Does pneumoperitoneum during laparoscopy increase bacterial translocation?
BACKGROUND
To evaluate the impact of laparoscopy in the presence of peritonitis, this study was designed to assess bacteremia caused by E. coli-induced peritonitis with a carbon dioxide pneumoperitoneum in a rat model.


METHODS
Sixty Sprague-Dawley rats were divided into inoculum groups (no E. coli, 10(6) colony-forming units [CFU] E. coli, and 10(8) CFU E. coli), followed by induction of a carbon dioxide pneumoperitoneum or no pneumoperitoneum. Fifteen-minute-interval blood cultures were obtained to determine time of bacteremia development. Statistical assessment to determine significant differences among groups was done using ANOVA and t-test analysis.


RESULTS
A total of 20 animals with E. coli introduced into the peritoneum and a carbon-dioxide-induced pneumoperitoneum had more frequent positive blood cultures at all time intervals compared to identical inoculum subgroups without a pneumoperitoneum. ANOVA revealed a significant difference in bacteremia within the same concentration inoculum groups in animals receiving a pneumoperitoneum vs none (p < 0.01). Bacteremia increased significantly as inoculum concentrations increased (25% with 10(6) E. coli inoculum vs 80% with 10(8) E. coli), especially among the insufflated subgroups (45% with 10(6) E. coli vs 100% with 10(8) E. coli) over 180 min (p < 0.01).


CONCLUSIONS
Carbon dioxide pneumoperitoneum increases the incidence of E. coli bacterial translocation from the peritoneum into the bloodstream in this rat model.
Evasovich
M R
MR
Department of General Surgery, Akron General Medical Center, 400 Wabash Avenue, Akron, OH 44307, USA.
Clark
T C
TC
Horattas
M C
MC
Holda
S
S
Treen
L
L
D000818:Animals; D016470:Bacteremia / Q000382:microbiology; D018988:Bacterial Translocation; D001794:Blood Pressure; D002245:Carbon Dioxide / Q000627:therapeutic use; D004195:Disease Models, Animal; D004926:Escherichia coli / Q000502:physiology*; D010535:Laparoscopy; D008297:Male; D010538:Peritonitis / Q000382:microbiology; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D051381:Rats; D017207:Rats, Sprague-Dawley
D002245:Carbon Dioxide