Surgical therapy attenuates abdominal and extra-abdominal inflammation in experimental peritonitis.
BACKGROUND
This study examines the influence of surgical management (elimination of the infectious focus and abdominal lavage) on survival and the inflammatory response in the various compartments of the body: local (abdomen), systemic (blood) and distant organ (lungs).


METHODS
Peritonitis was established in mice by cecal ligation and puncture (CLP). After 24 h, a group was made in which the infected cecum was resected and the abdominal cavity was lavaged (RES), and another group that received no surgical resection (NoRES). Survival was examined over a period of 96 h. Mice were sacrificed at 24 (sham and CLP), 48 and 72 h after CLP to measure inflammatory parameters.


RESULTS
Survival was significantly lower is NoRES compared to sham and RES (p = 0.006, p = 0.014, respectively). Intraperitoneal parameters were improved in the RES group compared to sham but results were not significantly different between groups. In plasma, levels of interleukin-6 (IL-6) were decreased in RES (p = 0.048). Accordingly, anti-inflammatory IL-10 in plasma was increased in this group (p = 0.031). In the lung, keratinocyte-derived chemokine (KC) and myeloperoxidase (MPO) was reduced indicating decreased granulocytes accumulation in the lung in the RES group (p = 0.012 and p = 0.004, respectively).


CONCLUSIONS
In experimental secondary peritonitis surgical management improves survival and attenuates the inflammatory response predominantly in the extra-abdominal compartments. This illustrates the importance of surgery in prevention of multiple organ failure and denotes the compartmentalized character of the inflammatory response. This polymicrobial model with implicated surgical intervention reflects the clinical situation and may be more appropriate to test therapeutic interventions than a model involving only CLP.
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
J W O
JW
van Till
B
B
Lamme
T J H
TJ
van Esch
T
T
van der Poll
T M
TM
van Gulik
M A
MA
Boermeester
D000005:Abdomen; D000818:Animals; D002432:Cecum / Q000293:injuries / Q000382:microbiology; D002634:Chemotaxis, Leukocyte / Q000276:immunology; D018836:Inflammation Mediators / Q000378:metabolism; D016753:Interleukin-10 / Q000378:metabolism; D015850:Interleukin-6 / Q000378:metabolism; D015603:Keratinocytes / Q000276:immunology / Q000378:metabolism; D008026:Ligation; D008168:Lung / Q000276:immunology; D008297:Male; D051379:Mice; D008810:Mice, Inbred C57BL; D009504:Neutrophils / Q000166:cytology / Q000276:immunology; D010538:Peritonitis / Q000276:immunology* / Q000401:mortality / Q000601:surgery*; D009195:Peroxidase / Q000378:metabolism; D013047:Specific Pathogen-Free Organisms; D015996:Survival Rate; D007507:Therapeutic Irrigation; D014951:Wounds, Stab
D018836:Inflammation Mediators; D015850:Interleukin-6; D016753:Interleukin-10; D009195:Peroxidase