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| IJCEM Copyright © 2008-All rights reserved. Published by e-Century Publishing Corporation, Madison, WI 53711 |
J Clin Exp Med 2013;6(3):153-165
Original Article
Surgical trauma and CO2-insufflation impact on adhesion formation in parietal and
visceral peritoneal lesions
Ospan A Mynbaev, Marina Yu Eliseeva, Zhomart R Kalzhanov, LV Lyutova, Sergei V Pismensky, Andrea Tinelli, Antonio Malvasi, Ioan-nis
P Kosmas
The Experimental Research & Modeling Division, Moscow State University of Medicine & Dentistry, Delegatskaya str 20/1, Moscow,
127374, Russia; The Department of Obstetrics, Gynecology & Reproductive Medicine, Peoples’ Friendship University of Russia,
Miklukho-Maklay, 21 Build 3, 117198, Moscow, Russia; The Institute of Reproductive Technologies AltraVita, Nagornaya 4A, 117186,
Moscow, Russia; Depart-ment of Pediatrics, Faculty of Pediatrics, A.D. Asfendiyarov Kazakh National Medical University, Tole bi street
88, Almaty, 050012, The Republic of Kazakhstan; Laboratory of Fermentative Fibrinolysis, Faculty of Biology, M.V. Lomonosov Moscow
State University, Vorobievy gori 1, building 12, Moscow, 119911, Russia; Laboratory of Pathophysiology, Faculty of Basic Medicine M.V.
Lomonosov Moscow State University, Lomonosovsky Prospekt 31-5, Moscow, 117192, Russia; Department of Anesthesiology and
Reanimation, Vishnevsky Institute of Surgery, 117997 Moscow, Russia; Department of Obstetrics and Gynaecology, Division of
Experimental Endoscopic Surgery, Imaging, Minimally Inva-sive Therapy and Technology, Vito Fazzi Hospital, Piazza Muratore, 73100
Lecce, Italy; Obstetrics and Gynecology Department, Santa Maria Hospital, Bari, Italy; Xatzikosta General Hospital, Ioannina, 45110,
Ioannina, Greece
Received December 19, 2012; Accepted February 7, 2013; Epub March 21, 2013; Published March 31, 2013
Abstract: CO2-insufflation and electrocoagulation were advanced as causative factors of postsurgical adhesions. We assumed that
severe tissue reaction due to electrocoagulation might obscure CO2-insufflation impact on adhesion formation. Therefore, the purpose
of this study was to evaluate the effects and interactions of surgical trauma and CO2-insufflation on adhesion formation. Prospective-
randomized study with 60 rats, equally divided into 3 groups. In the control group, the sidewall adhesion model was induced by
monopolar coagulation of the uterine horn and ipsilateral parietal peritoneum and by mechanical damaging – in the opposite side
through open laparoscopy without CO2-insufflation. In two other groups, CO2 was insufflated for 60 min at 15 cm of water, either before
or after the sidewall model-induction. Parameters of sidewall and lesion site adhesions of parietal peritoneum and uterine horns were
evaluated by scoring system and analyzed by two-way ANOVA with Bonferroni posttests, one-way ANOVA Student-Newman-Keuls
multiple comparisons test, as well as by two-tailed unpaired Mann-Whitney test. Monopolar coagulation significantly increased
peritoneal lesion site adhesion scores, as compared with the scores for mechanical damaging (p=0.0001). Visceral peritoneal lesion
sites were more predisposed to adhesion formation than parietal peritoneal lesion sites (p=0.0009), whereas CO2 did not affect
parameters of either sidewall or peritoneal lesion site adhesions, regardless of the insufflation mode (p>0.05). The data suggest that
both surgical trauma and peritoneal lesion sites had a substantial impact on adhesion formation, whereas CO2 did not interfere with
adhesion parameters irrespective of its insufflation mode. These findings may improve our insights into adhesion formation
pathophysiology and open new perspectives in developing future adhesion prevention strategies. (IJCEM1212008).
