ADHESION FORMATION AFTER LAPAROSCOPIC ANTERIOR RESECTION IN A PORCINEMODEL - A PILOT-STUDY

Although decreased adhesion formation is one of the accepted advantage s of laparoscopic colorectal surgery, no prospective studies have been done to support this claim. Therefore, we prospectively assessed adhe sion formation following laparoscopic anterior resection of the rectum in a porcine model. Five domestic female pigs underwent the procedure with a double-stapled intracorporeal anastomosis. After completion of the laparoscopic procedure, 50 cm of ileum was retrieved through the right lower port site. Controlled serosal abrasion of the antimesenter ic surface was performed using a fresh knife. The abraded loop was ret urned into the peritoneal cavity and the fascia closed at all port sit es. All animals underwent a midline laparotomy 3 weeks later to assess adhesions using a 0-3 score according to the density vascularity, and extent of adhesions, All animals survived the study period. The mean level of the anastomosis was 8 cm (range, 7-10) above the anal verge; all anastomoses were intact and completely healed. None of the animals had adhesions to the port sites. The anastomotic site was completely free of adhesions in four animals, and only one animal (20%) had grade 1 adhesions between the urine horns and the anastomosis. Conversely, all animals had adhesions of the abraded loop involving 60 cm (range, 40-75) of bowel and 7 cm (range, 4-9) of the abdominal wall (remote to the port sites); no other adhesions were noted, In this pilot study, serosal abrasion of the small bowel resulted in severe adhesion format ion in the porcine model. However, laparoscopic anterior resection of the rectum in the same animals was associated with only minimal insign ificant adhesions. Furthermore, unlike in laparotomy incisions, adhesi ons to port sites did not occur.