title: Peritoneal changes due to laparoscopic surgery.
abstract: BACKGROUND
  Laparoscopic surgery has been incorporated into common surgical practice. The peritoneum is an organ with various biologic functions that may be affected in different ways by laparoscopic and open techniques. Clinically, these alterations may be important in issues such as peritoneal metastasis and adhesion formation.
  
  
  METHODS
  A literature search using the Pubmed and Cochrane databases identified articles focusing on the key issues of laparoscopy, peritoneum, inflammation, morphology, immunology, and fibrinolysis.
  
  
  RESULTS
  Laparoscopic surgery induces alterations in the peritoneal integrity and causes local acidosis, probably due to peritoneal hypoxia. The local immune system and inflammation are modulated by a pneumoperitoneum. Additionally, the peritoneal plasmin system is inhibited, leading to peritoneal hypofibrinolysis.
  
  
  CONCLUSIONS
  Similar to open surgery, laparoscopic surgery affects both the integrity and biology of the peritoneum. These observations may have implications for various clinical conditions.
authors.affiliation: Department of Surgery, Jeroen Bosch Hospital, P.O. Box 1101, 5200 BD, 's-Hertogenbosch, The Netherlands. w.brokelman@jbz.nl
authors.forename: W J A
authors.initials: WJ
authors.lastname: Brokelman
authors.forename: M
authors.initials: M
authors.lastname: Lensvelt
authors.forename: I H M
authors.initials: IH
authors.lastname: Borel Rinkes
authors.forename: J H G
authors.initials: JH
authors.lastname: Klinkenbijl
authors.forename: M M P J
authors.initials: MM
authors.lastname: Reijnen
mesh_terms: D000138:Acidosis / Q000209:etiology; D000818:Animals; D002245:Carbon Dioxide / Q000008:administration & dosage / Q000009:adverse effects; D015815:Cell Adhesion Molecules / Q000378:metabolism; D015687:Cell Hypoxia; D016207:Cytokines / Q000378:metabolism; D004848:Epithelium / Q000473:pathology; D005341:Fibrinolysin / Q000502:physiology; D005342:Fibrinolysis; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000378:metabolism; D010535:Laparoscopy / Q000009:adverse effects*; D017737:Macrophages, Peritoneal / Q000502:physiology; D051379:Mice; D009366:Neoplasm Seeding; D010529:Peritoneal Cavity / Q000503:physiopathology* / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000556:secondary; D010537:Peritoneum / Q000276:immunology / Q000503:physiopathology* / Q000601:surgery; D010538:Peritonitis / Q000209:etiology / Q000503:physiopathology; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D000267:Tissue Adhesions / Q000209:etiology / Q000503:physiopathology; D014945:Wound Healing / Q000502:physiology
chemical_list: D015815:Cell Adhesion Molecules; D016207:Cytokines; D036341:Intercellular Signaling Peptides and Proteins; D002245:Carbon Dioxide; D005341:Fibrinolysin