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.
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ABSTRACT: Laparoscopic surgery is associated with a more favorable clinical outcome than that of conventional open surgery. This might be related to the magnitude of the tissue trauma. The aim of the present study was to examine the differences of the neuroendocrine and inflammatory responses between the two surgical techniques. Twenty-four patients with no major medical disease were randomly assigned to undergo laparoscopic (n = 13) or abdominal hysterectomy (n = 11). Venous blood samples were collected and we measured the levels of interleukin-6 (IL-6), CRP and cortisol at the time before and after skin incision, at the end of peritoneum closure and at 1 h and 24 h after operation. The laparoscopic hysterectomy group demonstrated less of an inflammatory response in terms of the serum IL-6 and CRP responses than did the abdominal hysterectomy group, and the laparoscopic hysterectomy group had a shorter hospital stay (P < 0.05). The peak serum IL-6 (P < 0.05) and CRP concentrations were significantly less increased in the laparoscopic group as compared with that of the abdominal hysterectomy group (P < 0.05), while the serum cortisol concentration showed a similar time course and changes and there were no significant difference between the groups. The response of interleukin-6 showed a significant correlation with the response of CRP (r = 0.796; P < 0.05). The laparoscopic surgical procedure leaves the endocrine metabolic response largely unaltered as compared with that of open abdominal hysterectomy, but it reduces the inflammatory response as measured by the IL-6 and CRP levels.Korean journal of anesthesiology 10/2010; 59(4):265-9. DOI:10.4097/kjae.2010.59.4.265
Chapter: Calculus Therapy[Show abstract] [Hide abstract]
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Chapter: Pediatric Endourology[Show abstract] [Hide abstract]
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