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Cheng WY, Lee XZ, Lai MSL, Ho YS, Chang RCC. PKR modulates sterile systemic inflammation-triggered neuroinflammation and brain glucose metabolism disturbances. Front Immunol 2025; 16:1469737. [PMID: 40070845 PMCID: PMC11893411 DOI: 10.3389/fimmu.2025.1469737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 02/06/2025] [Indexed: 03/14/2025] Open
Abstract
Sterile systemic inflammation may contribute to neuroinflammation and accelerate the progression of neurodegenerative diseases. The double-stranded RNA-dependent protein kinase (PKR) is a key signaling molecule that regulates immune responses by regulating macrophage activation, various inflammatory pathways, and inflammasome formation. This study aims to study the role of PKR in regulating sterile systemic inflammation-triggered neuroinflammation and cognitive dysfunctions. Here, the laparotomy mouse model was used to study neuroimmune responses triggered by sterile systemic inflammation. Our study revealed that genetic deletion of PKR in mice potently attenuated the laparotomy-induced peripheral and neural inflammation and cognitive deficits. Furthermore, intracerebroventricular injection of rAAV-DIO-PKR-K296R to inhibit PKR in cholinergic neurons of ChAT-IRES-Cre-eGFP mice rescued the laparotomy-induced changes in key metabolites of brain glucose metabolism, particularly the changes in phosphoenolpyruvate and succinate levels, and cognitive impairment in short-term and spatial working memory. Our results demonstrated the critical role of PKR in regulating neuroinflammation, brain glucose metabolism and cognitive dysfunctions in a peripheral inflammation model. PKR could be a novel pharmacological target for treating systemic inflammation-induced neuroinflammation and cognitive dysfunctions.
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Affiliation(s)
- Wai-Yin Cheng
- Laboratory of Neurodegenerative Diseases, School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Research Institute for Future Food, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- Department of Food Science and Nutrition, Faculty of Science, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Xin-Zin Lee
- Laboratory of Neurodegenerative Diseases, School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Michael Siu-Lun Lai
- Laboratory of Neurodegenerative Diseases, School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yuen-Shan Ho
- School of Nursing, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Raymond Chuen-Chung Chang
- Laboratory of Neurodegenerative Diseases, School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Khan H, Coleman S, Cuschieri A. Force-adjustable parallel-occlusion grasper. Int J Surg 2024; 110:750-757. [PMID: 37995091 PMCID: PMC10871571 DOI: 10.1097/js9.0000000000000911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/03/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND During laparoscopic surgery, the operating surgeon grasps sections of the gastrointestinal tract (GIT), including delicate structures, with long (270 mm) 5 mm diameter graspers. These grasping instruments increase the risk of iatrogenic damage due to crushing of the grasped tissue. This risk is increased significantly by diseases such as bacterial peritonitis and inflammatory bowel disease and reduced but not abolished by using parallel-closing laparoscopic instruments. This study describes the design and laboratory testing of fully developed and tested smart graspers capable of reducing the grasping force used for inflamed tissues and hollow viscera. MATERIALS AND METHODS In an ISO 13485-certified mechanical laboratory and CAD machine workshop, the authors have designed, developed, and evaluated a smart gasper capable of exerting a preselected uniform grasping force on the gastrointestinal tract and other structures/ tissues, through a mechanism incorporated in the handle of the instrument. This enables the control and graded reduction of the grasping force by the incorporation of a compression spring. The authors named the new instrument the force-adjustable parallel-occlusion grasper (FA-POG) because, in addition to applying a uniform force on the grasped bowel/tissue, it also enables the surgeon to select the force before grasping, depending on its physical condition, and pathological state. RESULTS FA-POG differs from traditional pinch-occlusion grasper in two respects: it exerts a uniform force on the grasped tissue/bowel and enables the operating surgeon to select and apply a predetermined uniform grasping force, ranging from 1 to 5 N, depending on the pathological condition of the bowel/structure. The ISO 13485-certified and fully developed prototype has been subjected to various grasping in-vitro tests using freshly harvested porcine small-bowel segments obtained from a local abattoir, using Instron tensiometry. CONCLUSIONS The authors designed and α/β tested a parallel-occlusion gasper that enables the operating surgeon to select the force before grasping. This grasper design consists of end-effectors jaws with a 4-bar linkage mechanism for wide, uniform parallel-occlusion force, surpassing traditional scissor-type laparoscopic graspers. It incorporates a force-level controller knob, based on a spring-loaded mechanism, enabling surgeon-preselected grip force to prevent excessive grasping. The authors validated the design experimentally using porcine small-bowel segments, optimizing teeth for maximum grip friction to minimize slippage.
