The role of carbon dioxide insufflation in preventing postoperative peritoneal adhesions in cecum scraping model in rats

Background and aims: Laparoscopic operations are associated with less trauma to peritoneum, lower bleeding, less invasive to intra abdominal organs and tissues, reduced manipulation of structures distant from the operative site, lower contamination with foreign bodies such as glove powder, starch powder, gauzes, operation materials, etc and early recovery.There are many reports about the superiority of the laparoscopic procedures than conventional operations for reducing the incidence of postoperative adhesions. Relationship between laparoscopy and postoperative adhesions has been studied on the basis of the less tissue trauma effect of laproscopy and it has been compared with open surgery about the effects on adhesion formation. In this study we explored the role of capnoperitoneum for the prevention of the postoperative adhesion formation.Materials and Methods: Thirty Wistar Albino type female rats those weights ranging from 250 ± 20 g were used. The rats were divided into 5 groups and each group consisted of six rats. Group 1 represented the Sham group while the Group 2 represented the control group. On the other hand, midline laparotomy was performed in Group 3 after carbon dioxide insufflation for 15 minutes. Then the scraping model was created. Group 4 underwent midline laparotomy after carbon dioxide insufflation for 15 minutes. Then the scraping model was created. The incision was closed by 3/0 vicryl after the procedure. After that carbon dioxide insufflation was applied for 45 minutes. Group 5 underwent midline laparotomy. After creating the scraping model carbon dioxide insufflation was applied for 45 minutes. The anterior abdominal wall was removed by making an inverted-U-shaped incision to anterior abdominal wall of whole rats and all the adhesions in the abdomen were examined and recorded. The tissue samples obtained were examined histopathologically and biochemical MDA and PAI studies were performed.Results: A statistically significant difference was observed between the groups relating to the inflammation,fibrosis and adhesion results.The findings associated with fibrosis, inflammation and adhesion were gradually decreased from Group 1 to Group 5.There was no statistically significant difference between the groups according to the PAI 1 levels. There was statistically significant difference between the groups associated with MDA levels The difference was resulted from Group 1 and Group 5. The MDA levels of Group 5 was found lower than the other groups while the MDA levels of Group 1 was found to be higher than the others. A strong, positive and linear relationship was detected between fibrosis findings and PAI 1 values. As long as the findings of adhesion are exacerbated, the PAI 1 levels are increased.Comment: Our results suggest that CO2 pneumoperitoneum has positive effects on development of postoperative intraperitoneal adhesions. It is impossible to say that the adhesion formation is reduced with mechanical effect due to creating the scraping model. The pathophysiological basis of postoperative adhesion formation is well-characterized. However, we think that capnoperitoneum reduces the postoperative adhesion formation via anti-inflammatory mechanism. Further studies are required to investigate this mechanism.