Comparison of adhesion reformation after laparoscopic and conventional adhesiolysis in an animal model

This study set out to compare adhesion reformation after conventional and l aparoscopic adhesiolysis using two different laparoscopic dissection techni ques. In a first operation, 36 rabbits underwent fixation of 6 cm(2) of the cecum with the serosa removed to the lateral abdominal wall to induce stan dardized adhesions. After 4 weeks, adhesiolysis was performed laparoscopica lly (n=12) or via laparotomy (n=12) using sharp and blunt dissection. In a third group (n=12), laparoscopic adhesiolysis was performed using monopolar electrocautery. Outcome was assessed by incidence, extent, and localizatio n of adhesion reformation, After conventional adhesiolysis, all rabbits dev eloped new adhesions relative to 79% after laparoscopic adhesiolysis. The e xtent of reformed adhesions (median) was greater after conventional adhesio lysis than laparoscopic adhesiolysis (2725 mm(2) vs 230 mm(2), P<0.001). Th e latter did not differ significantly from laparoscopic adhesiolysis by ele ctrocautery (310 mm(2)). There were small adhesions to 3 of 72 trocar wound s, but extensive adhesions to 33% of the abdominal incisions were found in the conventional group. In this standardized experimental setting, laparosc opic adhesiolysis is associated with a significantly reduced reformation of adhesions. Different laparoscopic dissection techniques have no significan t influence on the extent of adhesion reformation.