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

Yıl 2023, Cilt: 6 Sayı: 5, 1080 - 1086, 28.09.2023

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

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

Öz

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.

Anahtar Kelimeler

Postoperative adhesion, laparoscopy, capnoperitoneum

Kaynakça

• Menzies D. Postoperative adhesions: their treatment and relevance in clinical practice. Ann R Coll Surg Engl. 1993;75(3):147-153.
• ten Broek RP, Issa Y, van Santbrink EJ, et al. Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis. BMJ. 2013;347:f5588.
• Hellebrekers BW, Trimbos-Kemper TC, Trimbos JB, Emeis JJ, Kooistra T. Use of fibrinolytic agents in the prevention of postoperative adhesion formation. Fertil Steril. 2000;74(2):203-212. doi:10.1016/s0015-0282(00)00656-7
• Günay C,Sağlıyan A,Yaman İ. Ratlarda deneysel olarak oluşturulan intraabdominal adezyonların önlenmesinde aprotinin ile metilen mavisinin etkinliğinin karşılaştırılması. FÜ Sağlık Bil Derg. 2005;19(1):51-55.
• Reed KL, Stucchi AF, Becker JM. The peritoneal fibrinolytic response to conventional and prolonged surgery is similar. J Surg Res. 2009;152(2):175-177. doi:10.1016/j.jss.2008.04.042
• Rahimi VB, Shirazinia R, Fereydouni N, et al. Comparison of honey and dextrose solution on post-operative peritoneal adhesion in rat model. Biomed Pharmacother. 2017;92:849-855. doi:10.1016/j.biopha.2017.05.114
• Holmdahl L, Eriksson E, Eriksson BI, Risberg B. Depression of peritoneal fibrinolysis during operation is a local response to trauma. Surgery. 1998;123(5):539-544. doi:10.1067/msy.1998.86984
• Raftery AT. Effect of peritoneal trauma on peritoneal fibrinolytic activity and intraperitoneal adhesion formation. An experimental study in the rat. Eur Surg Res. 1981;13(6):397-401. doi:10.1159/000128208
• Schnüriger B, Barmparas G, Branco BC, Lustenberger T, Inaba K, Demetriades D. Prevention of postoperative peritoneal adhesions: a review of the literature. Am J Surg. 2011;201(1):111-121. doi:10.1016/j.amjsurg.2010.02.008
• Raisi A, Dezfoulian O, Davoodi F, Taheri S, Ghahremani SA. Salvia miltiorrhiza hydroalcoholic extract inhibits postoperative peritoneal adhesions in rats. BMC Complement Med Ther. 2021;21(1):126. doi:10.1186/s12906-021-03300-7
• Scott-Coombes D, Whawell S, Vipond MN, Thompson J. Human intraperitoneal fibrinolytic response to elective surgery. Br J Surg. 1995;82(3):414-417. doi:10.1002/bjs.1800820346
• Poerwosusanta H, Gunadi, Noor Z, et al. The effect of laparoscopy on mast cell degranulation and mesothelium thickness in rats. BMC Surg. 2020;20(1):111. doi:10.1186/s12893-020-00775-y
• Lau WY, Leow CK, Li AK. History of endoscopic and laparoscopic surgery. World J Surg. 1997;21(4):444-453. doi:10.1007/pl00012268
• Valdivieso E, Saenz R, Claudio N. Natural orifice transluminal endoscopic surgery: putting together minimally invasive techniques for a new era. Gastrointest Endosc. 2007;66(2):340-342. doi:10.1016/j.gie.2007.03.1039
• Are C, Talamini MA, Murata K, De Maio A. Carbon dioxide pneumoperitoneum alters acute-phase response induced by lipopolysaccharide. Surg Endosc. 2002;16(10):1464-1467. doi:10.1007/s00464-001-8305-5
• Ellis H, Moran BJ, Thompson JN, et al. Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet. 1999;353(9163):1476-1480. doi:10.1016/S0140-6736(98)09337-4
• Nagelschmidt M, Gerbecks D, Minor T. The impact of gas laparoscopy on abdominal plasminogen activator activity. Surg Endosc. 2001;15(6):585-588. doi:10.1007/s004640010282
• Brokelman WJ, Lensvelt M, Borel Rinkes IH, Klinkenbijl JH, Reijnen MM. Peritoneal changes due to laparoscopic surgery. Surg Endosc. 2011;25(1):1-9. doi:10.1007/s00464-010-1139-2