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Honjo K, Kawai M, Tsuchiya Y, Ro H, Sugimoto K, Takahashi M, Tomiki Y, Sakamoto K. Risk factors for small-bowel obstruction after colectomy for colorectal cancer: a retrospective study. Surg Today 2023; 53:1038-1046. [PMID: 36949236 DOI: 10.1007/s00595-023-02674-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/31/2022] [Indexed: 03/24/2023]
Abstract
PURPOSE Postoperative adhesions are a concerning complication of abdominal surgery with major implications on quality of life. This study aimed to investigate the risk factors for postoperative small-bowel obstruction (SBO) after colectomy for colorectal cancer. METHODS We reviewed the clinicopathological variables of 1646 patients who underwent colectomy for colorectal cancer between 2009 and 2018. RESULTS SBO occurred following primary tumor resection for colorectal cancer in 67 (4.1%) of the 1646 patients. The median observation period was 7.5 (range: 3.0-12.0) years. Multivariate analysis revealed that rectal tumors, anastomotic leakages, previous abdominal surgeries, and longer operating times were all correlated with postoperative SBO, but there were no differences in the incidence of SBO between laparoscopic vs. open surgery. The use of adhesion prevention material had no effect on SBO. Our data showed that the onset of SBO tended to be relatively early, within a year after surgery (89.5%). CONCLUSIONS Tumor localization in the rectum is associated with several problems, including a wide resection area, prolonged operative duration, and high risk of anastomotic leakage, which may increase the risk of SBO. Laparoscopic surgery and adhesion prevention material did not demonstrate a clear preventive effect against SBO.
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Affiliation(s)
- Kumpei Honjo
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Masaya Kawai
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yuki Tsuchiya
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hisashi Ro
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kiichi Sugimoto
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Makoto Takahashi
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yuichi Tomiki
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kazuhiro Sakamoto
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Montalva L, Incerti F, Qoshe L, Haffreingue A, Marsac L, Frérot A, Peycelon M, Biran V, Bonnard A. Early laparoscopic-assisted surgery is associated with decreased post-operative inflammation and intestinal strictures in infants with necrotizing enterocolitis. J Pediatr Surg 2023; 58:708-714. [PMID: 36585304 DOI: 10.1016/j.jpedsurg.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 10/12/2022] [Accepted: 11/13/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In 2015, a protocol including early laparoscopy-assisted surgery in the treatment of necrotizing enterocolitis (NEC) was implemented at our institution. Carbon dioxide insufflation during laparoscopy may have an anti-inflammatory effect. We aimed to compare post-operative outcome after early laparoscopy-assisted surgery and classical laparotomy for NEC. MATERIAL AND METHODS Charts of premature infants undergoing surgery for NEC (2012-2021) were reviewed. Cases operated by early laparoscopy-assisted surgery (2015-2021) were compared to infants operated for NEC between 2012 and 2015 (laparotomy-NEC). Outcomes were post-operative CRP, need for reintervention, mortality, and the occurrence of post-NEC intestinal strictures. CRP was measured on the day of surgery (POD-0), 2 days (POD-2), and 7 days after surgery (POD-7). Data were compared using contingency tables for categorical variables and Student t-test or Mann-Whitney test for continuous variables. RESULTS Infants with NEC operated by early laparoscopy (n = 48) and laparotomy (n = 29) were similar in terms of perforation (60% vs 58%, p = 0.99) and POD-0 CRP (139 vs 124 mg/L, p = 0.94). Delay between first signs of NEC and surgery was shorter in the laparoscopy group (3 vs 6 days, p = 0.004). Early laparoscopy was associated with a lower CRP on POD-2 (108 vs 170, p = 0.005) and POD-7 (37 vs 68, p = 0.002), as well as a lower rate of post-operative intestinal stricture (34% vs 61%, p = 0.04). CONCLUSIONS In addition to being safe and feasible in premature infants, early laparoscopic-assisted surgery was associated with decreased NEC-related post-operative inflammation and strictures. A prospective, randomized study is needed in order to evaluate short and long-term effects of laparoscopy in infants with NEC. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Louise Montalva
- Department of Pediatric General Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France; University Paris-Cité, Paris, France.
