The degree of local inflammatory response after colonic resection depends on the surgical approach: an observational study in 61 patients.

Torben Glatz,Ann-Kathrin Lederer,Philipp Anton Holzner,Birte Kulemann,Goran Marjanovic,Jens Hoeppner,Gabriel Seifert,Ulrich Theodor Hopt

doi:10.1186/s12893-015-0097-y

Torben Glatz, Ann-Kathrin Lederer + Show 6 more

Open Access

https://doi.org/10.1186/s12893-015-0097-y

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Journal: BMC surgery	Publication Date: Oct 6, 2015
Citations: 41	License type: cc-by

Affiliation: University of Freiburg

Abstract

BackgroundClinical data indicate that laparoscopic surgery reduces postoperative inflammatory response and benefits patient recovery. Little is known about the mechanisms involved in reduced systemic and local inflammation and the contribution of reduced trauma to the abdominal wall and the parietal peritoneum.MethodsIncluded were 61 patients, who underwent elective colorectal resection without intraabdominal complications; 17 received a completely laparoscopic, 13 a laparoscopically- assisted procedure and 31 open surgery. Local inflammatory response was quantified by measurement of intraperitoneal leukocytes and IL-6 levels during the first 4 days after surgery.ResultsThere was no statistical difference between the groups in systemic inflammatory parameters and intraperitoneal leukocytes. Intraperitoneal interleukin-6 was significantly lower in the laparoscopic group than in the laparoscopically-assisted and open group on postoperative day 1 (26.16 versus 43.25 versus 40.83 ng/ml; p = 0.001). No difference between the groups was recorded on POD 2–4. Intraperitoneal interleukin-6 showed a correlation with duration of hospital stay on POD 1 (0.233, p = 0.036), but not on POD 2–4.Patients who developed a surgical wound infection showed higher levels of intraperitoneal interleukin-6 on postoperative day 2–4 (POD 2: 42.56 versus 30.02 ng/ml, p = 0.03), POD 3: 36.52 versus 23.62 ng/ml, p = 0.06 and POD 4: 34.43 versus 19.99 ng/ml, p = 0.046). Extraabdominal infections had no impact.ConclusionThe analysis shows an attenuated intraperitoneal inflammatory response on POD 1 in completely laparoscopically-operated patients, associated with a quicker recovery. This effect cannot be observed in patients, who underwent a laparoscopically-assisted or open procedure. Factors inflicting additional trauma to the abdominal wall and parietal peritoneum promote the intraperitoneal inflammation process.

Highlights

Clinical data indicate that laparoscopic surgery reduces postoperative inflammatory response and benefits patient recovery
Patients Among the 61 patients, 17 were operated completely laparoscopically, 13 laparoscopically- assisted with additional laparotomy and 31 underwent open surgery
We present the first study analyzing the physiological course of ip IL-6 levels over 4 days after colonic surgery

Summary

Introduction

Clinical data indicate that laparoscopic surgery reduces postoperative inflammatory response and benefits patient recovery. Little is known about the mechanisms involved in reduced systemic and local inflammation and the contribution of reduced trauma to the abdominal wall and the parietal peritoneum. Major abdominal surgery and laparotomy causes a release of local and systemic cytokines, inducing a systemic inflammatory response syndrome [1,2,3]. Local peritoneal inflammation is thought to play a role in patient recovery and in development of perioperative complications [4,5,6,7]. Retrospective analyses indicate a beneficial effect of laparoscopically- performed surgery on patient recovery and even on the occurrence of serious complications like anastomotic leak and on patient survival [14,15,16,17].

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