Keywords: Sidewall, lesion site adhesions, CO2-pneumoperitoneum, surgical trauma, parietal, visceral peritoneum
Address correspondence to: Dr. Ospan A Mynbaev, The experimental researches & modeling division, Box. No 19.15 Delegatskaya
str., 20/1 Moscow, 127374, Russia. Phone: +79161271546; E-mail: ospanmynbaev@hotmail.com
Original Article
Surgical trauma and CO2-insufflation impact on adhesion formation in parietal and
visceral peritoneal lesions
Ospan A Mynbaev, Marina Yu Eliseeva, Zhomart R Kalzhanov, LV Lyutova, Sergei V Pismensky, Andrea Tinelli, Antonio Malvasi, Ioan-nis
P Kosmas
The Experimental Research & Modeling Division, Moscow State University of Medicine & Dentistry, Delegatskaya str 20/1, Moscow,
127374, Russia; The Department of Obstetrics, Gynecology & Reproductive Medicine, Peoples’ Friendship University of Russia,
Miklukho-Maklay, 21 Build 3, 117198, Moscow, Russia; The Institute of Reproductive Technologies AltraVita, Nagornaya 4A, 117186,
Moscow, Russia; Depart-ment of Pediatrics, Faculty of Pediatrics, A.D. Asfendiyarov Kazakh National Medical University, Tole bi street
88, Almaty, 050012, The Republic of Kazakhstan; Laboratory of Fermentative Fibrinolysis, Faculty of Biology, M.V. Lomonosov Moscow
State University, Vorobievy gori 1, building 12, Moscow, 119911, Russia; Laboratory of Pathophysiology, Faculty of Basic Medicine M.V.
Lomonosov Moscow State University, Lomonosovsky Prospekt 31-5, Moscow, 117192, Russia; Department of Anesthesiology and
Reanimation, Vishnevsky Institute of Surgery, 117997 Moscow, Russia; Department of Obstetrics and Gynaecology, Division of
Experimental Endoscopic Surgery, Imaging, Minimally Inva-sive Therapy and Technology, Vito Fazzi Hospital, Piazza Muratore, 73100
Lecce, Italy; Obstetrics and Gynecology Department, Santa Maria Hospital, Bari, Italy; Xatzikosta General Hospital, Ioannina, 45110,
Ioannina, Greece
Received December 19, 2012; Accepted February 7, 2013; Epub March 21, 2013; Published March 31, 2013
Abstract: CO2-insufflation and electrocoagulation were advanced as causative factors of postsurgical adhesions. We assumed that
severe tissue reaction due to electrocoagulation might obscure CO2-insufflation impact on adhesion formation. Therefore, the purpose
of this study was to evaluate the effects and interactions of surgical trauma and CO2-insufflation on adhesion formation. Prospective-
randomized study with 60 rats, equally divided into 3 groups. In the control group, the sidewall adhesion model was induced by
monopolar coagulation of the uterine horn and ipsilateral parietal peritoneum and by mechanical damaging – in the opposite side
through open laparoscopy without CO2-insufflation. In two other groups, CO2 was insufflated for 60 min at 15 cm of water, either before
or after the sidewall model-induction. Parameters of sidewall and lesion site adhesions of parietal peritoneum and uterine horns were
evaluated by scoring system and analyzed by two-way ANOVA with Bonferroni posttests, one-way ANOVA Student-Newman-Keuls
multiple comparisons test, as well as by two-tailed unpaired Mann-Whitney test. Monopolar coagulation significantly increased
peritoneal lesion site adhesion scores, as compared with the scores for mechanical damaging (p=0.0001). Visceral peritoneal lesion
sites were more predisposed to adhesion formation than parietal peritoneal lesion sites (p=0.0009), whereas CO2 did not affect
parameters of either sidewall or peritoneal lesion site adhesions, regardless of the insufflation mode (p>0.05). The data suggest that
both surgical trauma and peritoneal lesion sites had a substantial impact on adhesion formation, whereas CO2 did not interfere with
adhesion parameters irrespective of its insufflation mode. These findings may improve our insights into adhesion formation
pathophysiology and open new perspectives in developing future adhesion prevention strategies. (IJCEM1212008).
Keywords: Sidewall, lesion site adhesions, CO2-pneumoperitoneum, surgical trauma, parietal, visceral peritoneum
Address correspondence to: Dr. Ospan A Mynbaev, The experimental researches & modeling division, Box. No 19.15 Delegatskaya
str., 20/1 Moscow, 127374, Russia. Phone: +79161271546; E-mail: ospanmynbaev@hotmail.com