• Orhurhu VJ, Gao CC, Ku C. Carbon Dioxide Embolism. In: StatPearls. Treasure Island (FL): StatPearls Publishing; November 28, 2022.
• Fuentes JM, Hanly EJ, Aurora AR, et al. CO2 abdominal insufflation pretreatment increases survival after a lipopolysaccharide-contaminated laparotomy. J Gastrointest Surg. 2006;10(1):32-38. doi:10.1016/j.gassur.2005.07.031
• Hanly EJ, Mendoza-Sagaon M, Murata K, Hardacre JM, De Maio A, Talamini MA. CO2 Pneumoperitoneum modifies the inflammatory response to sepsis. Ann Surg. 2003;237(3):343-350. doi:10.1097/01.SLA.0000055271.58945.E2
• Hanly EJ, Aurora AR, Fuentes JM, et al. Abdominal insufflation with CO2 causes peritoneal acidosis independent of systemic pH. J Gastrointest Surg. 2005;9(9):1245-1252. doi:10.1016/j.gassur.2005.09.007
• O'Boyle CJ, deBeaux AC, Watson DI, et al. Helium vs carbon dioxide gas insufflation with or without saline lavage during laparoscopy. Surg Endosc. 2002;16(4):620-625. doi:10.1007/s00464-001-8218-3
• West MA, Hackam DJ, Baker J, Rodriguez JL, Bellingham J, Rotstein OD. Mechanism of decreased in vitro murine macrophage cytokine release after exposure to carbon dioxide: relevance to laparoscopic surgery. Ann Surg. 1997;226(2):179-190. doi:10.1097/00000658-199708000-00010
• Kopernik G, Avinoach E, Grossman Y, et al. The effect of a high partial pressure of carbon dioxide environment on metabolism and immune functions of human peritoneal cells-relevance to carbon dioxide pneumoperitoneum. Am J Obstet Gynecol. 1998;179(6 Pt 1):1503-1510. doi:10.1016/s0002-9378(98)70016-x
• Douvdevani A, Rapoport J, Konforty A, Yulzari R, Moran A, Chaimovitz C. Intracellular acidification mediates the inhibitory effect of peritoneal dialysate on peritoneal macrophages. J Am Soc Nephrol. 1995;6(2):207-213. doi:10.1681/ASN.V62207
• Guzmán-Valdivia Gómez G, Tena-Betancourt E, Angulo Trejo M. Different doses of enoxaparin in the prevention of postoperative abdominal adhesions. experimental study. Ann Med Surg (Lond). 2021;73:103132. doi:10.1016/j.amsu.2021.103132
• Menger MD, Vollmar B. Surgical trauma: hyperinflammation versus immunosuppression?. Langenbecks Arch Surg. 2004;389(6):475-484. doi:10.1007/s00423-004-0472-0
• Romeo C, Cruccetti A, Turiaco A, et al. Monocyte and neutrophil activity after minor surgical stress. J Pediatr Surg. 2002;37(5):741-744. doi:10.1053/jpsu.2002.32268
• Miyano G, Yamataka A, Doi T, et al. Carbon dioxide pneumoperitoneum prevents intraperitoneal adhesions after laparotomy in rats. J Pediatr Surg. 2006;41(5):1025-1028. doi:10.1016/j.jpedsurg.2005.12.048
• Soltany S. Postoperative peritoneal adhesion: an update on physiopathology and novel traditional herbal and modern medical therapeutics. Naunyn Schmiedebergs Arch Pharmacol. 2021;394(2):317-336. doi:10.1007/s00210-020-01961-8
• Cheong YC, Laird SM, Li TC, Shelton JB, Ledger WL, Cooke ID. Peritoneal healing and adhesion formation/reformation. Hum Reprod Update. 2001;7(6):556-566. doi:10.1093/humupd/7.6.556
• bryant LR. an evaluation of the effect of fibrinolysin on intraperitoneal adhesion formation. Am J Surg. 1963;106:892-897. doi:10.1016/0002-9610(63)90152-1
• Moris D, Chakedis J, Rahnemai-Azar AA, et al. Postoperative abdominal adhesions: clinical significance and advances in prevention and management. J Gastrointest Surg. 2017;21(10):1713-1722. doi:10.1007/s11605-017-3488-9
• Corona R, Verguts J, Schonman R, Binda MM, Mailova K, Koninckx PR. Postoperative inflammation in the abdominal cavity increases adhesion formation in a laparoscopic mouse model. Fertil Steril. 2011;95(4):1224-1228. doi:10.1016/j.fertnstert.2011.01.004
• Dixon CT, Rixford EL. Cytologic response to peritoneal irritation in man: a protective mechanism. Am J Surg. 1934;25(3):504-505.