Influence of laparoscopy and laparotomy on gasometry, leukocytes and cytokines in a rat abdominal sepsis model.
OBJECTIVE
Laparoscopic surgery is associated with reduced surgical trauma, and less acute phase response, as compared with open surgery. Cytokines are important regulators of the biological response to surgical and anesthetic stress. The aim of this study was to determine if CO2 pneumoperitoneum would change cytokine expression, gas parameters and leukocyte count in septic rats.


METHODS
Wistar rats were randomly assigned to five groups: control (anesthesia only), laparotomy, CO2 pneumoperitoneum, cecum ligation and puncture by laparotomy, and laparoscopic cecum ligation and puncture. After 30 min of the procedures, arterial blood samples were obtained to determine leukocytes subpopulations by hemocytometer. TNFalpha, IL-1beta, IL-6 were determined in intraperitoneal fluid (by ELISA). Gas parameters were measured on arterial blood, intraperitoneal and subperitoneal exudates.


RESULTS
Peritoneal TNFalpha, IL-1beta and IL-6 concentrations were lower in pneumoperitoneum rats than in all other groups (p<0.05). TNFalpha, IL-1beta and IL-6 expression was lower in the laparoscopic than in laparotomic sepsis (p<0.05). Rats from laparoscopic cecum ligation and puncture group developed significant hypercarbic acidosis in blood and subperitoneal fluid when compared to open procedure group. Total white blood cells and lymphocytes were significantly lower in laparoscopic cecum ligation and puncture rats than in the laparotomic (p<0.01). Nevertheless, the laparotomic cecum ligation rats had a significant increase in blood neutrophils and eosinophils when compared with controls (p<0.05).


CONCLUSIONS
This study demonstrates that the CO2 pneumoperitoneum reduced the inflammatory response in an animal model of peritonitis with respect to intraperitoneal cytokines, white blood cell count and clinical correlates of sepsis. The pneumoperitoneum produced hypercarbic acidosis in septic animals.
Araújo Filho
Irami
I
Federal University of Rio Grande do Norte, Brazil.
Honorato Sobrinho
Abraão Allen
AA
Rego
Amália Cinthia Meneses do
AC
Garcia
Ana Claudia M de Amorim
AC
Fernandes
Daniele Pimentel
DP
Cruz
Thaís Medeiros
TM
Costa
Ticiana Cabral da
TC
Medeiros
Aldo Cunha
AC
D000818:Animals; D002245:Carbon Dioxide / Q000378:metabolism; D016207:Cytokines / Q000378:metabolism*; D010535:Laparoscopy / Q000009:adverse effects; D007813:Laparotomy; D007958:Leukocyte Count; D007962:Leukocytes / Q000378:metabolism*; D008297:Male; D010538:Peritonitis / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects; D011897:Random Allocation; D051381:Rats; D017208:Rats, Wistar; D013312:Stress, Physiological / Q000378:metabolism
D016207:Cytokines; D002245:Carbon Dioxide