PURPOSE: Unrecognized bowel injury following laparoscopy has a subtle and delayed clinical presentation compared with that after open surgery. We determined peritoneal and systemic immune function in laparoscopic and open bowel injury cases. We propose that laparoscopy does not activate immune responses to the same extent as open surgery. MATERIALS AND METHODS: A total of 40 rabbits were divided into 4 groups. Two study groups were subjected to laparoscopic and open bowel injury, and 2 control groups underwent pneumoperitoneum and sham open surgery, respectively, without bowel injury. Animals were sacrificed 1 day, 3 days and 1 week postoperatively. Macroscopic and histological findings were analyzed. Peritoneal fluid, systemic white blood count (WBC) and differentials were done with a hemocytometer. Peritoneal fluid and serum interleukin (IL)-8 concentrations were measured by enzyme-linked immunosorbent assay. RESULTS: Macroscopic and histological findings were indistinguishable in the 2 study groups. However, study groups demonstrated higher peritoneal WBCs than their respective controls at 1 and 3 days (p <0.05). Peritoneal WBC was lower in the laparoscopy than in the open study group at 3 days (p <0.05). There was a significant decrease in peritoneal lymphocytes and monocytes in the laparoscopic vs the open study group at 3 days. No differences were found in systemic WBC or differentials among all groups. Peritoneal IL-8 concentrations were higher in the laparoscopic bowel injury than in the laparoscopic control group at 1 and 3 days (p <0.05). However, there were no differences in peritoneal or serum IL-8 concentrations between both study groups. CONCLUSIONS: Laparoscopic surgery seems to be unable to sustain peritoneal immune responses, which may mask reliable clinical signs and symptoms of peritonitis associated with bowel injury.
PURPOSE: Unrecognized bowel injury following laparoscopy has a subtle and delayed clinical presentation compared with that after open surgery. We determined peritoneal and systemic immune function in laparoscopic and open bowel injury cases. We propose that laparoscopy does not activate immune responses to the same extent as open surgery. MATERIALS AND METHODS: A total of 40 rabbits were divided into 4 groups. Two study groups were subjected to laparoscopic and open bowel injury, and 2 control groups underwent pneumoperitoneum and sham open surgery, respectively, without bowel injury. Animals were sacrificed 1 day, 3 days and 1 week postoperatively. Macroscopic and histological findings were analyzed. Peritoneal fluid, systemic white blood count (WBC) and differentials were done with a hemocytometer. Peritoneal fluid and serum interleukin (IL)-8 concentrations were measured by enzyme-linked immunosorbent assay. RESULTS: Macroscopic and histological findings were indistinguishable in the 2 study groups. However, study groups demonstrated higher peritoneal WBCs than their respective controls at 1 and 3 days (p <0.05). Peritoneal WBC was lower in the laparoscopy than in the open study group at 3 days (p <0.05). There was a significant decrease in peritoneal lymphocytes and monocytes in the laparoscopic vs the open study group at 3 days. No differences were found in systemic WBC or differentials among all groups. Peritoneal IL-8 concentrations were higher in the laparoscopic bowel injury than in the laparoscopic control group at 1 and 3 days (p <0.05). However, there were no differences in peritoneal or serum IL-8 concentrations between both study groups. CONCLUSIONS: Laparoscopic surgery seems to be unable to sustain peritoneal immune responses, which may mask reliable clinical signs and symptoms of peritonitis associated with bowel injury.
Authors: C Tsigris; A Tsechpenakis; N Nikiteas; I Tzogios; I S Vlachos; Th Diamantis; D N Perrea Journal: Surg Endosc Date: 2008-07-22 Impact factor: 4.584