Laparoscopic surgery-induced changes in oxidative stress markers in human plasma.
BACKGROUND
The induction of the pneumoperitoneum increases intraabdominal pressure (IAP), causing splanchnic ischemia, whereas its deflation normalizes IAP and splanchnic blood flow. This procedure appears to represent an ischemia-reperfusion model in humans.


METHODS
Thirty laparoscopic cholecystectomies (LC) were performed in 30 patients with a mean age of 54.6 +/- 15.6 years. A group of 20 patients mean age, 57.3 +/- 9.65 who underwent open cholecystectomy (OC) was also studied. Vein plasma levels of thiobarbituric acid-reactive substances (TBARS), a marker of free radical production; plasma total antioxidant status (TAS); and uric acid (UA) levels were measured preoperatively, 5 min after deflation of the pneumoperitoneum or at the end of operation, and 24 h postoperatively. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin (TBL) levels were measured preoperatively and 24 h after the operation.


RESULTS
In the LC group, significant elevations in the concentration of TBARS were observed in the early postoperative measurements in comparison with the preoperative measurements. TAS and UA levels were decreased significantly 24 h postoperatively compared to preoperative levels. The postoperative levels of AST, ALT, and TBL increased significantly in comparison with the preoperative levels. In the OC group, no alterations in the concentration of TBARS were observed in the postoperative period. The other parameters had changes similar to those recorded for the LC group.


CONCLUSIONS
Free radical-induced lipid peroxidation associated with a decrease in plasma antioxidant capacity and UA levels as well as altered hepatic function is observed after deflation of the pneumoperitoneum. These results suggest that free radicals are generated at the end of a laparoscopic procedure, possibly as a result of an ischemia-reperfusion phenomenon induced by the inflation and deflation of the pneumoperitoneum.
Glantzounis
G K
GK
Department of Surgery, G. Hatzikosta General Hospital, Makriyianni Avenue, GR45001 Ioannina, Greece.
Tselepis
A D
AD
Tambaki
A P
AP
Trikalinos
T A
TA
Manataki
A D
AD
Galaris
D A
DA
Tsimoyiannis
E C
EC
Kappas
A M
AM
D000410:Alanine Transaminase / Q000097:blood; D000975:Antioxidants / Q000032:analysis; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002763:Cholecystectomy / Q000009:adverse effects; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D005609:Free Radicals; D006801:Humans; D007511:Ischemia / Q000209:etiology; D015227:Lipid Peroxidation; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress / Q000502:physiology*; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D013152:Splanchnic Circulation; D017392:Thiobarbituric Acid Reactive Substances / Q000032:analysis*; D014527:Uric Acid / Q000097:blood
D000975:Antioxidants; D015415:Biomarkers; D005609:Free Radicals; D017392:Thiobarbituric Acid Reactive Substances; D014527:Uric Acid; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin