title: The degree of local inflammatory response after colonic resection depends on the surgical approach: an observational study in 61 patients.
abstract: BACKGROUND
  Clinical data indicate that laparoscopic surgery reduces postoperative inflammatory response and benefits patient recovery. Little is known about the mechanisms involved in reduced systemic and local inflammation and the contribution of reduced trauma to the abdominal wall and the parietal peritoneum.
  
  
  METHODS
  Included were 61 patients, who underwent elective colorectal resection without intraabdominal complications; 17 received a completely laparoscopic, 13 a laparoscopically- assisted procedure and 31 open surgery. Local inflammatory response was quantified by measurement of intraperitoneal leukocytes and IL-6 levels during the first 4 days after surgery.
  
  
  RESULTS
  There was no statistical difference between the groups in systemic inflammatory parameters and intraperitoneal leukocytes. Intraperitoneal interleukin-6 was significantly lower in the laparoscopic group than in the laparoscopically-assisted and open group on postoperative day 1 (26.16 versus 43.25 versus 40.83 ng/ml; p = 0.001). No difference between the groups was recorded on POD 2-4. Intraperitoneal interleukin-6 showed a correlation with duration of hospital stay on POD 1 (0.233, p = 0.036), but not on POD 2-4. Patients who developed a surgical wound infection showed higher levels of intraperitoneal interleukin-6 on postoperative day 2-4 (POD 2: 42.56 versus 30.02 ng/ml, p = 0.03), POD 3: 36.52 versus 23.62 ng/ml, p = 0.06 and POD 4: 34.43 versus 19.99 ng/ml, p = 0.046). Extraabdominal infections had no impact.
  
  
  CONCLUSIONS
  The analysis shows an attenuated intraperitoneal inflammatory response on POD 1 in completely laparoscopically-operated patients, associated with a quicker recovery. This effect cannot be observed in patients, who underwent a laparoscopically-assisted or open procedure. Factors inflicting additional trauma to the abdominal wall and parietal peritoneum promote the intraperitoneal inflammation process.
authors.affiliation: Department of General and Visceral Surgery, Albert Ludwigs University of Freiburg, Freiburg im Breisgau, Germany. Torben.Glatz@uniklinik-freiburg.de.
authors.forename: Torben
authors.initials: T
authors.lastname: Glatz
authors.affiliation: Department of General and Visceral Surgery, Albert Ludwigs University of Freiburg, Freiburg im Breisgau, Germany.
authors.forename: Ann-Kathrin
authors.initials: AK
authors.lastname: Lederer
authors.affiliation: Department of General and Visceral Surgery, Albert Ludwigs University of Freiburg, Freiburg im Breisgau, Germany.
authors.forename: Birte
authors.initials: B
authors.lastname: Kulemann
authors.affiliation: Department of General and Visceral Surgery, Albert Ludwigs University of Freiburg, Freiburg im Breisgau, Germany.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Seifert
authors.affiliation: Department of General and Visceral Surgery, Albert Ludwigs University of Freiburg, Freiburg im Breisgau, Germany.
authors.forename: Philipp Anton
authors.initials: PA
authors.lastname: Holzner
authors.affiliation: Department of General and Visceral Surgery, Albert Ludwigs University of Freiburg, Freiburg im Breisgau, Germany.
authors.forename: Ulrich Theodor
authors.initials: UT
authors.lastname: Hopt
authors.affiliation: Department of General and Visceral Surgery, Albert Ludwigs University of Freiburg, Freiburg im Breisgau, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Hoeppner
authors.affiliation: Department of General and Visceral Surgery, Albert Ludwigs University of Freiburg, Freiburg im Breisgau, Germany.
authors.forename: Goran
authors.initials: G
authors.lastname: Marjanovic
mesh_terms: D000328:Adult; D003082:Colectomy / Q000009:adverse effects*; D003108:Colonic Diseases / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000209:etiology*