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Hyperoxia and prevention of adhesion formation: a laparoscopic mouse model for open surgery
Author(s) -
Binda MM,
Koninckx PR
Publication year - 2010
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2009.02370.x
Subject(s) - hyperoxia , pneumoperitoneum , medicine , adhesion , hypothermia , anesthesia , surgery , laparoscopy , chemistry , organic chemistry , lung
Please cite this paper as: Binda M, Koninckx P. Hyperoxia and prevention of adhesion formation: a laparoscopic mouse model for open surgery. BJOG 2010;117:331–339. Objective CO 2 pneumoperitoneum with more than 10% oxygen enhances adhesions. As during open surgery the peritoneum is exposed to air (20% oxygen), in this hyperoxia‐enhanced adhesion model we evaluated the effect of hypothermia and products with known effectiveness in hypoxia (pure CO 2 pneumoperitoneum) and normoxia (CO 2 pneumoperitoneum plus 3–4% oxygen) models. Results were expected to be important for adhesion prevention in open surgery, and, moreover, similarities and differences between the three models would be important to identify differences in pathways of adhesion formation between laparoscopy and laparotomy. Design Two experiments were performed in which the effect of hypothermia (32°C), a surfactant (phospholipids), a barrier (Hyalobarrier ® gel), reactive oxygen species scavengers (superoxide dismutase, SOD, and ascorbic acid, AA), anti‐inflammatory agents (dexamethasone and nimesulide), a calcium channel blocker (diltiazem) and recombinant plasminogen activator (r‐PA) were evaluated upon adhesions. Setting University Hospital. Population BALB/c mice. Methods Hyperoxia‐enhanced adhesions were induced by performing laparoscopically bipolar lesions during 60 minutes of CO 2 pneumoperitoneum plus 12% oxygen at 37°C body temperature. Main outcome measures Adhesions were scored after 7 days. Results In this model, adhesions were reduced by hypothermia ( P < 0.02; Wilcoxon), phospholipids ( P = 0.03), Hyalobarrier ® gel ( P < 0.004), dexamethasone ( P < 0.005) and diltiazem ( P < 0.01). A significant but quantitatively borderline effect was seen for AA ( P < 0.002) and r‐PA ( P = 0.0005), whereas SOD and nimesulide did not have any effect. Conclusions Hyperoxia‐enhanced adhesions were prevented by hypothermia, dexamethasone, phospholipids, Hyalobarrier ® gel, diltiazem, r‐PA and AA. All effects were similar to those in the hypoxia‐enhanced adhesion model, suggesting that the underlying mechanisms are similar.