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Open Lysis of Adhesions (LOA) is More Effective in Decreasing Adhesion Reformation Than Laparoscopic LOA in a Rat Model
Scott G Prushik, Cary B Aarons, Ronald Matteotti, Karen L Reed, Adam C Gower, Arthur F Stucchi, James M Becker
Boston University Medical Center, Boston, MA
Introduction: Approximately 94% of patients develop adhesions following abdominal surgery, many requiring a second operation for LOA. Several studies describe the role of fibrinolysis in adhesion formation; however, few address adhesion reformation following LOA. The aim of this study was to determine the effects of open vs. laparoscopic LOA on adhesion reformation and peritoneal fibrinolytic activity in a rat adhesion model.
Methods: Intraabdominal adhesions were surgically induced in 28 rats using our ischemic button model. Seven days later, rats underwent laparoscopy (N=16) or laparotomy (N=12) to score and lyse adhesions. Seven days after LOA, adhesions were again scored in 20 animals. Peritoneal tissue and fluid were collected 24 hours after LOA (N=8) for analysis of tissue plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1) mRNA and fibrinolytic activity, respectively.
Results: At first look, 78±3.0% of buttons formed adhesions. There was a significant reduction (p<0.05) in adhesion reformation after both open and laparoscopic LOA. Open LOA, however, further decreased adhesion reformation (p<0.05) compared to laparoscopic LOA (42±3.2% vs. 17±6.3%). Also compared with laparoscopic LOA, tPA mRNA levels were increased by 13% and fibrinolytic activity was increased by 2-fold (2.5±0.64 U/ml vs. 1.2±0.54 U/ml) in animals undergoing open LOA. Interestingly, animals undergoing open LOA showed a 241% increase in PAI-1 mRNA levels (p<0.05) and a 2-fold increase in the tPA:PAI-1 ratio (56±10.6% vs. 29±2.7%)(p=0.052) compared to animals undergoing laparoscopic LOA.
Conclusions: In this experimental model, open LOA significantly decreases adhesion reformation compared to laparoscopic LOA and upregulates the peritoneal fibrinolytic system.
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