title: Peritoneal damage: the inflammatory response and clinical implications of the neuro-immuno-humoral axis.
abstract: BACKGROUND
  The peritoneum is a bilayer serous membrane that lines the abdominal cavity. We present a review of peritoneal structure and physiology, with a focus on the peritoneal inflammatory response to surgical injury and its clinical implications.
  
  
  METHODS
  We conducted a nonsystematic clinical review. A search of the Ovid MEDLINE database from 1950 through January 2009 was performed using the following search terms: peritoneum, adhesions, cytokine, inflammation, and surgery.
  
  
  RESULTS
  The peritoneum is a metabolically active organ, responding to insult through a complex array of immunologic and inflammatory cascades. This response increases with the duration and extent of injury and is central to the concept of surgical stress, manifesting via a combination of systemic effects, and local neural pathways via the neuro-immuno-humoral axis. There may be a decreased systemic inflammatory response after minimally invasive surgery; however, it is unclear whether this is due to a reduced local peritoneal reaction.
  
  
  CONCLUSIONS
  Interventions that dampen the peritoneal response and/or block the neuro-immuno-humoral pathway should be further investigated as possible avenues of enhancing recovery after surgery, and reducing postoperative complications.
authors.affiliation: Department of Surgery, South Auckland Clinical School, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. tsammour@middlemore.co.nz
authors.forename: Tarik
authors.initials: T
authors.lastname: Sammour
authors.forename: Arman
authors.initials: A
authors.lastname: Kahokehr
authors.forename: Mattias
authors.initials: M
authors.lastname: Soop
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Hill
mesh_terms: D006801:Humans; D056724:Immunity, Humoral; D007249:Inflammation / Q000503:physiopathology; D018836:Inflammation Mediators / Q000502:physiology; D010537:Peritoneum / Q000276:immunology* / Q000294:innervation* / Q000502:physiology / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology
chemical_list: D018836:Inflammation Mediators