A comparative study of angiogenic and cytokine responses after laparoscopic cholecystectomy performed with standard- and low-pressure pneumoperitoneum.
BACKGROUND
Surgical procedures enhance production of pro- and anti-inflammatory cytokines and angiogenic factors that play a pivotal role in the immunological response to surgical trauma and take part in the pathogenesis of tumor growth and adhesions formation. The purpose of the study was to access the influence of low-pressure CO(2) pneumoperitoneum on the inflammatory and angiogenic responses during the postoperative period after laparoscopy.


METHODS
The study group consisted of 40 patients, operated on due to cholelithiasis using standard-pressure (n = 20) and low-pressure (n = 20) CO(2) pneumoperitoneum. Serum concentration of interleukin (IL)-6, IL-8, IL-10, vascular endothelial growth factor (VEGF)-A, and endostatin were measured before and at 6, 24, and 48 h after surgery with commercially available enzyme-linked immunosorbent assay (ELISA).


RESULTS
Concentrations of IL-6 increased significantly after the operations in both groups. No differences were observed between the groups in regards to IL-6, IL-8, and IL-10 levels. Concentrations of VEGF-A measured at 6 and 48 h were significantly lower in patients who underwent laparoscopies performed with low-pressure pneumoperitoneum. No significant variations were observed in endostatin serum concentration. Concentrations of the studied parameters were not influenced by duration of surgery or by age, gender, or body mass index (BMI) of the patients.


CONCLUSIONS
The results obtained in our study do not show any significant differences between studied operative procedures with regards to systemic inflammatory response. Changes in the concentrations of VEGF-A and endostatin observed in the studied population may suggest this technique is more favorable with regards to angiogenesis process intensity, along with all its consequences and implications.
Torres
Kamil
K
Department of Human Anatomy, Medical University of Lublin, Lublin, Poland. kamil.torres@am.lublin.pl
Torres
Anna
A
Staśkiewicz
Grzegorz J
GJ
Chrościcki
Andrzej
A
Loś
Tadeusz
T
Maciejewski
Ryszard
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D002245:Carbon Dioxide / Q000008:administration & dosage / Q000494:pharmacology; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D002769:Cholelithiasis / Q000097:blood / Q000601:surgery; D043169:Endostatins / Q000097:blood* / Q000378:metabolism; D005260:Female; D006801:Humans; D006874:Hydrostatic Pressure; D007249:Inflammation / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D015850:Interleukin-6 / Q000097:blood / Q000378:metabolism; D016209:Interleukin-8 / Q000097:blood / Q000378:metabolism; D007378:Interleukins / Q000097:blood* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D042461:Vascular Endothelial Growth Factor A / Q000097:blood* / Q000378:metabolism; D055815:Young Adult
D043169:Endostatins; C508600:IL6 protein, human; D015850:Interleukin-6; D016209:Interleukin-8; D007378:Interleukins; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D002245:Carbon Dioxide