Impact of laparoscopy with carbon dioxide versus helium on local and systemic inflammation in an animal model of peritonitis.
Increased intraperitoneal pressure and insufflation of carbon dioxide during laparoscopy may cause sepsis by promoting systemic inflammation in patients with intra-abdominal inflammatory diseases. The influence of carbon dioxide and helium during laparoscopy on bacteremia, endotoxemia, the plasma concentration of tumor necrosis factor-alpha (TNF-alpha), TNF-alpha secretion ex vivo by peripheral blood mononuclear cells (PBMCs), and intraperitoneal abscess formation was investigated in an animal model. A standardized fecal inoculum was injected intraperitoneally, and rats underwent laparoscopy with either carbon dioxide (N = 20) or helium (N = 20) or no further manipulation (control group; N = 20). Bacteremia was significantly more common 1 hour after laparoscopy with CO2 than in animals receiving helium or the control group. Furthermore, helium use led to a significant decrease of bacteremia 1 week after intervention. Fecal inoculation caused significant leukocytopenia in all groups within 1 hour after intervention, with complete recovery only in the helium-treated group (p < 0.05). The TNF-alpha plasma concentration was significantly lower in the helium-treated group, and suppression of ex vivo production recovered only in the animals undergoing laparoscopy with helium (p < 0.05). The number of intraperitoneal abscesses was significantly lower after laparoscopy with helium (2+/-1.5) than after CO2 laparoscopy (6.3+/-5.1) or in the control group (5.2+/-4.8). Laparoscopy with CO2 increased systemic inflammation only slightly, while helium use was associated with a significant lower incidence of bacteremia and local and systemic inflammation compared with the control group.
Department of General, Visceral, Vascular and Thoracic Surgery, Humboldt University of Berlin, Charité, Germany.
C A
CA
Jacobi
J
J
Ordemann
E
E
Halle
H D
HD
Volk
J M
JM
Müller
D000038:Abscess / Q000097:blood / Q000276:immunology / Q000601:surgery*; D000818:Animals; D016470:Bacteremia / Q000175:diagnosis / Q000276:immunology / Q000601:surgery; D002245:Carbon Dioxide; D004195:Disease Models, Animal; D004731:Endotoxins / Q000097:blood; D006371:Helium; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D007958:Leukocyte Count; D007962:Leukocytes / Q000276:immunology / Q000378:metabolism; D008297:Male; D010538:Peritonitis / Q000097:blood / Q000276:immunology / Q000601:surgery*; D051381:Rats; D017208:Rats, Wistar; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis / Q000378:metabolism
D004731:Endotoxins; D014409:Tumor Necrosis Factor-alpha; D002245:Carbon Dioxide; D006371:Helium