Hypoxaemia induced by CO2 or helium pneumoperitoneum is a co-factor in adhesion formation in rabbits

A prospective randomized trial in a rabbit model was performed to test the hypothesis that the increase in adhesion formation following prolonged pneu moperitoneum is mediated by peritoneal hypoxaemia. Laparoscopic standardize d opposing lesions were performed in uterine horns and pelvic sidewalls by bipolar coagulation and CO2 laser in six groups of eight animals. Pure CO2 or helium pneumoperitoneum was used for 10 (groups I and IV) or 45 min (gro ups II and V) to confirm the effect of duration of pneumoperitoneum and 96% of CO2 or helium with 4% of oxygen (group III and VI) for 45 min to assess the effect of the addition of oxygen. After 7 days, adhesion formation was scored by laparoscopy, By two-way analysis of variance, total, extent, typ e and tenacity of adhesion scores increased (P = 0.0003, P = 0.0004, P = 0. 0004 and P = 0.004) with increasing duration of pneumoperitoneum and decrea sed (P = 0.02, P = 0.03, P = 0.01 and P = 0.05) with the addition of oxygen . No differences were found between CO2 and helium. Tn conclusion these dat a confirm the effect of pneumoperitoneum upon adhesions and demonstrate its reduction by oxygen, strongly suggesting that the main cause of adhesion f ormation is the relatively superficial hypoxaemia produced by the pneumoper itoneum.