ADHESION FORMATION FROM RELEASE OF DERMOID CONTENTS IN THE PERITONEAL-CAVITY AND EFFECT OF COPIOUS LAVAGE - A PROSPECTIVE, RANDOMIZED, BLINDED, CONTROLLED-STUDY IN A RABBIT MODEL

Objectives: To determine, in a rabbit model, whether peritoneal exposu re to dermoid cyst material produces inflammation and adhesions above control levels and whether saline lavage reduces the degree of periton eal reaction. Design: A prospective, randomized, blinded, controlled s tudy of adhesion formation. Thirty New Zealand white female rabbits we re assigned randomly to five experimental groups: [1] laparoscopy with intraperitoneal injection of human dermoid material, [2] laparoscopy with intraperitoneal injection of human dermoid material and subsequen t lavage to clear all visible dermoid material, [3] laparoscopy with s aline lavage, [4] laparoscopy with intraperitoneal injection of human follicular fluid (antigenic control), and [5] laparoscopy alone. Main Outcome Measures: Six weeks after initial laparoscopy, inflammation an d adhesions were scored in several categories via visual assessment (r ange 0 to 15) and histologic microscopic evaluation (range 0 to 24). D ata were evaluated using Kruskal-Wallis and Mann-Whitney U nonparametr ic tests. Results: For groups 1, 2, 3, 4, and 5, respectively, mean +/ - SEM total inflammation-adhesion scores were 13.85 +/- 0.55, 2.90 +/- 1.15, 0 +/- 0, 1.50 +/- 1.00, and 0 +/- 0 for clinical evaluation and 16.83 +/- 1.22, 7.33 +/- 1.76, 0 +/- 0, 0 +/- 0, and 0 +/- 0 for hist ologic evaluation. Using nonparametric tests, significant differences were found between groups in clinical and histologic scores. Conclusio ns: Dermoid material produces a significant peritonitis. Results of th e clinical evaluation demonstrate that saline lavage brings inflammati on and adhesion formation close to control levels. However, results of the histologic evaluation suggest that the decrement in inflammation as a result of lavage may be less dramatic than that found by clinical evaluation.