The influence of intraoperative complications on adhesion formation duringlaparoscopic and conventional cholecystectomy in an animal model

Background: The aim of this study was to evaluate the extent of postoperati ve adhesion formation after laparoscopic and open cholecystectomy. Materials and methods: Qualified surgeons performed 60 experimental laparos copic cholecystectomies (LC) in dogs with the aim to acquire the laparoscop ic technique. To assess the relation between the complications during the o peration (bleeding, laceration of the liver bed, or gallbladder perforation ) and the formation of adhesions, surviving animals were divided into four groups according to the type of complication occurred. Assessment of the re sults was made by second-look laparoscopy 4 weeks after LC using the adhesi on index (AI; score range, 0-4). The animals then were killed so the extent of adhesion formation could be measured. As a control, open cholecystectom y was performed in 15 dogs without intraoperative complications. The Mann-W hitney rank-sum test and Dunn's method were used for statistical analysis. Results: No adhesion formation or intraoperative complications were registe red in the laparoscopic group 1. In all the cases wherein bleeding or lacer ation of the liver bed occurred and was managed with electrocoagulation, ad hesions formed. Adhesion formation in these groups was significantly higher than in "ideal LC" or cases of gallbladder perforation alone (p < 0.01). A ll the animals in the control group developed significantly more adhesions than those in the experimental group (p < 0.05). Conclusions: It seems that LC has a lower rate of adhesion formation than t he conventional open technique. Complications such as bleeding or laceratio n of the liver bed during LC can enhance adhesion formation. No adhesion fo rmation can be mentioned in relation to gallbladder perforation during LC.