title: Effects of low and standard intra-abdominal pressure on systemic inflammation and immune response in laparoscopic adrenalectomy: A prospective randomised study.
abstract: BACKGROUND
  The advantages of laparoscopic adrenalectomy (LA) over open adrenalectomy are undeniable. Nevertheless, carbon dioxide (CO2) pneumoperitoneum may have an unfavourable effect on the local immune response. The aim of this study was to compare changes in the systemic inflammation and immune response in the early post-operative (p.o.) period after LA performed with standard and low-pressure CO2 pneumoperitoneum.
  
  
  METHODS
  We studied, in a prospective randomised study, 51 patients consecutively with documented adrenal lesion who had undergone a LA: 26 using standard-pressure (12-14 mmHg) and 25 using low-pressure (6-8 mmHg) pneumoperitoneum. White blood cells (WBC), peripheral lymphocyte subpopulation, human leucocyte antigen-DR (HLA-DR), neutrophil elastase, interleukin (IL)-6 and IL-1, and C-reactive protein (CRP) were investigated.
  
  
  RESULTS
  Significantly higher concentrations of neutrophil elastase, IL-6 and IL-1 and CRP were detected p.o. in the standard-pressure group of patients in comparison with the low-pressure group (P < 0.05). A statistically significant change in HLA-DR expression was recorded p.o. at 24 h, as a reduction of this antigen expressed on the monocyte surface in patients from the standard group; no changes were noted in low-pressure group patients (P < 0.05).
  
  
  CONCLUSIONS
  This study demonstrated that reducing the pressure of the pneumoperitoneum to 6-8 mmHg during LA reduced p.o. inflammatory response and averted p.o. immunosuppression.
authors.affiliation: Department of Surgery, University of L'Aquila, L'Aquila, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Schietroma
authors.affiliation: Department of Surgery, University of L'Aquila, L'Aquila, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Pessia
authors.affiliation: Department of Surgery, University of L'Aquila, L'Aquila, Italy.
authors.forename: Derna
authors.initials: D
authors.lastname: Stifini
authors.affiliation: Department of Surgery, University of L'Aquila, L'Aquila, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Lancione
authors.affiliation: Department of Surgery, University of L'Aquila, L'Aquila, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Carlei
authors.affiliation: Department of Surgery, University of L'Aquila, L'Aquila, Italy.
authors.forename: Emanuela Marina
authors.initials: EM
authors.lastname: Cecilia
authors.affiliation: Department of Surgery, University of L'Aquila, L'Aquila, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Amicucci
keywords: Immune response; laparoscopic adrenalectomy (LA); standard-pressure/low-pressure pneumoperitoneum