To perform operative procedures in an optimized local atmosphere: Can it reduce post-operative adhesion formation?

Abstract Background Adhesion formation is a major problem following abdominal surgery as it creates a considerable economic burden in addition to an increased risk for complications. In the present study, an effort was made to reduce post-operative adhesion formation by creating an artificial atmosphere within and around the abdominal cavity during an open surgical procedure. Methods 82 Wistar male rats (Clr:WI) (200 gr, 7 weeks) were randomized into two groups. The abdominal cavity of the control group was exposed to the normal atmosphere of the operating-theatre during surgery (21% O 2 , 21 °C, 40–47% relative humidity (RH)), while the abdominal cavity of the study group was exposed to an artificial atmosphere during surgery (3–6% O 2 , >75% CO 2 , 95–100% RH, 37 °C). Adhesion induction consisted of a laparotomy along linea-alba, four lesions in the anterior abdominal-wall, blood from the tail vein dripped inside the abdominal cavity and exposure to the atmosphere around the wound by use of self-retaining retractors. In addition, a liquid-sample for quantitative bacteriologic cultivation and bacterial load (CFU/ml) calculation was taken just before closure. After 3 weeks the abdominal cavity was scored for the extent, tenacity and severity of adhesions before the rats were euthanized. The two-sample-Wilcoxon-rank-sum test was used in the analysis. Results Highly significant differences in postoperative total adhesion score, extent-, severity- and tenacity-score were found ( P P  > 0.05). Conclusions The rats exposed to the warmed and humidified artificial atmosphere consisting of more than 75% carbon dioxide and 3–4% oxygen during surgery had more severe and more post-operative adhesions compared to the rats that were exposed to the ambient air during surgery.