PELVIC ADHESION FORMATION AFTER PELVIC LYMPHADENECTOMY - COMPARISON BETWEEN TRANSPERITONEAL LAPAROSCOPY AND EXTRAPERITONEAL LAPAROTOMY IN APORCINE MODEL

Compared to extraperitoneal laparotomy, the transperitoneal approach i s associated with increased enteric morbidity. Recently, transperitone al laparoscopy has been employed as a method to surgically stage patie nts with gynecologic malignancies. The objective of this study was to investigate pelvic adhesion formation in a porcine model after pelvic lymphadenectomy performed via transperitoneal laparoscopy (LS) compare d to extraperitoneal laparotomy (EP). Ten adult, female hogs underwent LS and 10 underwent EP. A complete pelvic lymphadenectomy was perform ed in each animal. Three weeks after the lymphadenectomy, the animals underwent exploratory laparotomy, and the adhesions were quantified. N ineteen animals were evaluable. The adhesion scores for the laparoscop y group (N = 10, mean = 0.075 +/- 0.17) were not statistically differe nt from those of the laparotomy group (N = 9, mean = 0.28 +/- 0.52, P > 0.5). Eight of 10 (80%) and 5 of 9 (56%) animals in the LS and EP gr oups, respectively, had no adhesions after pelvic lymphadenectomy. Adh esion formation is one of many critical issues concerning the utility of pretreatment surgical staging, especially for cancer of the cervix. It is remarkable that only 20% of the animals undergoing laparoscopy in this study had de novo adhesions after pelvic lymph node dissection and that the mean total adhesion score was not statistically differen t from the extraperitoneal laparotomy. Therefore, transperitoneal lapa roscopic pelvic lymphadenectomy may not induce the degree of adhesion formation associated with the transperitoneal laparotomy technique. (C ) 1994 Academic Press, Inc.