Increased systemic inflammation after laparotomy vs laparoscopy in an animal model of peritonitis.
OBJECTIVE
To study the influence of laparotomy and laparoscopy on local and systemic inflammation in a rat model of peritonitis.


METHODS
Bacteremia, peripheral leukocyte subpopulations, tumor necrosis factor alpha (TNF-alpha) plasma levels, and ex vivo secretion of peripheral blood mononuclear cells were investigated after laparotomy and laparoscopy in a prospective randomized experimental study.


METHODS
Surgical department of a university hospital.


METHODS
60 male inbred Wistar rats.


METHODS
Standardized fecal inoculum was injected intraperitoneally and rats underwent laparotomy (n=20), laparoscopy (n=20), or no further manipulation (control group, n=20). Blood samples were obtained during the perioperative course to determine bacteremia, leukocytic subpopulations, TNF-alpha plasma levels, and ex vivo secretion. The number of intraperitoneal abscesses was determined in each animal after 1 week.


METHODS
The hypothesis of the experiment was that laparoscopy with carbon dioxide leads to an increase of local and systemic inflammation in comparison with the laparotomy and control groups.


RESULTS
One hour after intervention, bacteremia was significantly higher in the laparotomy and laparoscopy groups compared with the control group (P=.01). Fecal inoculum caused significant monocytopenia and lymphocytopenia in all groups within 1 hour after intervention (P<.05), with complete recovery on day 2 only in the laparoscopy and control groups. Laparotomy caused a significant increase in TNF-alpha plasma levels and decrease of ex vivo production of TNF-alpha compared with the other 2 groups (P<.05).


CONCLUSIONS
Laparotomy and laparoscopy increased the incidence of bacteremia and systemic inflammation in this peritonitis model. The inflammatory response was significantly higher in the laparotomy group compared with the laparoscopy group.
Jacobi
C A
CA
Department of Surgery, University of Berlin, Germany.
Ordemann
J
J
Zieren
H U
HU
Volk
H D
HD
Bauhofer
A
A
Halle
E
E
Müller
J M
JM
D018784:Abdominal Abscess / Q000209:etiology; D000818:Animals; D016470:Bacteremia / Q000209:etiology / Q000276:immunology; D004195:Disease Models, Animal; D010535:Laparoscopy / Q000009:adverse effects*; D007813:Laparotomy / Q000009:adverse effects*; D007962:Leukocytes; D008297:Male; D010538:Peritonitis / Q000150:complications / Q000209:etiology* / Q000276:immunology; D011897:Random Allocation; D051381:Rats; D017208:Rats, Wistar; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D014409:Tumor Necrosis Factor-alpha