title: Manipulation of the small intestine as a cause of the increased inflammatory response after open compared with laparoscopic surgery.
abstract: BACKGROUND
  Laparoscopic surgery of the gastrointestinal tract involves a reduced immune response compared with open surgery. The aim of this study was to assess manual handling of the gut in open procedures as the principal cause of the enhanced immune response.
  
  
  METHODS
  Eighteen Landrace pigs underwent gastrectomy by three different methods: conventional open wound with bowel manipulation, laparoscopically assisted gastrectomy, and gastrectomy without manipulation using a combination of open wound and laparoscopic surgical devices. Local inflammatory changes were assessed by ascites formation, intestinal adhesion development and intestinal inflammatory gene expression. Associated systemic inflammatory changes were determined by measuring portal and systemic plasma endotoxin levels, plasma inflammatory cytokine levels, liver inflammatory gene expression and transaminase levels.
  
  
  RESULTS
  Significantly more postoperative intra-abdominal fluid and adhesions were seen in the open group. The expression of inflammatory cytokines was significantly greater in the intestine and liver in the open group. Portal and systemic levels of endotoxin, inflammatory cytokines and transaminases were also higher.
  
  
  CONCLUSIONS
  Manual handling of organs during gastrectomy is an important contributor to the molecular and humoral inflammatory response to surgery, supporting the use of minimally invasive techniques in gastrointestinal surgery.
authors.affiliation: Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Japan. naoki.hiki@jfcr.or.jp
authors.forename: N
authors.initials: N
authors.lastname: Hiki
authors.forename: N
authors.initials: N
authors.lastname: Shimizu
authors.forename: H
authors.initials: H
authors.lastname: Yamaguchi
authors.forename: K
authors.initials: K
authors.lastname: Imamura
authors.forename: K
authors.initials: K
authors.lastname: Kami
authors.forename: K
authors.initials: K
authors.lastname: Kubota
authors.forename: M
authors.initials: M
authors.lastname: Kaminishi
mesh_terms: D000818:Animals; D016207:Cytokines / Q000378:metabolism*; D018076:DNA, Complementary / Q000378:metabolism; D004751:Enteritis / Q000276:immunology*; D005743:Gastrectomy / Q000379:methods*; D007111:Immunity, Cellular; D007421:Intestine, Small / Q000276:immunology* / Q000378:metabolism / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D010812:Physical Stimulation; D011897:Random Allocation; D013552:Swine; D013997:Time Factors
chemical_list: D016207:Cytokines; D018076:DNA, Complementary