This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Open adhesiolysis is more effective in reducing adhesion reformation than laparoscopic adhesiolysis in an experimental model. BJS 2010; 97: 420-427.
Published: 25th January 2010
Authors: S. G. Prushik, A. F. Stucchi, R. Matteotti, C. B. Aarons, K. L. Reed, A. C. Gower et al.
Background
This study compared adhesion reformation after open and laparoscopic adhesiolysis in a rat model.
Method
Adhesions were induced by surgically creating ischaemic buttons on the peritoneal side wall. After 7 days the animals underwent laparoscopy with carbon dioxide insufflation or laparotomy to score and lyse adhesions. Peritoneal tissue and fluid were collected after 24 h in a subset of animals, and adhesion reformation was scored 7 days after lysis in the remainder. Tissue plasminogen activator (tPA), plasminogen activator inhibitor (PAI) 1, transforming growth factor (TGF) β1 and tumour necrosis factor (TNF) α mRNA, and total fibrinolytic activity were assessed. The abdomen of non‐operated animals was insufflated for 7, 15 or 30 min with carbon dioxide, after which tPA and PAI‐1 mRNA and total fibrinolytic activity were measured.
Results
Animals that underwent open adhesiolysis had 60 per cent fewer reformed adhesions than the laparoscopic adhesiolysis group (P < 0·001). There were no differences in tPA activity or tPA, PAI‐1 and TNF‐α mRNA between groups, but TGF‐β1 mRNA levels were significantly increased in the open group. Carbon dioxide insufflation did not affect peritoneal tPA activity.
Conclusion
Open adhesiolysis may be more beneficial in minimizing adhesion reformation in the management of adhesion‐related complications. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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