Peritoneal host defenses are less impaired by laparoscopy than by open operation

Abstract

There is a growing body of evidence that laparoscopic surgery is physiologically less injurious than open surgery. We hypothesized that the open technique results in a greater impairment of peritoneal and systemic defense mechanisms than does the laparoscopic technique. Nissen fundoplication, standardized in technique and duration, was performed in 16 pigs. The procedure was performed through a standard midline incision (OPEN, n = 8) or with laparoscopic technique and CO2 pneumoperitoneum (LAP, n = 8). The peritoneal cavity was instilled with 400 cc of normal saline, either alone (not contamined, n = 8) or containing 10(9) E. coli/ml (contaminated, n = 8). Quantitative cultures, cell count, and flow cytometry were performed on blood and peritoneal fluid samples obtained at timed intervals. We found that host defense processes were better preserved after LAP than by OPEN surgery. Peritoneal and systemic monocyte class II antigen expression, and serum tumor necrosis factor-alpha activity was greater in the OPEN group compared with the LAP group, but peritoneal bacterial clearance was more efficient in the LAP group. These data may illustrate a potential benefit of laparoscopic surgery in cases of peritoneal contamination.

Effect of CO₂ Pneumoperitoneum on the Systemic and Peritoneal Cytokine Response in a LPS-Induced Sepsis Model

“…However, changes in plasma endotoxin levels immediately after the operative procedure were not measured in those studies. Collet et al [24] reported peritoneal bacterial clearance to be greater in animals undergoing laparoscopic procedures than in those undergoing open procedures. Our data support this observation, and we believe that the transient increase in the endotoxin level may be mediated by increased translymphatic absorption due to the increased intra-abdominal pressure.…”

Experimental Study of Cardiorespiratory and Stress Factors in Esophageal Surgery Using Robot-Assisted Thoracoscopic or Open Thoracic Approach

“…In a controlled trial on children who underwent open or laparoscopic Nissen fundoplication, McHoney et al 32 reported no significant response in TNF-␣ levels in the postoperative period in either group. However, in an experimental study on pigs, Collet et al 33 showed increased serum TNF-␣ activity in open fundoplication compared with the laparoscopic group.…”

Impact of pressure and gas type on anastomotic wound healing in rats

“…With regard to the wounds induced by the surgical approach, clinical studies underlined improved healing and a reduction in wound complications due to the use of minimally invasive surgery [1,2]. Furthermore, animal studies have shown improved healing of skin infections and a less-impaired peritoneal host defence after CO 2 laparoscopy than after laparotomy [3,4]. In contrast, another experimental analysis of the effect of CO 2 insufflation on the quality of dermal wound healing revealed no difference when compared with laparotomy [5].…”