning

confidence: 99%

Validation of peritoneal adhesion index as a standardized classification to universalize peritoneal adhesions definition

et al. 2017

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Peritoneal adhesion index (PAI) is a score based on appearance and distribution of peritoneal adhesions. The study aims to assess the validity of PAI in order to standardize the definition of peritoneal adhesions. The study includes an expert survey to assess the feasibility of the score and a prospective observational and multicenter trial to assess its validity. 96% of surgeons of the survey consider PAI a useful tool. From January 2013 to March 2015, 205 patients were enrolled to undergo a surgical intervention for bowel obstruction caused by peritoneal adhesions in 21 centers. PAI was significantly higher in the population with previous surgery (P=0.043) and in patients who underwent two previous surgical interventions, if compared to those with only one previous intervention (P=0.012). Length of surgery was significantly longer in patients with higher PAI (P<0.001). Patients with a higher PAI showed a clinically higher risk for early bowel re-obstruction and for early re-intervention. The AUC of the ROC curve for early re-occlusion is 0.8. PAI can be considered a feasible and useful score.

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Experimental study of adhesion formation in open and laparoscopic fundoplication

Abstract: These findings indicate that laparoscopic fundoplication in rats leads to less severe adhesions of a different type (parietal) compared with those seen in the open controls.

Cited by 63 publications

References 21 publications

Impacto da vídeocirurgia na prevenção de aderências

Impacto da vídeocirurgia na prevenção de aderências

Reduction, Regrowth, and de novo Formation of Abdominal Adhesions after Laparoscopic Adhesiolysis: A Prospective Analysis

Validation of peritoneal adhesion index as a standardized classification to universalize peritoneal adhesions definition

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