Intraperitoneal immunity and pneumoperitoneum

Chekan, Edward; Nataraj, Chandra; Clary, Erik M.; Hayward, Thomas Z.; Brody, Fred; Stamat, J. C.; Fina, Mariapaola; Eubanks, William S.; Westcott, Carl

doi:10.1007/s004649901189

Cited by 58 publications

(44 citation statements)

References 20 publications

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“…Thus it has been reported that carbon dioxide suppresses the function of peritoneal macrophages while helium insufflation did not have any influence on cell function [6]. Furthermore Puttick et al [7]analyzed tumor cell lyses by macrophages after gas incubation with either 100% carbon dioxide or 100% helium and found a significant decrease in cell lyses in the carbon dioxide group while helium had no negative effects on cell lyses.…”

Section: Experimental Studies Investigating the Influence Of The Pneumentioning

confidence: 99%

Immunologic Changes during Minimally Invasive Surgery

Jacobi¹,

Wenger²,

Opitz³

et al. 2002

Dig Surg

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Although recent experimental and clinical trials have documented that postoperative inflammation and changes in different immunologic parameters are less pronounced after laparoscopic approaches in comparison to open surgery, it still remains unclear what influence the pneumoperitoneum itself has on immunologic defense and function. This is mainly due to the endpoints of the different studies which investigate changes in the so-called immunologic parameters (cell subunits, C-reactive protein, cytokines, catecholamines or other stress hormones in plasma samples) rather than analyzing immunologic functions, such as cell activation, production of proteins, cell proliferation or in vivo immune defenses. So far, especially in clinical trials, no correlation has been demonstrated between the changes in immunologic parameters and relevant postoperative clinical endpoints, such as postoperative complications. Thus further clinical prospective randomized studies with relevant clinical endpoints and additional investigations of immunologic parameters are needed to prove the consequences of either minimally invasive surgery or open procedures on postoperative immune functions.

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Section: Experimental Studies Investigating the Influence Of The Pneumentioning

confidence: 99%

Immunologic Changes during Minimally Invasive Surgery

Jacobi¹,

Wenger²,

Opitz³

et al. 2002

Dig Surg

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“…These findings contribute to explain the reduction of cytokine release when animals and patients are operated under effect of CO 2 pneumoperitoneum. Whereas these effects might be considered beneficial from the standpoint of inflammation following elective surgery, one experimental study suggests that CO 2 induced immunossuppression might be deleterious in the setting of infection 13 . The clinical significance of these findings remains unknown.…”

Section: Discussionmentioning

confidence: 99%

“…In one study, CO 2 blocked superoxide release from activated polimorphonuclear leukocytes and significantly reduced the secretion of IL-1 from human peritoneal macrophages 12 . Whereas these effects might be considered beneficial from the standpoint of inflammation following elective surgery, experimental evidence suggests that the CO 2 induced immunossuppression might be deleterious in the setting of infection 13 . This may have an adverse effect on clinical outcome when compared with open procedures.…”

Section: Introductionmentioning

confidence: 99%

Influence of laparoscopy and laparotomy on gasometry, leukocytes and cytokines in a rat abdominal sepsis model

