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Increased transperitoneal bacterial translocation in laparoscopic surgery
M C Horattas1, N Haller, D Ricchiuti
1Akron General Medical Center, Northeastern Ohio Universities College of Medicine, 400 Wabash Avenue, Akron, Ohio 44307, USA.
Background:
The indications for laparoscopic surgery have expanded to include diseases possibly associated with peritonitis such as appendicitis, perforated peptic ulcers, and diverticulitis. The safety of carbon dioxide (CO2) pneumoperitoneum in the presence of peritonitis has not been proved. Our previous investigations demonstrated increased bacteremia associated with CO2 insufflation. In effort to clarify the relative effects of intraabdominal pressure and type of gas, this study was designed to measure bacterial translocation with different gases at different pressures of pneumoperitoneum.
Methods:
For this study, 110 rats were given intraperitoneal bacterial innoculations with Escherichia coli and equally divided into five groups of 20 animals each. The study groups included a control group with no pneumoperitoneum administered (n = 30), insufflation at a commonly used pressure of 14 mmHg with helium (n = 20) and CO2 (n = 20), and low insufflation at 3 mmHg with helium (n = 20) and CO2 (n = 20) in an effort to minimize influences related to pressure. Blood cultures were checked at 15-min intervals for the first 45 min, then hourly thereafter for a total of 165 min after peritoneal inoculation with 2 x 10(7) E. coli.
Results:
There is increased risk of bacterial translocation in comparing groups that underwent pneumoperitoneum with those that did not in the rat peritonitis model. Furthermore, these findings are dependent on the presence or absence of gas, but not necessarily on the type of gas used for insufflation. In the low-pressure groups of both gases (helium and CO2), bacterial translocation was significantly increased, as compared with the control group. Low pressure also was associated with increased bacterial translocation, as compared with high pressure, but beyond 30 min of insufflation, no significant differences were apparent.
Conclusions:
The risk of bacterial translocation in the E. coli rat peritonitis model is increased with insufflation using CO2 or helium, and this effect is more significant at lower pressures (3 mmHg) than at higher pressures (14 mmHg). However, no clinically applicable conclusions regarding the relative effects from type of gas or insufflation pressures could be confirmed.
Insights
Pneumoperitoneum with carbon dioxide (CO2) or helium during peritonitis in rats increases bacterial translocation, especially at lower pressures. The type of gas used was less significant than the presence of gas and pressure levels.
Area of Science:
- Surgical innovation and patient safety
- Microbiology and infection control
- Gastrointestinal disease research
Background:
- Laparoscopic surgery indications are expanding to include peritonitis-associated conditions.
- The safety of carbon dioxide (CO2) pneumoperitoneum in peritonitis remains unproven.
- Previous studies indicated increased bacteremia with CO2 insufflation.
Purpose of the Study:
- To investigate bacterial translocation with different gases and pressures during pneumoperitoneum.
- To clarify the roles of intra-abdominal pressure and gas type in bacterial translocation.
- To assess the safety of CO2 and helium pneumoperitoneum in a peritonitis model.
Main Methods:
- 110 rats with induced peritonitis were inoculated with Escherichia coli.
- Groups included a control (no pneumoperitoneum), and pneumoperitoneum with helium or CO2 at 14 mmHg and 3 mmHg.
- Blood cultures were monitored for bacterial translocation over 165 minutes.
Main Results:
- Pneumoperitoneum significantly increased bacterial translocation compared to controls.
- Bacterial translocation was elevated in low-pressure (3 mmHg) groups for both helium and CO2.
- Gas type was less influential than the presence of gas and pressure in bacterial translocation.
Conclusions:
- Insufflation with CO2 or helium increases bacterial translocation in a rat peritonitis model.
- Lower insufflation pressures (3 mmHg) are associated with a greater risk of bacterial translocation.
- Clinical conclusions on gas type or pressure effects remain unconfirmed.