A comparative study of postoperative adhesions following laser surgery by laparoscopy versus laparotomy in the rabbit model.

In this study, we tested the null hypothesis that intraperitoneal adhesion formation and reduction after laser surgery are the same whether the surgery is performed by laparoscopy or laparotomy. Twenty rabbits were randomly assigned to either laparoscopy or laparotomy and subjected to standardized laser incisions over one uterine horn and over the peritoneal surface of either lower quadrant. Three weeks later, five animals from each group underwent laparoscopy and the other five received laparotomy to score the extent of postoperative adhesions formed and to carry out laser adhesiolysis. The same power density was delivered to tissues in both procedures. Three weeks after the second operative intervention, the animals were killed and the intraperitoneal adhesions blindly scored (scale of 0-3). After the initial procedure, adhesions were absent in the laparoscopy group, but in the laparotomy group, adhesions were frequently present not only at the operative sites of the peritoneal surfaces and uterine horn, but also on the bowel, bladder, and opposite uterine horn where no apparent injury had been inflicted (P less than .005). Three weeks after adhesiolysis, a significant reduction was observed in the mean adhesion scores in the laparoscopy group, but not in the laparotomy group (P = .001). These results lead to the rejection of the null hypothesis and confirm the clinical observation that besides reducing operative trauma, discomfort, and cost, laparoscopic laser surgery is very effective in reducing intraperitoneal adhesions and causes significantly less postoperative adhesion formation than does laparotomy.