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Immediate peritoneal response to bacterial contamination during laparoscopic surgery
E M Targarona1, M Rodríguez, M Camacho
1Service of Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. etargarona@lsp.santpau.es
Surgical Endoscopy
|October 26, 2005
Summary
Laparoscopic surgery (LS) shows a transient impairment in peritoneal response to sepsis, but ultimately offers better control of abdominal infections compared to open surgery due to less overall injury. This study analyzed the early peritoneal response to contamination in a CO(2) environment.
Area of Science:
- Surgical Innovation and Immunology
- Minimally Invasive Surgery Research
- Peritoneal Response to Sepsis
Background:
- Laparoscopic surgery (LS) is associated with reduced surgical trauma and preserved immune function.
- LS demonstrates a lower incidence of septic complications compared to open surgery.
- In vitro studies suggest CO(2) may impair macrophage function, potentially affecting peritoneal response to contamination.
Purpose of the Study:
- To investigate the early peritoneal response to bacterial contamination under carbon dioxide (CO(2)) insufflation.
- To compare the inflammatory mediator release in response to sepsis across different surgical models: laparotomy (LAP), CO(2) laparoscopy (CO(2)-LC), and wall-lift laparoscopy (WL-LC).
- To clarify the controversy regarding the peritoneal response to sepsis in the context of LS.
Main Methods:
- 192 CD-1 mice were divided into three groups: LAP, CO(2)-LC, and WL-LC (n=64 each).
- Mice received either an Escherichia coli suspension or saline, followed by peritoneal fluid collection at 1.5, 3, 6, and 12 hours post-surgery.
- Levels of monocyte chemoattractant protein-1 (MCP-1), interleukin-6 (IL-6), and prostaglandin E(2) (PGE(2)) were quantified.
Main Results:
- CO(2)-LC showed significantly earlier and higher MCP-1 levels compared to LAP. WL-LC also demonstrated a significant increase in MCP-1 compared to LAP.
- IL-6 levels increased significantly in all models, with earlier and higher elevations observed in WL-LC compared to LAP. Contaminated CO(2)-LC groups showed significant differences compared to non-contaminated groups.
- PGE(2) levels increased significantly in non-contaminated groups across all models, with no significant differences observed between groups, including in contaminated scenarios.
Conclusions:
- While CO(2) laparoscopy may transiently impair the immediate peritoneal response to sepsis, the overall lower surgical injury compared to open surgery facilitates better control of abdominal infections.
- The study highlights differences in early inflammatory mediator release depending on the surgical technique and presence of contamination.
- LS appears to offer a superior outcome in managing peritoneal contamination despite potential transient effects of CO(2) on immune cells.