title: Peritonitis from perforated appendicitis: stress response after laparoscopic or open treatment.
abstract: Elevated intra-abdominal pressure during laparoscopy may promote systemic inflammatory response. In patients with generalized peritonitis from perforated appendicitis, we sought to compare acute phase response and immunologic status from laparoscopic and open approach. One hundred and  forty-seven consecutive patients underwent appendectomy for perforated appendicitis (73 patients had laparoscopic appendectomy and 74 patients had open appendectomy. Bacteremia, endotoxemia, white blood cells, peripheral lymphocytes subpopulation, human leukocyte antigen-DR (HLA-DR), neutrophil-elastase,  interleukin-1 and 6 (IL-1 and 6), and C-reactive protein were investigated. One hour after intervention, bacteremia was significantly higher in the open group compared with the laparoscopic group (P < 0.05). A significantly higher concentration of systemic endotoxin was detected  intraoperatively in the open group of patients in comparison with the laparoscopic group (P < 0.05). Laparotomy caused a significant increase in neutrophil concentration, neutrophil-elastase, IL-1 and 6, and C-reactive protein and a decrease of HLA-DR. We recorded 6 cases (8.1%)  of intra-abdominal abscess in the open group and one (1.3%) in the laparoscopic group (P < 0.05). Open appendectomy, in case of peritonitis, increased the incidence of bacteremia, endotoxemia, and systemic inflammation compared with laparoscopic appendectomy. Early enhanced postoperative  systemic inflammation may cause lower transient immunologic defense after laparotomy (decrease of HLA-DR), leading to enhanced sepsis in these patients.
authors.affiliation: Department of Surgery, University of L'Aquila, Italy. schietroma2001@yahoo.it
authors.forename: Mario
authors.initials: M
authors.lastname: Schietroma
authors.forename: Federica
authors.initials: F
authors.lastname: Piccione
authors.forename: Francesco
authors.initials: F
authors.lastname: Carlei
authors.forename: Marco
authors.initials: M
authors.lastname: Clementi
authors.forename: Zuleyka
authors.initials: Z
authors.lastname: Bianchi
authors.forename: Fabiola
authors.initials: F
authors.lastname: de Vita
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Amicucci
mesh_terms: D000005:Abdomen / Q000503:physiopathology* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D001062:Appendectomy / Q000009:adverse effects* / Q000379:methods; D001064:Appendicitis / Q000150:complications* / Q000601:surgery; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007375:Interleukin-1 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D010535:Laparoscopy / Q000009:adverse effects*; D007813:Laparotomy / Q000009:adverse effects*; D019272:Leukocyte Elastase / Q000097:blood; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000201:enzymology / Q000473:pathology; D010538:Peritonitis / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D011312:Pressure; D011379:Prognosis; D012189:Retrospective Studies; D012308:Risk Management; D012422:Rupture, Spontaneous; D013314:Stress, Mechanical; D055815:Young Adult
chemical_list: D007375:Interleukin-1; D015850:Interleukin-6; D002097:C-Reactive Protein; D019272:Leukocyte Elastase