| | - Filippo Incerti
- Department of Pediatric General Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France; University Paris-Cité, Paris, France
| | - Livia Qoshe
- Department of Pediatric General Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France; Princeton Internships in Civic Service, Princeton University, Princeton, NJ, USA
| | - Aurore Haffreingue
- Department of Pediatric General Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Lucile Marsac
- Department of Pediatric Anesthesia, Intensive Care and Pain Management, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alice Frérot
- Neonatal Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Matthieu Peycelon
- Department of Pediatric General Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France; University Paris-Cité, Paris, France
| | - Valérie Biran
- Neonatal Intensive Care Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Arnaud Bonnard
- Department of Pediatric General Surgery and Urology, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France; University Paris-Cité, Paris, France
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Teuben MPJ, Heeres M, Blokhuis T, Spijkerman R, Knot E, Vrisekoop N, Pfeifer R, Pape HC, Koenderman L, Leenen LPH. Shift of Neutrophils From Blood to Bone Marrow Upon Extensive Experimental Trauma Surgery. Front Immunol 2022; 13:883863. [PMID: 35655784 PMCID: PMC9152003 DOI: 10.3389/fimmu.2022.883863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Extensive trauma surgery evokes an immediate cellular immune response including altered circulatory neutrophil numbers. The concurrent bone marrow (BM) response however is currently unclear. We hypothesize that these BM changes include (1) a relative reduction of the bone marrow neutrophil fraction and (2) increasing heterogeneity of the bone marrow neutrophil pool due to (3) the appearance of aged/returning neutrophils from circulation into the BM-compartment. Materials and Methods Eight pigs were included in a standardized extensive trauma surgery model. Blood and bone marrow samples were collected at baseline and after 3 hours of ongoing trauma surgery. Leukocyte and subtype counts and cell surface receptor expression levels were studied by flow cytometry. Results All animals survived the interventions. A significant drop in circulating neutrophil counts from 9.3 to 3.2x106 cells/ml (P=0.001) occurred after intervention, whereas circulatory neutrophil cell surface expression of CD11b increased. The concurrent bone marrow response included an increase of the BM neutrophil fraction from 63 ± 3 to 71 ± 3 percent (P<0.05). Simultaneously, the BM neutrophil pool became increasingly mature with a relative increase of a CXCR4high-neutrophil subtype that was virtually absent at baseline. Conclusion The current study shows a shift in composition of the BM neutrophil pool during extensive trauma surgery that was associated with a relatively circulatory neutropenia. More specifically, under these conditions BM neutrophils were more mature than under homeostatic conditions and a CXCR4high-neutrophil subset became overrepresented possibly reflecting remigration of aged neutrophils to the BM. These findings may contribute to the development of novel interventions aimed to modify the trauma-induced immune response in the BM.
