Immune response to laparoscopic bowel injury.
ABSTRACT Laparoscopic bowel injuries are rare but potentially fatal if recognition is delayed. Unlike the situation after open surgery, patients with unrecognized bowel injury after laparoscopy do not present with the typical "acute surgical abdomen." We investigated monocyte, neutrophil, and lymphocyte apoptosis as indicators of the immune response and whether this response is stimulated or suppressed by laparoscopic bowel injury compared with bowel injury induced during open surgery.
After an animal protocol was approved, laparoscopy was performed in a rabbit model. A total of 44 animals were divided into four groups of 11 rabbits each. Laparoscopic bowel injury was created using 30-W electrocautery at 0 (control), 1, and 5 hours after induction of pneumoperitoneum. Bowel injury was created in the fourth group during open laparotomy. Animals were euthanized at 0, 1 day, 1 week, or 2 weeks after surgery. Apoptosis was assessed by staining the nuclei of blood cells with H-33342 dye.
At 1 week, neutrophil, monocyte, and lymphocyte apoptosis levels were 2.4- to 5-fold lower after laparoscopy (1-hour pneumoperitoneum) compared with open surgery. However, at 2 weeks, the percentage of apoptosis had equalized in the two groups. Interestingly, with longer laparoscopic procedures (5 hours), the percentage of apoptosis at 0 and 1 day more closely approached that seen after open surgery. At 2 weeks, there was a significant difference in apoptosis levels in all cell types between the experimental groups compared with controls (P < 0.001). No animals undergoing a 5-hour open procedure survived to 2 weeks after bowel injury.
Open surgery resulted in a significant increase in programmed cell death compared with controls in the immediate postoperative period following bowel injury. Laparoscopic surgery produced a delayed response and after 2 weeks with bowel perforation approached open surgery levels. The difference in the degree of cellular death may be secondary to a smaller degree of stimulation of the immune response in laparoscopic surgery.
- SourceAvailable from: Fahrettin Yildiz[Show abstract] [Hide abstract]
ABSTRACT: Objectives: This study was planned to evaluate wheth-er possible changes in the hematological parameters and the biochemical markers can be used to detect obstruction-induced (strangulated) intestinal ischemia. Materials and Methods: Forty rats divided into five groups underwent the following procedures: Group 1 rats were treated with only laparotomy (sham-operated con-trols). To the strangulated hernia groups surgical induc-tion of strangulated intestinal obstruction was performed. Tissue and blood samples were taken at 30 minutes (group 2), 2nd hour (group 3), 4th hour (group 4) and 6th hour (group 5) respectively, and then LDH, CPK, ALP, AST, ALT, D-dimer levels and blood cells counts were measured and histopathological examination was done. Results: Focal mucosal necrosis accompanied was con-firmed by histological findings in the strangulated intestinal ischemia group after second hour. Serum D-dimer, ALT, ALP, CPK levels and neutrophil count became elevated at second hour, which was statistically significant. Conclusion: In patients with hernia, after reduction of the intestinal hernia, raised levels of serum D-dimer, ALT, ALP, CPK levels and neutrophil count may indicate the pres-ence of a bowel ischemia. However, more comprehen-sive clinical studies are required to evaluate the potential survival benefit by using the laboratory tests as a marker and/or a useful diagnostic tool of the need for laparotomy.Trakya Universitesi Tip Fakultesi Dergisi - TRAK UNIV TIP FAK DERG. 01/2009;
Chapter: Pediatric Endourology[Show abstract] [Hide abstract]
ABSTRACT: Minimally invasive surgery is gaining popularity in both adult and pediatric urology. There are multiple applications with varied outcomes comparable to open surgery. The goal is to decrease postoperative discomfort, minimize hospital stays, and improve cosmesis. It is imperative to gain more information about the long-term outcomes so we can decide the best applications.12/2005: pages 323-349;
Chapter: Calculus Therapy[Show abstract] [Hide abstract]
ABSTRACT: Advances in ureteroscopic tecnique and technology have increased the scope of urological pathology that can be treated in a retrograde manner. “Combined approaches” that incorporate traditional antegrade access and retrograde access offer the urologist increased flexibility in the management of complex urinary tract pathology. In the following chapter, we review the indications, technique, and results associated with the combined approach to urolithiasis.12/2005: pages 145-155;