The role of carbondioxide insufflation in preventing postoperative peritoneal adhesions in rats

Year 2023, Volume: 6 Issue: 5, 1080 - 1086, 28.09.2023

Harun Karabacak , Murat Akın , Tonguç Utku Yılmaz , Güldal Yılmaz , Özlem Gülbahar

https://doi.org/10.32322/jhsm.1347370

Abstract

Aims: Adhesion is the pathological connections that occur during the healing with scar formation of peritoneal surface defects. CO2 is used the most frequently in laparoscopic operations for insufflation. It is believed that it causes to changes in the inflammatory reply of the pneumo-peritoneum, defects in acid-base balance and decrease in peritoneal macrophage functions. CO2 is the only gas whose immunologic effects have been shown. It has been proven in experimental studies that the CO2 insufflation causes to local peritoneal acidosis without affecting the systemic status. Moreover, it has also been shown that it decreases the pneumo-peritoneum TNF-α and IL-6 production; however, increases the IL-10 production which is an anti-inflammatory cytokine. In the literature, the relation between the laparoscopy and the postoperative adhesions has always been explained by taking the suggestion of its causing to less tissue trauma as a basis when compared with the open surgery. The inflammatory reply of the CO2 has been less dealt with. In this study, we wanted to find the answer to the question whether the capno-peritoneum has a role in preventing the postoperative adhesion formation only by using CO2 without a a laparoscopic operation.
Methods: 30 female Wistar Albino type rats whose weights varied between 250±20 were used in the study. The rats were divided into 5 groups. Each group had 6 rats. Rats were placed in standard polycarbon cages in groups of 6. The room temperature was kept in 21°C. The rats were fed with standard pellet food during the study and tap water was provided to them. The operational anesthesia was performed by injecting intramuscular Ketamine Hydrochloride (Ketalar, Parke Davis and Eczacıbaşı, İstanbul) 50 mg/kg and Xylazine hydrochloride (Rompun, Bayer HealthCare) 5 mg/kg.
Results: A meaningful difference (p<0.05) was determined between the inflammation results of the groups. The inflammation findings become lighter as moved from Group 1 to Group 5. A meaningful difference (p<0.05) was determined between the fibrosis results. The fibrosis findings become lower as moved from Group 1 to Group 5. A meaningful difference (p<0.05) was determined between the adhesion results of the groups. The adhesion findings become lower as moved from Group 1 to Group 5. A statistically meaningful difference was not determined (p>0.05) between the PAI values of the groups. A statistically meaningful difference was not determined (p<0.05) between the MDA values of the groups. The difference stems from Group 1 and Group 5. The MDA values of Group 1 is relatively higher than those of other groups; while the MDA values of Group 5 is found to be lower when compared with the other groups
Conclusion: Our results suggest that CO2 pneumo-peritoneum has positive effects in postoperative intraperitoneal adhesion development. Since we formed a scraping model in our study, we cannot suggest that the adhesion formation is decreased with mechanical effect. The patho-physiological and molecular bases of the postoperative adhesion formation have been documented and described well. However, we consider that the capno-peritoneum and postoperative adhesion formation is prevented with anti-inflammatory effect. We need to conduct more studies to examine this mechanism.

Keywords

Postoperative adhesion, laparoscopy, capnoperitoneum

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