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Published on: October 11, 2018
Effects of laparoscopic models on anaerobic bacterial growth with bacteroides fragilis in experimentally induced
Mustafa Sare1, Ahmet Ender Demirkiran, Nese Tastekin
1Gazi University, Faculty of Medicine, Department of General Surgery, Besevler, Ankara, Turkey. msare@med.gazi.edu.tr
Background:
Previous reports of recurrent intra-abdominal abcess formation after the laparoscopic treatment of perforated acute appendicitis led us to investigate the possible effects of gas insufflation on the spread of infection. We previously showed that Escherichia coli counts were significantly higher in a laparoscopy group that underwent carbon dioxide (CO2) insufflation than in control and laparotomy groups. The aim of this study is to investigate the effects of intra-abdominal CO2 and nitrous oxide (N2O) insufflation on anaerobic bacterial growth in a rat model.
Methods:
A standard strain of Bacteroides fragilis (ATCC 25285) was injected intraperitoneally (1 x 10(6) cfu/mL per kilogram) in 40 Wistar rats under sterile conditions. Forty rats with induced peritonitis were randomly divided into five groups: control, laparotomy, CO2 insufflation, N2O insufflation, and one group without pneumoperitoneum. Eight hours after the intraperitoneal injection of B. fragilis, peritoneal aspirates were obtained and inoculated onto Brucella agar. At the sixteenth hour of induced peritoneal infection (corresponding to hour 8 in the laparoscopy groups) all animals underwent laparotomy; peritoneal aspirates were obtained and inoculated into Brucella agar for bacterial counts. The colonies of B. fragilis were counted manually, and the results were expressed as the mean number of colony-forming units per milliliter.
Results:
No significant differences in microorganism counts were noted between the study groups before the procedure (p>.05 for all comparisons). We observed a significant increase in the number of bacteria (mean +/- SD) in the CO2 insufflation group between hour 8 and hour 16 of peritoneal contamination.
Conclusion:
The results suggest that CO2 insufflation may promote the growth of intra-abdominal anaerobic bacteria. Such bacterial growth may lead to intra-abdominal abcess formation or cause localized peritonitis to develop into generalized peritonitis. We suggest that laparoscopy without pneumoperitoneum may be preferred in patients with peritonitis.
Insights
Carbon dioxide (CO2) insufflation may promote anaerobic bacterial growth in the abdomen, potentially increasing the risk of abscesses after laparoscopic surgery for appendicitis. Avoiding CO2 insufflation in peritonitis patients may be safer.
Area of Science:
- Surgical Innovation
- Microbiology
- Medical Research
Background:
- Recurrent intra-abdominal abscesses reported after laparoscopic treatment of perforated appendicitis.
- Previous studies indicated higher Escherichia coli counts with CO2 insufflation compared to controls.
Purpose of the Study:
- To investigate the effects of intra-abdominal carbon dioxide (CO2) and nitrous oxide (N2O) insufflation on anaerobic bacterial growth.
- To assess the impact of gas insufflation on infection spread in a rat model.
Main Methods:
- Induced peritonitis in Wistar rats using Bacteroides fragilis.
- Randomized rats into five groups: control, laparotomy, CO2 insufflation, N2O insufflation, and no pneumoperitoneum.
- Collected peritoneal aspirates at 8 and 16 hours for bacterial counts.
Main Results:
- No significant differences in bacterial counts between groups before the procedure.
- A significant increase in anaerobic bacteria was observed in the CO2 insufflation group between 8 and 16 hours.
Conclusions:
- CO2 insufflation appears to promote the growth of intra-abdominal anaerobic bacteria.
- This bacterial proliferation may contribute to abscess formation or generalized peritonitis.
- Laparoscopy without pneumoperitoneum is suggested for patients with peritonitis.
