Intra-abdominal adhesions after open and laparoscopic cholecystectomy: an experimental model.

摘要

PURPOSE: To evaluate the incidence of intra-abdominal adherences after open and laparoscopic cholecystectomy, on the basis of an experimental study in pigs. MATERIALS AND METHODS: A total of 40 female pigs, mean weight 25 kg, underwent open cholecystectomy by right subcostal laparotomy (group A, n = 22) or laparoscopic cholecystectomy using a Storz laparoscope (group B, n = 18). After surgery, the abdominal wall was closed with polydioxanone suture and staples (group A) or with staples only (group B). One month later, the pigs underwent medial laparotomy to assess whether intra-abdominal adherences had developed. Incidences were compared between groups by the chi-square test with Yates correction. RESULTS: Five pigs in group A and one pig in group B died within 24 hours of surgery, leaving 17 pigs in each group. Mean operative time was similar for both groups (24.7 minutes in group A, 25.3 minutes in group B). In group A, 16 pigs (94%) developed intra-abdominal adherences, in all cases multiple; in group B, only 9 pigs (53%) developed adherences, and in 8 of these pigs only a single adherence was present (P < 0.03). CONCLUSIONS: The results of this study indicate that the incidence of intra-abdominal adherences is statistical lower after laparoscopic cholecystectomy than after open cholecystectomy.