Efficacy of barriers and hypoxia-inducible factor inhibitors to prevent CO2 pneumoperitoneum-enhanced adhesions in a laparoscopic mouse model

Study objectiveTo investigate the effects of hypoxia-inducible factor (HIF) inhibitors, flotation agents, barriers, and a surfactant on pneumoperitoneum-enhanced adhesions in a laparoscopic mouse model.DesignProspective randomized trial (Canadian Task Force classification I).SettingDepartment of Obstetrics and Gynecology, University Hospital Gasthuisberg, Catholic University of Leuven.SubjectsOne hundred fourteen female BALB/c mice.InterventionsAdhesions were induced during laparoscopy in BALB/c female mice. Pneumoperitoneum was maintained for 60 minutes with humidified CO2. In 3 experiments the effects of HIF inhibitors such as 17-allylamino 17-demethoxygeldanamycin, radicicol, rapamycin, and wortmanin, flotation agents such as Hyskon and carboxymethylcellulose, barriers such as Hyalobarrier gel and SprayGel, and surfactant such as phospholipids were evaluated.Measurements and main resultsAdhesions were scored after 7 days during laparotomy. Adhesion formation decreased with the administration of wortmannin (p <.01), phospholipids (p <.01), Hyalobarrier Gel (p <.01), and SprayGel (p <.01).ConclusionsThese experiments confirm the efficacy of barriers and phospholipids to separate or lubricate damaged surfaces. They also confirm the role of mesothelial hypoxia in this model by the efficacy of the HIF inhibitor wortmannin.