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Affiliation(s)
- Michel P J Teuben
- Department of Trauma, University Medical Centre Utrecht, Utrecht, Netherlands.,Center for Translational Immunology, University Medical Centre Utrecht, Utrecht, Netherlands.,Department of Traumatology, University Hospital Zürich, Zürich, Switzerland
| | - Marjolein Heeres
- Department of Trauma, University Medical Centre Utrecht, Utrecht, Netherlands.,Center for Translational Immunology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Taco Blokhuis
- Department of Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Roy Spijkerman
- Department of Trauma, University Medical Centre Utrecht, Utrecht, Netherlands.,Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Eric Knot
- Department of Trauma, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Nienke Vrisekoop
- Center for Translational Immunology, University Medical Centre Utrecht, Utrecht, Netherlands.,Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Roman Pfeifer
- Department of Traumatology, University Hospital Zürich, Zürich, Switzerland
| | | | - Leo Koenderman
- Center for Translational Immunology, University Medical Centre Utrecht, Utrecht, Netherlands.,Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Luke P H Leenen
- Department of Trauma, University Medical Centre Utrecht, Utrecht, Netherlands
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Harvitkar RU, Gattupalli GB, Najmu S, Joshi A. Emergency Laparoscopic Management of Perforative Peritonitis: A Retrospective Study. Cureus 2021; 13:e20121. [PMID: 34873564 PMCID: PMC8640191 DOI: 10.7759/cureus.20121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/11/2022] Open
Abstract
Background Peritonitis was previously considered a contraindication for minimally invasive surgery due to the risk of malignant hypercapnia partial pressure of carbon-dioxide (PCO2) and toxic shock syndrome. The objective of this retrospective study was to evaluate the role of laparoscopic surgery (LS) in selected patients with perforative peritonitis and to study its feasibility, safety, and outcomes. Patients and methods This was a retrospective study of 25 patients spanning over five years from 2015 to 2020. This study comprised all patients who were diagnosed with perforative peritonitis on preoperative physical/clinical examination, radiological evaluations, and who were stable enough to withstand pneumoperitoneum. Patients were evaluated for causes, operative time, duration of hospital stay, intra-, and postoperative complications, time taken to resume normal activity, and conversion to open surgery. Data was extracted from the hospital electronic medical records, for the above-mentioned parameters. Results Twenty-five patients with perforative peritonitis underwent diagnostic and therapeutic LS in our institute. The mean age was 46 years (35-79 years). Ten patients (40%) were diagnosed with gastro-duodenal perforation. Out of these ten patients, ninepatients (90%) were managed totally laparoscopically, while one patient (10%) required conversion to open surgery. There were 15 patients (60%) with small bowel perforation. Thirteen of the 15 patients were managed laparoscopically, with the remaining two requiring conversion to open surgery. The average time taken for the procedure was 90 minutes. The mean time to initiate the postoperative peroral liquid diet was 3.4 days. The mean postoperative stay was 6.9 days. The time taken to resume normal activity was 10-12 days. Conclusions Laparoscopic management is feasible and safe for patients with perforative peritonitis. Careful patient selection and the surgeon’s experience with the procedure are critical determinants of success.
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Affiliation(s)
| | | | - Sakib Najmu
- Surgery, Queen Alexandra Hospital, Portsmuth, GBR
| | - Abhijit Joshi
- Gastrointestinal and Endo-Laparoscopic Surgery, Dr L.H. Hiranandani Hospital, Mumbai, IND
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Teuben M, Heeres M, Blokhuis T, Hollman A, Vrisekoop N, Tan E, Pfeifer R, Pape HC, Koenderman L, Leenen LPH. Instant intra-operative neutropenia despite the emergence of banded (CD16 dim/CD62L bright) neutrophils in peripheral blood - An observational study during extensive trauma-surgery in pigs. Injury 2021; 52:426-433. [PMID: 33208273 DOI: 10.1016/j.injury.2020.