SS  Vol.4 No.9 , September 2013
Influence of Peritoneal Suture on the Formation of Abdominal Adhesions in Wistar Rats: Is Suturing Worthwhile?
Abstract: Purpose: The purpose of the present study was to determine the effect of peritoneal closure on the formation of abdominal adhesions by verifying their degree of damage on intestinal portions and the omentum with the abdominal wall. Given the different reports found in the literature concerning peritoneal closure mostly in obstetrics and gynecology, any objective information based on statistically tested results may be of great value in the everyday surgery practice. Material and Method: This is an experimental model on which a laparotomy is performed on the free cavity of the abdominal wall in growing rats. Young Wistar rats (approximately 1 month old) were operated through a long median xipho-umbilical abdominal incision. The animals were divided in 3 groups with fifteen rats each: in Group I, only the peritoneum was left open and all the other layers of the abdominal wall were closed; the rats in Group II had their peritoneums closed with unabsorbable cord (Prolene 4-0, Ethicon?). The abdominal wall of the rats in Group III (control) was only opened up to the musculature. The peritoneum, which remained intact and closed, was carefully prodded with the grip of tweezers to avoid lesions and/or perforations in the peritoneum. Results: There were no deaths nor incisional dehiscence and/or hernias among the animals. Nine animals of Group I presented adhesions (60%), whereas there were adhesions in all the fifteen animals of Group II (100%). In Group III adhesions were found in two animals (13%). The percentage of adhesions in Group II was significantly higher than those observed in Groups I and III (p < 0.0001). Adhesions were mostly formed by the abdominal omentum. It was not observed any effect of the procedure on viscera. Conclusion: The experimental model that was suggested is appropriate for the establishment and study of peritoneal adhesions. The rate of adhesions found in the Group II was significantly higher (p < 0.0001) than the rate observed in the Group I and Group III, suggesting that peritoneum suture can play a important role in the adhesion processes.
Cite this paper: N. Andrade, M. Vinagre, L. Canabarro and W. França, "Influence of Peritoneal Suture on the Formation of Abdominal Adhesions in Wistar Rats: Is Suturing Worthwhile?," Surgical Science, Vol. 4 No. 9, 2013, pp. 401-404. doi: 10.4236/ss.2013.49078.

[1]   B. Schnüriger, et al., “Prevention of Postoperative Peritoneal Adhesions: A Review of the Literature,” The American Journal of Surgery, Vol. 201, No. 1, 2011, pp. 111-121. doi:10.1016/j.amjsurg. 2010.02.008

[2]   H. Ellis, “The Clinical Significance of Adhesions: Focus on Intestinal Obstruction,” European Journal of Surgery, Vol. 577, 1997, pp. 5-9.

[3]   H. Ellis, et al., “The Cause and Prevention of Postoperative Intraperitoneal Adhesions,” Surgery, Gynecology & Obstetrics, Vol. 133, No. 3, 1971, pp. 497-511.

[4]   Y. C. Cheong, et al., “Peritoneal Closure—To Close or Not to Close,” Human Reproduction, Vol. 16, No. 8, 2001, pp. 1548-1552. doi:10.1093/humrep/16.8.1548

[5]   G. H. Limpscomb, et al., “Peritoneal Closure at Vaginal Hysterectomy: A Reassessment,” Obstetrics & Gynecology, Vol. 87, No. 1, 1996, pp. 40-43. doi:10.1016/0029-7844(95)00362-2

[6]   H. S. Grundsell, et al., “Randomized Study of Non-Closure of Peritoneum in Lower Segment Cesarean Section,” Acta Obstetricia et Gynecologica Scandinavica, Vol. 77, No. 1, 1998, pp. 110-115. doi:10.1080/00016349808565823

[7]   M. McNally, et al., “Does Closure of the Peritoneum during Caesarian Section Influence Postoperative Morbidity and Subsequent Bladder Adhesion Formation?” Journal of Obstetrics & Gynaecology, Vol. 17, No. 3, 1997, pp. 239-241. doi:10.1080/01443619750113131

[8]   W. Weerawetwat, et al., “Closure versus Non-Closure of Visceral and Parietal Peritoneum at Caesarean Delivery: 16 Years Study,” Journal of the Medical Association of Thailand, Vol. 87, No. 9, 2004, pp. 1007-1011.

[9]   W. Franca, et al., “Maturity of the Myenteric Plexus Is Decreased in the Gastroschisis Rat Model,” Fetal Diagnosis and Therapy, Vol. 23, No. 1, 2008, pp. 60-68. doi:10.1159/000109228

[10]   W. G. Cochran, Some Methods for Strengthening the Commun x2 Test,” Biometrics, Vol. 10, No. 4, 1954, pp. 417-451. doi:10.2307/3001616

[11]   C. J. Leon, et al., “Comparison of Closure vs Non-Closure of the Peritoneal Layer in the Formation of Postoperative Adhesions to the Abdominal Wall,” Arquivos Brasileiros de Cirurgia Digestiva, Vol. 9, No. 4, 1994, pp. 102-107.

[12]   R. C. Glasmeyer, et al., “The Importance of Closing the Peritoneum at Laparotomy: Experimental Study,” Revista Médica do Paraná, Vol. 43, No. 2, 1985, pp. 26-27.

[13]   D. M. Duffy, et al., “Is Peritoneal Closure Necessary?” Surgery Gynecology & Obstetrics, Vol. 49, No. 12, 1994, pp. 817-822. doi:10.1097/00006254-199412000-00005

[14]   H. Ellis, “The Scientific Basis of the Management of Injury, Wounds, and Ulcers in the Twentieth Century,” Annals of the Royal College of Surgeons of England, Vol. 60, 1978, pp. 219-221.

[15]   H. Ellis, “The Cause and Prevention of Post Operative Intraperitoneal Adhesions,” Surgery Gynecology & Obstetrics, Vol. 133, No. 3, 1971, pp. 497-511.

[16]   H. Ellis, “The Aetiology of Post-Operative Abdominal Adhesion: An Experimental Study,” British Journal of Surgery, Vol. 50, No. 219, 1962 pp. 10-16. doi:10.1002/bjs.18005021904

[17]   M. L. P. B. Simoes, et al., “Closure x Non-Closure of the Peritoneum and the Adhesions Formation: Experimental Study in Rats,” Revista Brasileira de Cirurgia, Vol. 86, No. 6, 1996, pp. 303-305.

[18]   C. K. Sung and K. H. Kim, “Missed Injuries in Abdominal Trauma,” Journal of Trauma, Vol. 41, No. 2, 1996, pp. 276-282.

[19]   F. Nagele, et al., “Closure or Nonclosure of the Visceral Peritoneum at Cesarean Delivery,” American Journal of Obstetrics & Gynecology, Vol. 174, No. 4, 1996, pp. 1366-1370. doi:10.1016/S0002-9378(96)70686-5