et al. 2006

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Purpose: Laparoscopic surgery is associated with reduced surgical trauma, and less acute phase response, as compared with open surgery. Cytokines are important regulators of the biological response to surgical and anesthetic stress. The aim of this study was to determine if CO 2 pneumoperitoneum would change cytokine expression, gas parameters and leukocyte count in septic rats. Methods: Wistar rats were randomly assigned to five groups: control (anesthesia only), laparotomy, CO 2 pneumoperitoneum, cecum ligation and puncture by laparotomy, and laparoscopic cecum ligation and puncture. After 30 min of the procedures, arterial blood samples were obtained to determine leukocytes subpopulations by hemocytometer. TNFα, IL-1β, IL-6 were determined in intraperitoneal fluid (by ELISA). Gas parameters were measured on arterial blood, intraperitoneal and subperitoneal exsudates. Results: Peritoneal TNFα, IL-1β and IL-6 concentrations were lower in pneumoperitoneum rats than in all other groups (p<0.05). TNFα, IL-1β and IL-6 expression was lower in the laparoscopic than in laparotomic sepsis (p<0.05). Rats from laparoscopic cecum ligation and puncture group developed significant hypercarbic acidosis in blood and subperitoneal fluid when compared to open procedure group. Total white blood cells and lymphocytes were significantly lower in laparoscopic cecum ligation and puncture rats than in the laparotomic (p<0.01). Nevertheless, the laparotomic cecum ligation rats had a significant increase in blood neutrophils and eosinophils when compared with controls (p<0.05). Conclusions: This study demonstrates that the CO 2 pneumoperitoneum reduced the inflammatory response in an animal model of peritonitis with respect to intraperitoneal cytokines, white blood cell count and clinical correlates of sepsis. The pneumoperitoneum produced hypercarbic acidosis in septic animals. Key words: Pneumoperitoneum. Carbon Dioxide. Sepsis. Acidosis. Leucocytes. RESUMO Objetivo:A cirurgia laparoscópica está associada com trauma reduzido e baixa resposta na fase aguda do trauma, quando comparada com a cirurgia aberta. As citocinas e o balanço ácido-base são fatores importantes da resposta biológica ao trauma cirúrgico-anestésico. O objetivo deste estudo foi determinar se o pneumoperitôneo com CO 2 altera a expressão das citocinas, a gasometria e a contagem diferencial de leucócitos em ratos com sepse abdominal. Métodos: Ratos Wistar foram aleatoriamente distribuídos em 5 grupos: controle (somente anestesia), laparotomia, pneumoperitôneo com CO 2 , ligadura e punção do ceco por laparotomia, ligadura e punção do ceco por laparoscopia. Após 30 minutos dos procedimentos, sangue arterial foi colhido para leucometria diferencial em hemocitômetro. TNFα, IL-1β e IL-6 foram dosadas no líquido intraperitoneal (por ELISA). Os parâmetros gasosos foram medidos no sangue arterial e nos exsudatos intraperitoneal e subperitoneal. Resultados: Os valores de TNFα, IL-1β e IL-6 foram significantemente menores nos ratos submetidos ao pneumoperitôneo do que em...

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“…Peritoneal macrophages function as the immune system's first line of defense in the abdominal cavity. A fair number of small animal studies that assessed peritoneal macrophage function after carbon dioxide pneumoperitoneum have reported diminished macrophage cytokine release and impaired ability of the macrophages to clear intraperitoneal bacterial loads [25][26][27]. Other animal studies, however, have reported conflicting results.…”

Section: F Peritoneal Macrophagesmentioning

confidence: 99%

Immunologic Consequences and Considerations of the Laparoscopic Approach

Feingold¹,

Carter²,

Whelan³

2006

The Sages Manual

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The introduction of advanced laparoscopic operations in the early 1990s led to a close examination of the immunologic consequences of both open and closed surgical methods. This scrutiny has significantly increased our understanding of the impact of surgery on the body and will, it is hoped, lead to new perioperative pharmacologic therapies that will lessen the deleterious immunologic effects of all types of surgery. Before the laparoscopic era, it had been well established that major open surgery is associated with the temporary suppression of a variety of cells that are involved with both innate and specific immunity, including lymphocytes, neutrophils, monocytes, and macrophages. Interactions between cells, chemotaxis, expression of surface antigens, the ability to produce cytokines, and other functions of these immune system cells are negatively influenced by open surgical trauma. Further, the ability to mount a positive response to a delayed-type hypersensitivity (DTH) recall antigen challenge is suppressed after surgery [1][2][3][4][5].The relative contribution of each part of an abdominal procedure (abdominal wall access incision versus intraabdominal dissection and resection) to postsurgical immunosuppression had not been assessed before the advent of advanced laparoscopic methods. The results of recent studies suggest that the method of entry into the abdomen is the most important determinant of postoperative immune function. Minimally invasive methods, for a variety of immune parameters, have been shown to be associated with significantly better preserved function when compared to the equivalent open procedure. Of note, in many cases the differences are small and short lived, on the order of a day, and sometimes less for several variables. For a number of parameters no differences have been noted.It should be realized that the clinical significance, if any exists, of the immune function differences that have been found has not been determined. Better preserved postoperative cell-mediated immune function, in theory, may have an impact on the rate of infections and, possibly, tumor recurrence rates and survival.This chapter reviews the available literature in this area and also speculates on how our improved understanding of surgery's impact on the immune system may lead to novel perioperative treatments in the future.

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Intraperitoneal immunity and pneumoperitoneum

Cited by 58 publications

References 20 publications

Immunologic Changes during Minimally Invasive Surgery

Immunologic Changes during Minimally Invasive Surgery

Influence of laparoscopy and laparotomy on gasometry, leukocytes and cytokines in a rat abdominal sepsis model

Immunologic Consequences and Considerations of the Laparoscopic Approach

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