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Histologic study of peritoneal adhesions in children and in a rat model
M Torre1, A Favre, A Pini Prato
1Divisione e Cattedra di Chirurgia Pediatrica, Istituto G. Gaslini, Largo G. Gaslini, 16147, Genova, Italy.
Insights
Peritoneal adhesions (PA) formation requires both a direct injury to the mesothelium and contamination with foreign bodies (FB). Minimizing FB contamination during surgery is crucial for preventing PA in pediatric patients.
Area of Science:
- Surgical pathology
- Histology
Background:
- Peritoneal adhesions (PA) are a significant cause of morbidity in pediatric surgical patients.
- The exact pathogenesis of PA remains largely unknown.
- Foreign bodies (FB) accidentally contaminating the surgical field are a potential contributing factor to PA formation.
Purpose of the Study:
- To investigate the role of FB in the formation of PA.
- To elucidate the combined effect of peritoneal injury and FB on adhesion development.
Main Methods:
- Histologic examination of PA in a rat model and in pediatric surgical patients.
- Rats were subjected to laparotomy with peritoneal rubbing (Group A), injection of FB (Group B), or both (Group C).
- Adhesions from pediatric patients with prior abdominal surgeries were collected and stained.
Main Results:
- PA were observed in rats with peritoneal rubbing (Group A) and those with both rubbing and FB injection (Group C), but not with FB injection alone (Group B).
- Group C rats exhibited a higher grade of adhesions compared to Group A.
- Microscopic FB particles were consistently found within the connective tissue of PA in both animal and human samples.
Conclusions:
- PA formation necessitates two distinct stimuli: direct mesothelial injury and the presence of a solid substrate (FB).
- Reducing FB contamination during surgical procedures is critical for preventing PA.
- Laparoscopic surgery may be particularly beneficial in minimizing FB contamination and subsequent adhesion formation.
Abstract:
Peritoneal adhesions (PA) represent a major cause of morbidity in pediatric surgical patients. The pathogenesis is still largely unknown. A possible role could be played by foreign bodies (FB) accidentally contaminating the operative field during surgery. We report a histologic study of PA in a rat model and in children, investigating the role of FB in their formation. Abdominal adhesions were studied in 18 rats. In 6 (group A) we performed a laparotomy and rubbed the visceral and parietal peritoneum with a cotton bud. In 6 (group B) we performed a minimal laparotomy and injected powdered autologous and heterologous material into the peritoneal cavity, avoiding any peritoneal abrasions. In 6 (group C) we performed a laparotomy and applied both treatment methods, i.e., rubbing and injection of FB. After 1 month, at autopsy rats were classified according to the presence and grade of surgical adhesions. Twenty-two PA were also collected from seven children undergoing abdominal surgery in whom one or more procedures had been previously performed. The adhesions were stained with hematoxylin-eosin and Giemsa stains for histologic examination. Adhesions were found in 4 rats of group A and all 6 rats of group C. None were identified in group B. Group C rats showed a higher grade of adhesions with respect to group A. In both humans and animals PA were always found to coexist with microscopic particles of solid substances, which were incorporated inside the connective tissue. However, after simple injection of FB into the abdominal cavity we did not observe any PA. These data suggest that two different stimuli are necessary for adhesion formation: a direct lesion of the mesothelial layers and a solid substrate (FB). We underline the importance of reducing contamination with FB during surgery. On the basis of these considerations, the laparoscopic approach seems to be particularly pertinent.