[Comparison of local and systemic inflammation after laparotomy or laparoscopy in the rat sepsis model].
BACKGROUND
Laparoscopic techniques are frequently used in patients with peritonitis or intra-abdominal inflammatory diseases although increased intraperitoneal pressure may cause sepsis by promoting bacteraemia and systemic inflammatory response.


METHODS
This experimental study investigates the influence of laparotomy and laparoscopy on bacteraemia, tumour necrosis factor (TNF)-alpha and endotoxin plasma levels. Standardized foecal inoculum was injected intraperitoneally and rats underwent either laparotomy (n = 20), laparoscopy (n = 20), or no further manipulation in the control group (n = 20).


RESULTS
One hour after intervention, bacteraemia was significantly higher in both the laparotomy or laparoscopy groups than in the control group (P = 0.01). Foecal inoculum caused a significant increase in TNF-alpha and endotoxin plasma levels 1 h after intervention with the significantly highest levels after laparotomy (P < 0.05). In addition, the mean number of intraperitoneal abscesses were also significantly higher (P < 0.05) after laparatomy (n = 10) than after laparoscopy (n = 8) or in the control group (n = 5).


CONCLUSIONS
Laparotomy and laparoscopy increased the incidence of bacteraemia and systemic inflammation compared to control group. However, inflammatory response and intraperitoneal abscess formation were significantly higher in the laparotomy group than in the laparoscopy group.
Jacobi
C A
CA
Chirurgische Klinik, Humboldt-Universität, Berlin.
Zieren
H U
HU
Sabat
R
R
Lorenz
W
W
Halle
F E
FE
Müller
J M
JM
D018784:Abdominal Abscess / Q000503:physiopathology; D000818:Animals; D016470:Bacteremia / Q000503:physiopathology; D001419:Bacteria / Q000472:pathogenicity; D004731:Endotoxins / Q000097:blood; D005243:Feces / Q000382:microbiology; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D019060:Minimally Invasive Surgical Procedures; D010538:Peritonitis / Q000503:physiopathology*; D051381:Rats; D018746:Systemic Inflammatory Response Syndrome / Q000503:physiopathology*; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D014774:Virulence
D004731:Endotoxins; D014409:Tumor Necrosis Factor-alpha