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Open Access Research article

Severe inflammatory reaction induced by peritoneal trauma is the key driving mechanism of postoperative adhesion formation

Sergei V Pismensky12, Zhomart R Kalzhanov5, Marina Yu Eliseeva34, Ioannis P Kosmas6 and Ospan A Mynbaev23*

Author Affiliations

1 Laboratory of Pathophysiology, Faculty of Basic Medicine and Laboratory of Fermentative Fibrinolysis, Faculty of Biology, M.V. Lomonosov Moscow State University, Lomonosovsky Prospekt 31-5, Moscow, 117192, Russia

2 The Experimental Research & Modeling Division, Moscow State University of Medicine & Dentistry, Delegatskaya str 20/1, Moscow, 127473, Russia

3 Department of Obstetrics and Gynecology, the Institute of Advanced Training of the Federal Medical-Biological Agency of Russia, Volokalamsky road 30, Moscow, 123182, Russia

4 The Institute of Reproductive Technologies AltraVita, Nagornaya 4A, Moscow, 117186, Russia

5 Department of Pediatrics, Faculty of Pediatrics, A.D. Asfendiyarov Kazakh National Medical University, Tole bi street 88, Almaty, 050012, The Republic of Kazakhstan

6 Laboratory of Physiology, Faculty of Medicine, University of Ioannina, Ioannina, 45110, Greece

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BMC Surgery 2011, 11:30  doi:10.1186/1471-2482-11-30

Published: 14 November 2011

Abstract

Background

Many factors have been put forward as a driving mechanism of surgery-triggered adhesion formation (AF). In this study, we underline the key role of specific surgical trauma related with open surgery (OS) and laparoscopic (LS) conditions in postoperative AF and we aimed to study peritoneal tissue inflammatory reaction (TIR), remodelling specific complications of open surgery (OS) versus LS and subsequently evaluating AF induced by these conditions.

Methods

A prospective randomized study was done in 80 anaesthetised female Wistar rats divided equally into 2 groups. Specific traumatic OS conditions were induced by midline incision line (MIL) extension and tissue drying and specific LS conditions were remodelled by intraperitoneal CO2 insufflation at the 10 cm of water. TIR was evaluated at the 24th, 72nd, 120th and 168th hour by scoring scale. Statistical analysis was performed by the non-parametric t test and two-way ANOVA using Bonferroni post-tests.

Results

More pronounced residual TIR was registered after OS than after LS. There were no significant TIR interactions though highly significant differences were observed between the OS and LS groups (p < 0.0001) with regard to surgical and time factors. The TIR change differences between the OS and LS groups were pronounced with postoperative time p < 0.05 at the 24th and 72nd; p < 0.01 - 120th and p < 0.001 - 168th hrs. Adhesion free wounds were observed in 20.0 and 31.0% of cases after creation of OS and LS conditions respectively; with no significant differences between these values (p > 0.05). However larger adhesion size (41.67 ± 33.63) was observed after OS in comparison with LS (20.31 ± 16.38). The upper-lower 95% confidential limits ranged from 60.29 to 23.04 and from 29.04 to 11.59 respectively after OS and LS groups with significant differences (p = 0.03). Analogous changes were observed in adhesion severity values. Subsequently, severe TIR parameters were followed by larger sizes of severe postoperative adhesions in the OS group than those observed in the LS group.

Conclusions

MIL extension and tissue drying seem to be the key factors in the pathogenesis of adhesion formation, triggering severe inflammatory reactions of the peritoneal tissue surrounding the MIL resulting in local and systemic consequences. CO2 insufflation however, led to moderate inflammation and less adhesion formation.