Peritonitis from perforated peptic ulcer and immune response

Area of Science:

• Surgical Innovation
• Gastroenterology
• Immunology

Background:

• Elevated intra-abdominal pressure during laparoscopy can increase risks of bacteremia and systemic inflammation.
• Perforated peptic ulcer (PPU) with generalized peritonitis presents significant surgical challenges.
• Comparing laparoscopic and open approaches is crucial for managing PPU complications.

Purpose of the Study:

• To compare the acute phase response, immunologic status, and bacterial translocation between laparoscopic and open repair of PPU.
• To evaluate the impact of surgical approach on systemic inflammation and infection markers.

Main Methods:

• A comparative study of 115 patients with PPU: 58 laparoscopic repair (LR) and 57 open repair (OR).
• Investigated markers including bacteremia, endotoxemia, white blood cells, HLA-DR, neutrophil-elastase, IL-1, IL-6, and CRP.
• Data collected from July 2005 to September 2011.

Main Results:

• Laparoscopic repair showed significantly lower bacteremia and endotoxemia one hour post-intervention compared to open repair.
• Open surgery led to increased neutrophil counts, neutrophil-elastase, IL-1, IL-6, and CRP, with a decrease in HLA-DR.
• Intra-abdominal abscesses were significantly less frequent after LR (1.7%) than OR (10.3%).

Conclusions:

• Open repair of PPU with peritonitis increases bacteremia, endotoxemia, and systemic inflammation compared to laparoscopic repair.
• Postoperative inflammation following laparotomy may transiently impair immune defenses (reduced HLA-DR), increasing sepsis risk.
• Laparoscopic approach appears to be a safer and more effective method for PPU management in peritonitis.