Peritoneal acidosis mediates immunoprotection in laparoscopic surgery.
BACKGROUND
We have shown previously that abdominal insufflation with CO(2) increases serum levels of IL-10 and TNFalpha and increases survival among animals with lipopolysaccharide (LPS)-induced sepsis, even after a laparotomy. We demonstrated previously that the effect of CO(2) is not from changes in systemic pH, although the peritoneum is locally acidotic during abdominal insufflation with CO(2) even when systemic pH is corrected. We hypothesized that acidification of the peritoneum via means other than CO(2) insufflation would produce alterations in the inflammatory response similar to those associated with CO(2) pneumoperitoneum.


METHODS
In total, 42 rats were randomized into 7 groups (n = 6): 1) LPS only, 2) anesthesia control, 3) helium pneumoperitoneum, 4) CO(2) pneumoperitoneum, 5) buffered mild acid lavage, 6) buffered strong acid lavage, and 7) buffered strong acid lavage + helium pneumoperitoneum. Animals received anesthesia with vaporized isoflurane (except the LPS-only group) and their respective abdominal treatment (pneumoperitoneum and/or lavage) for 30 min followed immediately by stimulation with systemic LPS (1 mg/kg, IV). Blood was harvested via cardiac puncture 60 min after LPS injection, and serum levels of IL-10 and TNFalpha levels were determined by enzyme-linked immunosorbent assay.


RESULTS
Mean peritoneal pH decreased (P < .05) after CO(2) pneumoperitoneum, buffered strong acid lavage, and buffered strong acid lavage + helium pneumoperitoneum, and it decreased (P = .1) after helium pneumoperitoneum alone and buffered mild acid lavage. IL-10 levels were increased (P < .01), and TNFalpha levels decreased (P < .001) among animals with acidic peritoneal cavities compared with animals with pH-normal peritoneal cavities. Decreasing peritoneal pH correlated with both increasing IL-10 levels (r = -.465, P < .01) and decreasing TNFalpha levels (r = 0.448, P < .01). Among animals with peritoneal acidosis, there were no differences in levels of IL-10 or TNFalpha regardless of insufflation status (P > .05 for both cytokines).


CONCLUSIONS
Acidification of the peritoneal cavity whether by abdominal insufflation or by peritoneal acid lavage increases serum IL-10 and decreases serum TNFalpha levels in response to systemic LPS challenge. The degree of peritoneal acidification correlates with the degree of inflammatory response reduction. These results support the hypothesis that pneumoperitoneum-mediated attenuation of the inflammatory response after laparoscopic surgery occurs via a mechanism of peritoneal cell acidification.
Hanly
Eric J
EJ
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Aurora
Alexander A
AA
Shih
Samuel P
SP
Fuentes
Joseph M
JM
Marohn
Michael R
MR
De Maio
Antonio
A
Talamini
Mark A
MA
D000138:Acidosis / Q000209:etiology / Q000503:physiopathology*; D000818:Animals; D002245:Carbon Dioxide; D004195:Disease Models, Animal; D006863:Hydrogen-Ion Concentration; D007327:Insufflation / Q000009:adverse effects* / Q000379:methods; D016753:Interleukin-10 / Q000097:blood; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008070:Lipopolysaccharides; D008297:Male; D010533:Peritoneal Lavage; D010537:Peritoneum / Q000503:physiopathology*; D010538:Peritonitis / Q000139:chemically induced / Q000276:immunology / Q000517:prevention & control*; D010865:Pilot Projects; D011027:Pneumoperitoneum / Q000139:chemically induced / Q000503:physiopathology; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D008070:Lipopolysaccharides; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D002245:Carbon Dioxide