title: The role of the spleen in laparoscopy-associated inflammatory response.
abstract: BACKGROUND
  Carbon dioxide (CO(2)) pneumoperitoneum alters the inflammatory response in animal models of sepsis. The spleen is a key organ in inflammation and its removal was predicted to modify this effect.
  
  
  METHODS
  The acute phase inflammatory response to lipopolysaccharide (LPS) challenge in male rats was examined for the effects of splenectomy (spx) and the technique of removal (open or laparpscopic). A series of experiments compared LPS-only controls with LPS injection 2 or 9 days following open spx, lap CO2 spx, open sham, or lap CO2 sham. The method of splenectomy was studied by randomization to control, open spx, lap CO2 spx, lap helium (He) spx, or lap air spx with LPS challenge on postoperative day 2. Serum levels of tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (INF-gamma) and, interleutin (IL) 10 were collected at multiple time points, assayed by commercial enzyme-linked immunosorbent assay, analyzed by analysis of variance.
  
  
  RESULTS
  Levels of TNF-alpha at 1.5 were significantly lower following open sham than following lap sham (p < 0.05). Splenectomy drastically reduced INF-gamma and TNF-alpha levels compared to controls (p < 0.05) on postoperative day 2. No method of spx preserved TNF-alpha or INF-gamma responses. Recovery of TNF-alpha response on day 9 was delayed in the spx groups.
  
  
  CONCLUSIONS
  Splenectomy dramatically reduces TNF-alpha and INF-gamma responses to LPS challenge, although by different mechanisms. Pneumoperitoneum-mediated modulation of the septic inflammatory response is partially dependent on the spleen.
authors.affiliation: Department of Surgery, Center for Minimally Invasive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287-4665, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Bachman
authors.forename: E J
authors.initials: EJ
authors.lastname: Hanly
authors.forename: D
authors.initials: D
authors.lastname: Saad
authors.forename: J I
authors.initials: JI
authors.lastname: Nwanko
authors.forename: J
authors.initials: J
authors.lastname: Lamb
authors.forename: A E
authors.initials: AE
authors.lastname: Herring
authors.forename: M R
authors.initials: MR
authors.lastname: Marohn
authors.forename: A
authors.initials: A
authors.lastname: De-Maio
authors.forename: M A
authors.initials: MA
authors.lastname: Talamini
mesh_terms: D000210:Acute-Phase Reaction / Q000097:blood / Q000209:etiology*; D000818:Animals; D002245:Carbon Dioxide; D007371:Interferon-gamma / Q000097:blood; D016753:Interleukin-10 / Q000097:blood; D010535:Laparoscopy; D008070:Lipopolysaccharides / Q000008:administration & dosage; D008297:Male; D011028:Pneumoperitoneum, Artificial; D051381:Rats; D017207:Rats, Sprague-Dawley; D018805:Sepsis / Q000097:blood / Q000209:etiology / Q000276:immunology; D013154:Spleen / Q000276:immunology*; D013156:Splenectomy / Q000009:adverse effects* / Q000379:methods*; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
chemical_list: D008070:Lipopolysaccharides; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D002245:Carbon Dioxide; D007371:Interferon-gamma