Adhesion Induction in an Experimental Rat Study
Christian W. Wallwiener, Bernhard Kraemer, Markus Wallwiener, Christoph Brochhausen, Keith B. Isaacson, Taufiek K. Rajab
Emma Holt
A breakdown of big words
The original study is titled "The Extent of Adhesion Induction Through Electrocoagulation and Suturing in an Experimental Rat Study." Let's begin by breaking down each of these large words. First, adhesion is a band of scar tissue that binds two parts of tissues together, often resulting in an injury during surgery. Electrocoagulation is a technique used for medical treatment (and other various things) that clots tissue using a high-frequency electrical current to stop bleeding. Suturing is simply stitching up a wound or incision with a suture in order to minimize the risks of bleeding and infection. This method is thousands of years old.
Purpose of this study
Researchers Christian W. Wallwiener, Bernhard Kraemer, Markus Wallwiener, Christoph Brochhausen, Keith B. Isaacson, and Taufiek K. Rajab investigated the effect of those 3 types of peritoneal (layer of thin tissue lining the abdomen and covering organs) trauma that occurs during surgery using rodents as their subjects. Adhesions occur after abdominal and pelvic surgery in more than 70% of cases, causing serious complications including intestinal obstruction and infertility for patients. This is quite the chain reaction because then prolonged subsequent operations may take place, causing a greater risk of enterotomy and a considerable financial burden on the health system. Ouch.
An analysis of the relationship between electrocoagulation and adhesion formation is indicated because the two seem to show similarities. Adhesion formation is believed to occur secondary to peritoneal damage and suturing is shown to induce adhesion formation. Similarly, electrocoagulation is known to influence adhesion formation but is also used to achieve hemostasis, which is the stopping of a flow of blood. Thus, sparking this analysis I just mentioned. Still with me?
Material & methods
Thirty-five wistar rats with a weight range of 220-280 g were "housed" under standardized laboratory conditions that fell in line with European requirements. The study was conducted at Charles River Laboratories in Sulzfeld, Germany and every operation to induce adhesions were performed by the same surgeon every time. The surgeon induced anesthesia by nebulized isoflurane, intraperitoneal ketamine and xylazin. The peritoneal cavity was opened by a 4-cm midline incision and the animal was allocated to one of the five experimental groups according to a randomized plan. The table below displays each experimental group.
Both lateral body walls of the animal were then traumatized accordingly and one animal from each group was operated per session.
The effect of minimal electrocoagulation was examined by creating lesions through sweeps of a bipolar forceps with a duration of 1 second and standardized pressure. For extensive electrocoagulation, standardized lesions were created using sweeps of 3 second durations and three times more pressure. Mechanical trauma also had standardized lesions created by denuding (a.k.a stripping something of its covering) the peritoneum mechanically. And finally, to study the additive effect of suturing, the lesions were created by suturing plus minimal electrocoagulation or mechanical denuding. Hemostasis was achieved by using pressure from a sterile swab and each surgery was approximately 20 minutes from incision to the closure of the skin. The animals were observed daily for signs of complications and ultimately sacrificed after 14 days using carbon dioxide.
Results & summary
Overall, the study investigates the extent of adhesion induction through electrocoagulation, suturing, and mechanical trauma of the peritoneum and abdominal wall. The researchers found that mechanical denuding of the peritoneum did not result in adhesion formation and after minimal electrocoagulation, the average adhesion quantity of the traumatized area was 0%. However, the results for extensive electrocoagulation was a 50% adhesion. The clinical relevance of adhesion quality is not yet clear so they've determined that further investigation will be needed to decide if traumatization correlates with adhesion quality.
The results suggest that superficial trauma to the peritoneum doesn't lead to adhesion formation. But, trauma of the layers deep to the peritoneum may lead to increased adhesion formation. This calls attention to the role of the tissue and musculature underlying the peritoneum in adhesion formation. It's important to keep in mind the limitations when interpreting the results, including the number of animals available and the different traumatized areas in different groups. Overall, superficial trauma may be a trivial factor in adhesion formation whereas additional trauma leads significantly to increased adhesion formation. The data concludes that there is a range concerning the extent of trauma by electrocoagulation at the lower end of which there is little adhesion formation.
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