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Peritoneal response to a septic challenge. Comparison between open laparotomy, pneumoperitoneum laparoscopy, and wall
C Balagué1, E M Targarona, M Pujol
1Department of General and Digestive Surgery, Hospital de la Santa Creu i Sant Pau, Avda. Padre Claret 167, 08025 Barcelona, Spain.
Background:
Laparoscopic surgery has a lower incidence of surgical infection than open surgery. Differential factors that may modify the bacterial biology and explain this finding to some extent include CO(2) atmosphere, less desiccation of intraabdominal structures, fewer temperature changes, and a better preserved peritoneal and systemic immune response. Previous data suggest that the immune response and acute phase response are better preserved after laparoscopy. Therefore, we designed a study to evaluate the early peritoneal response to sepsis in an experimental peritonitis model comparing open surgery with CO(2) and abdominal wall lift laparoscopy.
Methods:
The study subjects comprised 360 mice distributed into the following four groups: group 1, n = 72 (controls); group 2, n = 96 (open surgery), 2-3 cm laparotomy, with abdominal cavity exposed to the air for 30 min; group 3, n = 96, CO(2) laparoscopy (5 mmHg pneumoperitoneum) for 30 min; group 4, n = 96, wall lift laparoscopy for 30 min. Intraabdominal contamination in the four groups was induced with 1 ml of E. coli suspension (1 x 10(4) CFU/ml) 10 min before abdomen closure. Peritoneal fluid and blood samples were obtained 1.5, 3, 24, and 72 h after surgery, and TNF, IL-1, and IL-6 were measured (via ELISA), as well as quantitative culture.
Results:
The number of CFU (colony-forming units) obtained in peritoneal fluid and positive blood culture rates were significantly lower in the laparoscopic groups than in the open group. IL-1 peritoneal levels were significantly lower after 24 h and 72 h in the laparoscopy groups. IL-6 levels decreased sharply in the laparoscopy groups at 24 h and 72 h. There were no differences between the two types of laparoscopy models (CO(2) and wall lift).
Conclusions:
Peritoneal response to sepsis is better preserved after laparoscopy than after open surgery. CO(2) does not seem to influence bacterial growth. According to these findings, laparoscopy entails less local trauma and better preserved intraabdominal conditions.
Insights
Laparoscopic surgery preserves the peritoneal immune response better than open surgery, leading to lower infection rates. Carbon dioxide (CO2) pneumoperitoneum did not affect bacterial growth in this study.
Area of Science:
- Surgical Innovation
- Immunology
- Microbiology
Background:
- Laparoscopic surgery demonstrates a lower incidence of surgical infection compared to open surgery.
- Factors like CO2 atmosphere and preserved immune response may contribute to reduced infection rates.
- Previous research suggests a better-preserved immune and acute-phase response after laparoscopy.
Purpose of the Study:
- To evaluate the early peritoneal response to sepsis.
- To compare open surgery with CO2 laparoscopy and abdominal wall lift laparoscopy in an experimental peritonitis model.
Main Methods:
- 360 mice were divided into four groups: control, open surgery, CO2 laparoscopy, and wall lift laparoscopy.
- Intra-abdominal contamination with E. coli was induced before abdominal closure.
- Peritoneal fluid and blood samples were collected at various time points to measure cytokine levels (TNF, IL-1, IL-6) and bacterial load.
Main Results:
- Laparoscopic groups showed significantly lower colony-forming units (CFU) and positive blood culture rates than the open surgery group.
- Peritoneal IL-1 levels were significantly lower at 24 and 72 hours in laparoscopy groups.
- IL-6 levels decreased sharply in laparoscopy groups at 24 and 72 hours, with no difference between CO2 and wall lift laparoscopy.
Conclusions:
- The peritoneal response to sepsis is better preserved following laparoscopy compared to open surgery.
- CO2 pneumoperitoneum does not appear to influence bacterial growth.
- Laparoscopy results in less local trauma and better-preserved intra-abdominal conditions.
