A Comparative Study of Postoperative Adhesions and HistologicReactions Following Pelvic Surgery by Operative Pelviscopy VersusLaparotomy in the Rabbit

Seo, Jung Ho; Park, Hyoung Moo; Bae, Do Hwan; Hur, Min

Abstract

Development of adhesions following pelvic surgery is a leading failure of reconstructive surgery. The aims of this study were to compare the occurrence of adhesions after a standard uterine injury infilicted by laparoscopy versus laparotomy, to compare the efficacy of 32% dextran 70 used for adhesion prophylaxis and to compare the tissue reactions to the catgut, polypropylene, polyglactin and polydioxanone suture materials. Forty rabbits were randomly assigned to four groups, of which group 1 and group 2 received operations via laparoscopy and group 3 and group 4 received via laparotomy. During operations, group 1 and group 3 were irrigated and administered with 10 ml of 32% dextran 70. The uterine horns were incised and anastomosed with four suture materials respectively. After six weeks, thirty eight rabbits were assigned to laparotomy to assess the extent of intraperitoneal adhesions. The intraperitoneal adgesions were graded according to their severity. Tissue block were obtained from the suture sites for histologic assessment. Adhesions were significantly less in laparoscopy-treated group than in laparotomy-treated group but there are no differences in the inflammatory reactions to suture material, operative manipulations or 32% dextran 70. Moderate fibrosis persisted around the catgut and oplypropylene suture, but not at all around the polydioxanone and polyglactin sutures. The routine use of intraperitioneal 32% dextran 70 has been suggested as an adjuvant to prevent postoperative adhesions, however it's user did not reduce the formation of adhesions in this study.