LAPAROSCOPY VERSUS LAPAROTOMY - AN EVALUATION OF ADHESION FORMATION AFTER PELVIC AND PARAAORTIC LYMPHADENECTOMY IN A PORCINE MODEL

OBJECTIVE: Our purpose was to determine whether there is a difference in adhesion formation after pelvic and paraaortic lymphadenectomy with transperitoneal laparoscopy compared with both extraperitoneal laparo tomy and transperitoneal laparotomy in a porcine model. STUDY DESIGN: Ninety female hogs underwent pelvic and paraaortic lymphadenectomy: 40 with transperitoneal laparoscopy, 40 with extraperitoneal laparotomy, and 10 with transperitoneal laparotomy. Three weeks after the initial surgery, a laparotomy was performed to assess adhesion formation. RES ULTS: The transperitoneal laparotomy group had significantly higher ad hesion formation, with a 100% (10 of 10) adhesion rate. In the transpe ritoneal laparoscopy group, 12 of 40 hogs (30%) had adhesions develop versus 8 of 38 (21%) in the extraperitoneal laparotomy group (p = not significant). Also no differences were found in the transperitoneal la paroscopy and extraperitoneal laparotomy groups when comparing adhesio n thickness or the total surface area of adhesions. More anterior abdo minal wall adhesions were noted in the extraperitoneal laparotomy grou p (5 of 38) than in the transperitoneal laparoscopy group (0 of 40, p = 0.02). CONCLUSIONS: Pelvic and paraaortic lymphadenectomy performed with transperitoneal laparoscopy does not increase adhesion formation when compared with extraperitoneal laparotomy in a porcine model. The transperitoneal laparoscopy (and extraperitoneal laparotomy) approach also induces significantly fewer adhesions than transperitoneal laparo tomy.