Abstracts
1998 Digestive Disease Week

#1007

FASCIAL CLOSURE DECREASES PORT SITE IMPLANTATION FOLLOWING LAPAROSCOPY IN A RAT PERITONEAL SEEDING MODEL. A.B. Johnson, D. Dillehay, K. Macken, G.W. Daneker, and J.G. Hunter. Department of Surgery, Emory University School of Medicine. Atlanta, GA.

Wound implantation following laparoscopic resection of colon cancer occurs without direct specimen contact with the wound. Fascial closure of laparoscopic port sites is not routine, allowing fluid within the peritoneal cavity access to the subcutaneous tissue. We hypothesized that fascial closure would prevent subcutaneous tumor implantation following laparoscopic surgery. Methods: An HT-29 human colon cancer cell line suspension of 6 x 105 cells in serum free media, was injected under direct vision into the peritoneal cavities of 38 six week old athymic nude(RH-rnu) rats. A 3mm trocar was inserted into each quadrant of the anterior abdominal wall of 19 rats and the abdomen was inflated with CO2 to a pressure of six to eight mmHg. 3mm fascial incisions were made in each quadrant of the 19 rats that did not receive laparoscopy. The skin of the RUQ and RLQ incisions of all 38 rats was closed with 5-0 nylon. The fascia and skin of the LUQ and LLQ incisions was closed in two layers with 5-0 Monocryl(Ethicon, Inc.) and 5-0 nylon. Six weeks later the abdominal walls were examined grossly for wound implantation. A five-point gross morphology scale was devised based on the histologic depth of abdominal wall penetration. Statistical analysis was performed using the Wilcoxon Rank Sum test. Results: The frequency of subcutaneous implantation score representing the greatest penetration (3 or 4) for the 38 wounds in each of the quadrants was:

Conclusions: Pneumoperitoneum increases the depth of implantation when the fascial layer is left open. Fascial closure significantly decreases the frequency of wound implantation especially in rats receiving laparoscopy. Fascial closure may lower the incidence of wound recurrence following laparoscopic colectomy to a level seen following conventional colon resection for adenocarcinoma.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.