Intraabdominal adhesion formation after preperitoneal dissection in the murine model

Background: The laparoscopic approach to hernia repair has been advocated b y many as a potentially superior method of herniorraphy. Several techniques have been described, each with its own proposed advantages. These techniqu es involve different anatomic approaches, the most recent of which is the t otally extraperitoneal approach (TEPA). One presumed advantage of the extra peritoneal approach is the avoidance of adhesion formation because the peri toneum is not entered and mesh is not placed in direct contact with intra-a bdominal structures. We hypothesize, however, that when the peritoneum is d issected from the abdominal wall, it is partially devascularized, leading t o scar formation and potential adhesion formation. This would suggest that the TEPA method of herniorraphy may not completely avoid the risks of intra -abdominal adhesion formation. Methods: After appropriate approval was obtained, 88 male Sprague-Dawley ra ts were divided into two equal groups. One group underwent laparotomy follo wed by careful blunt dissection of the peritoneum from the left abdominal w all. The control group underwent laparotomy without manipulation of the per itoneum. All animals were re-explored 14 days later, and the abdominal cavi ty was examined for adhesions. The type and location of any adhesion was re corded. Results: Adhesion formation occurred in 10 of 44 (23%) subjects in the peri toneal dissection group, compared with 3 of 44 (7%) in the nondissection gr oup (p < 0.05). Conclusions: Dissection of the peritoneum from the overlying abdominal wall in the murine model leads to intraabdominal adhesion formation. This sugge sts that peritoneal dissection in the TEPA method of herniorraphy may lead to intra-abdominal adhesion formation.