Adhesion formation in intubated rabbits increases with high insufflation pressure during endoscopic surgery

The aim of the study was to test the hypothesis that the increase in adhesi on formation by CO2 pneumoperitoneum is caused by mesothelial hypoxaemia, T herefore the effect of the intra-abdominal pressure together with the flow rate upon adhesion formation was evaluated in rabbits following laser and b ipolar lesions during endoscopic surgery using humidified CO2 at 35 +/- 1 d egrees C, The intra-abdominal pressure and flow rate were 5 mmHg and 1 l/mi n in group 1 (n = 5), 5 mmHg and 10 l/min in group 2 (n = 4), 20 mmHg and 1 l/min in group 3 (n = 5) and 20 mmHg and 10 l/min in group 4 (n = 4) respe ctively, A rapid and reliable intubation method for rabbits was developed t o permit high insufflation pressure. By two-way analysis of variance, total adhesion scores following a laser lesion increased with flow rate (P = 0.0 003) and insufflation pressure (P = 0.002). Total adhesion scores of bipola r lesions increased with pressure (P = 0.02) but not with flow rate (P = 0. 1). The total adhesion scores of laser and bipolar lesions together increas ed with flow rate (P = 0.005) and with insufflation pressure (P = 0.004). T here was no statistical interaction between flow rate and insufflation pres sure. In conclusion, the insufflation pressure in endoscopic surgery with C O2 pneumoperitoneum is a co-factor in adhesion formation, together with des iccation.