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Hum. Reprod. Advance Access published online on March 3, 2009
Human Reproduction, doi:10.1093/humrep/dep053
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© The Author 2009. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Prevention of adhesion formation in a laparoscopic mouse model should combine local treatment with peritoneal cavity conditioning{dagger}

M.M. Binda1 and P.R. Koninckx

Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium

1 Correspondence address. Leuven Institute for Fertility and Embryology (LIFE), Tiensevest 168, B3000 Leuven, Belgium. Tel: +32-16-270-190; Fax: +32-16-270-197; E-mail: Mercedes.Binda{at}gmail.com

BACKGROUND: Adhesion formation results from a series of local events at the trauma site. This process can be enhanced by factors derived from the peritoneal cavity such as mesothelial cell hypoxia (pneumoperitoneum with pure CO2), reactive oxygen species (pneumoperitoneum with more than 4% oxygen), desiccation and mesothelial trauma produced through manipulation. Adhesion prevention, therefore, should combine local treatment while minimizing adverse peritoneal factors through conditioning of the pneumoperitoneum.

METHODS: In a laparoscopic mouse model, adhesion induction comprised a mechanical lesion together with a humidified pneumoperitoneum for 60 min with pure CO2 at 37°C. Adhesion prevention consisted of a combination of treatments known to reduce adhesions, i.e. pneumoperitoneum with CO2 with the addition of 3–4% O2, reduction of body temperature (BT) to 32°C and application of antiadhesion products such as anti-inflammatory drugs (dexamethasone, nimesulide), calcium-channel blockers (diltiem), surfactants (phospholipids), barriers (Hyalobarrier gel), reactive oxygen species scavengers (superoxide dismutase and ascorbic acid) and recombinant plasminogen activator.

RESULTS: The addition of 3% O2 to the pneumoperitoneum or a lower BT decreased adhesions by 32% or 48%, respectively (P < 0.05, Wilcoxon), but were without additional effects when combined. In addition, if dexamethasone or Hyalobarrier® gel were administrated, the total reduction was 76% (P = 0.04) or 85% (P < 0.02), respectively.

CONCLUSIONS: Combining pneumoperitoneum conditioning together with dexamethasone or a barrier resulted in significant adhesion reduction in a laparoscopic mouse model.

Key words: post-operative adhesions/laparoscopy/humidified gas/pneumoperitoneum conditioning/mouse model

{dagger} The results of this manuscript were presented as an oral communication at the VIIIth PAX Meeting on post-operative adhesions, held in Clermont Ferrand, France, on 18–20 September 2008.

Submitted on December 18, 2008; resubmitted on January 28, 2009; accepted on January 30, 2009.


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