Abstract
Laparoscopic surgery is associated with reduced surgical trauma, and less acute phase response, as compared with open surgery. Cytokines are important regulators of the biological response to surgical and anesthetic stress. The aim of this study was to determine if CO2 pneumoperitoneum would change cytokine expression, gas parameters and leukocyte count in septic rats. Wistar rats were randomly assigned to five groups: control (anesthesia only), laparotomy, CO2 pneumoperitoneum, cecum ligation and puncture by laparotomy, and laparoscopic cecum ligation and puncture. After 30 min of the procedures, arterial blood samples were obtained to determine leukocytes subpopulations by hemocytometer. TNFalpha, IL-1beta, IL-6 were determined in intraperitoneal fluid (by ELISA). Gas parameters were measured on arterial blood, intraperitoneal and subperitoneal exudates. Peritoneal TNFalpha, IL-1beta and IL-6 concentrations were lower in pneumoperitoneum rats than in all other groups (p<0.05). TNFalpha, IL-1beta and IL-6 expression was lower in the laparoscopic than in laparotomic sepsis (p<0.05). Rats from laparoscopic cecum ligation and puncture group developed significant hypercarbic acidosis in blood and subperitoneal fluid when compared to open procedure group. Total white blood cells and lymphocytes were significantly lower in laparoscopic cecum ligation and puncture rats than in the laparotomic (p<0.01). Nevertheless, the laparotomic cecum ligation rats had a significant increase in blood neutrophils and eosinophils when compared with controls (p<0.05). This study demonstrates that the CO2 pneumoperitoneum reduced the inflammatory response in an animal model of peritonitis with respect to intraperitoneal cytokines, white blood cell count and clinical correlates of sepsis. The pneumoperitoneum produced hypercarbic acidosis in septic animals.
Highlights
Operative laparoscopy brought a new dimension to surgical practice, and many experimental and clinical studies have demonstrated feasibility, safety, cost-benefit, and pathophysiologic occurrences
Wistar rats were randomly assigned to five groups: control, laparotomy, CO2 pneumoperitoneum, cecum ligation and puncture by laparotomy, and laparoscopic cecum ligation and puncture
This study demonstrates that the CO2 pneumoperitoneum reduced the inflammatory response in an animal model of peritonitis with respect to intraperitoneal cytokines, white blood cell count and clinical correlates of sepsis
Summary
Operative laparoscopy brought a new dimension to surgical practice, and many experimental and clinical studies have demonstrated feasibility, safety, cost-benefit, and pathophysiologic occurrences. A theoretical concern with the use of laparoscopic techniques in clinical cases complicated by intra-abdominal infection and peritonitis, is that carbon dioxide pneumoperitoneum may increase the risk of bacteraemia and sepsis by increasing intra-abdominal pressure. CO2 blocked superoxide release from activated polimorphonuclear leukocytes and significantly reduced the secretion of IL-1 from human peritoneal macrophages[12] Whereas these effects might be considered beneficial from the standpoint of inflammation following elective surgery, experimental evidence suggests that the CO2 induced immunossuppression might be deleterious in the setting of infection[13]. This may have an adverse effect on clinical outcome when compared with open procedures. Gasometry, pro-inflammatory cytokines and leukocytes were analyzed
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