Effect of adding more than 3% oxygen to carbon dioxide pneumoperitoneum on adhesion formation in a laparoscopic mouse model

Objective

To investigate the effect of the addition of 3% or higher oxygen concentrations to the carbon dioxide (CO₂) pneumoperitoneum.

Design

Prospective, randomized trial.

Setting

Academic research center.

Animal(s)

Female Naval Medical Research Institute mice (n = 100).

Intervention(s)

Sixty minutes of CO₂ pneumoperitoneum with 0%, 3%, 6%, 9%, or 12% oxygen; induction of adhesions by the creation of standardized peritoneal lesions during laparoscopy.

Main outcome measure(s)

Adhesions were quantitatively and qualitatively scored after 7 days during laparotomy to determine [1] the effect of 60 minutes of CO₂ pneumoperitoneum with 0%, 3%, 6%, 9%, or 12% oxygen on adhesion formation, and [2] the effect of duration of CO₂ pneumoperitoneum and insufflation pressure on adhesion formation with the addition of 0%, 3%, and 12% oxygen.

Result(s)

Compared with a CO₂ pneumoperitoneum with 3% oxygen, adhesion formation is greater when either no oxygen or more than 3% oxygen is added to the CO₂ pneumoperitoneum. These effects persisted at higher insufflation pressures and longer duration of pneumoperitoneum, both known to increase adhesion formation with pure CO₂.

Conclusion(s)

This study confirms that adhesion formation is decreased with the addition of 3% oxygen to the CO₂ pneumoperitoneum. The addition of higher oxygen concentrations, however, is deleterious. Adhesions always increase with time and duration of the pneumoperitoneum.

Key words:  Adhesion formation , CO₂ pneumoperitoneum , laparoscopy , oxygen , mice