Influence of abdominal incision on the formation of postoperative peritoneal adhesions: an experimental study in rats.

Abstract

OBJECTIVE: To see if the three most commonly used abdominal incisions were associated with the development of postoperative peritoneal adhesions. DESIGN: Prospective experimental study. SETTING: University hospital, Spain. SUBJECTS: 30 Wistar rats. INTERVENTIONS: Three groups each of 10 rats underwent suprainfraumbilical midline laparotomy, right subcostal laparotomy or infraumbilical right transrectal laparotomy. MAIN OUTCOME MEASURES: The animals were killed after 30 days and adhesions quantified according to a special designed score which assessed the number of adhesions, their site, vascularisation, thickness, and strength. RESULTS: The transrectal incision was associated with most adhesions (median: 9.3, interquartile 7-10), followed by subcostal laparotomy (5.5, 4-6.7), and midline laparotomy (2.0, 0-7). CONCLUSIONS: Infraumbilical incisions away from the midline are more traumatic, damage more of the peritoneum, and are more likely to come into contact with the omentum, peritoneal fat, bowel loops, and pelvic contents, thereby predisposing to the formation of peritoneal adhesions.