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Local inflammatory peritoneal response to operative trauma: studies on cell activity, cytokine expression, and
W Sendt1, R Amberg, U Schöffel
1Department of Surgery, University of Freiburg, Germany.
Objective:
To test the hypothesis that different surgical procedures may lead to different degrees of activation of the human peritoneal response.
Design:
Clinical laboratory study.
Setting:
University Hospital, Germany.
Material:
Peritoneal specimens taken from the incision or parietal resection margins at the beginning and end of laparoscopic or open cholecystectomy, or other conventional open operations (n = 5 in each group).
Main Outcome Measures:
Detection of indicators of the inflammatory response: interleukin 1 (IL-1), interleukin 6 (IL-6), intercellular adhesion molecule- (ICAM-1), antibacterial protein (defensin 3 that reflects the activation of granulocytes), the antibody clone HAM 56 (for detection of local macrophages), and antibodies against macrophage inhibiting factor (MIF)-related proteins 8 and 14 (MRP 8 and 14).
Results:
The rise between preoperative and postoperative evaluations was significant for each variable (p < 0.05). With one single exception (IL-6 between laparoscopic cholecystectomy and other operations), the one way analysis of variance (ANOVA) showed no significant differences among the three groups in the detectable increases in staining. Linear regression analysis showed no correlation between length of operation and increases in immunohistochemically detected inflammatory variables.
Conclusion:
Minimally invasive surgery does not necessarily mean minimal peritoneal damage. The immunohistochemical evaluation of the local cellular response may provide additional objective criteria for the grading of operative trauma.