Experimental study of adhesion formation in open and laparoscopic fundoplication

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Abstract
Background: The extent of adhesion formation following both open and laparoscopic surgery remains unclear. This study aimed to evaluate the extent of postoperative adhesion formation after laparoscopic and open fundoplication in a rat model. Methods: Fifty-two male Sprague–Dawley rats were randomized into four groups: laparoscopic fundoplication (n = 20), open fundoplication (n = 20), laparoscopy (n = 6) and laparotomy (n = 6). Blood as well as intraperitoneal fluid was sampled for tumour necrosis factor (TNF)α measurement by enzyme-linked immunosorbent assay. All the rats were killed 3 weeks after operation, and adhesion formation was evaluated using a standardized scoring system. Results: There were no intergroup differences in body-weight gain after surgery. The overall mortality rate was 19 per cent and death was observed only in the fundoplication groups. Animals that had open fundoplication developed significantly more adhesions than those that underwent laparoscopic fundoplication (34 versus 21). Laparoscopic surgery induced predominantly parietal adhesions, whereas open surgery was more associated with visceral adhesions. The adhesions observed in the laparoscopic groups were significant thinner than those after open surgery and the tenacity of adhesions was decreased in laparoscopic compared with open surgery. The peak plasma level of TNF-α was reached during laparoscopic fundoplication, whereas the peak level was observed 3 h after open fundoplication. Intraperitoneal TNF-α levels showed no significant differences at 3 h. Conclusion: These findings indicate that laparoscopic fundoplication in rats leads to less severe adhesions of a different type (parietal) compared with those seen in the open controls.