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Deregulation of polymorphonuclear neutrophils (PMNs) is an essential step in the development of inflammatory complications upon trauma. Different neutrophil subtypes have been identified recently, however, the role of neutrophil subtypes in immunoregulation upon trauma is unclear. We hypothesize that extensive trauma surgery causes instant progressive heterogeneity of the blood neutrophil pool, and increased appearance of young (CD16dim/CD62Lbright) neutrophils in peripheral blood. MATERIAL AND METHODS A standardized extensive thoraco-abdominal porcine trauma surgery model was utilized, and 12 animals were included. Blood was collected at defined timepoints and neutrophil numbers and subtypes were studied by flowcytometry. Neutrophil subtypes were identified by differences in cell surface expression levels of CD16 (FcγRIII) and CD62L (L-selectin). Porcine neutrophil subtypes were further characterized after flow sorting. RESULTS Eleven animals survived the 3-hour surgical protocol. Neutrophil numbers dropped significantly from a mean of 8,6 ± 3,5 × 106 to 2,4 ± 1,8 × 106 cells/ml during 180 min, (p<0.001). Simultaneously, the blood PMN population became increasingly heterogeneous due to the appearance of new neutrophil subtypes. Cell sorting experiments and cytological analysis revealed that these porcine subtypes had specific morphological characteristics, mimicking their human counterparts. At baseline, 88% ± 1 percent of circulatory PMNs comprised of mature (CD16bright/CD62Lbright) PMNs, while at 3 h the blood PMN pool consisted of 59% ± 2 percent of mature subtypes (p<0.001). Despite a marked drop in neutrophil levels during surgery, absolute and relative numbers of banded (CD16dim/CD62Lbright) neutrophils continued to rise throughout surgery. CONCLUSION Standardized extensive trauma surgery was associated with instant progressive neutropenia and increased heterogeneity of the blood neutrophil pool. Furthermore, three different neutrophil subsets in peripheral porcine blood were identified over the course of surgery. Further studies should clarify their precise role in the development of early organ failure upon extensive trauma surgery. This for the first time exemplifies experimentally the time constraints and impact of damage control surgery after severe trauma.
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Affiliation(s)
- Michel Teuben
- University Medical Centre Utrecht, Department of Trauma, Heidelberglaan 100, 3584 Utrecht, the Netherlands; University Medical Centre Utrecht, Laboratory for Translational Research, Utrecht, the Netherlands; University Medical Center Zurich intoUniversity Hospital Zurich..
| | - Marjolein Heeres
- University Medical Centre Utrecht, Department of Trauma, Heidelberglaan 100, 3584 Utrecht, the Netherlands; University Medical Centre Utrecht, Laboratory for Translational Research, Utrecht, the Netherlands
| | - Taco Blokhuis
- Maastricht University Medical Centre, Department of Surgery, Maastricht, the Netherlands
| | - Arne Hollman
- University Medical Centre Utrecht, Department of Trauma, Heidelberglaan 100, 3584 Utrecht, the Netherlands; University Medical Centre Utrecht, Laboratory for Translational Research, Utrecht, the Netherlands
| | - Nienke Vrisekoop
- University Medical Centre Utrecht, Laboratory for Translational Research, Utrecht, the Netherlands
| | - Edward Tan
- Radboud University Medical Center, Department of Surgery, Nijmegen, the Netherlands
| | - Roman Pfeifer
- University Medical Center Zurich intoUniversity Hospital Zurich
| | | | - Leo Koenderman
- University Medical Centre Utrecht, Laboratory for Translational Research, Utrecht, the Netherlands
| | - Luke P H Leenen
- University Medical Centre Utrecht, Department of Trauma, Heidelberglaan 100, 3584 Utrecht, the Netherlands.
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Yanase F, Naorungroj T, Bellomo R. Glycocalyx damage biomarkers in healthy controls, abdominal surgery, and sepsis: a scoping review. Biomarkers 2020; 25:425-435. [PMID: 32597227 DOI: 10.1080/1354750x.2020.1787518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/17/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Despite wide interest in glycocalyx biomarkers, their values in healthy individuals, patients after abdominal surgery, and septic patients have been poorly understood. METHODS We searched MEDLINE, CENTRAL and EMBASE for papers measured glycocalyx biomarkers in healthy individuals, patients after abdominal surgery and septic patients. RESULTS We extracted 3948 titles and identified 58 eligible papers. Syndecan 1 was the most frequently measured biomarker (48 studies). Its mean or median value in healthy individuals varied to a biologically implausible degree, from 0.3 to 58.5 ng/ml, according to assay manufacturer. In post-operative patients, syndecan 1 levels increased after pancreatic surgery or liver surgery, however, they showed minor changes after hysterectomy or laparoscopic surgery. In septic patients, biomarker levels were higher than in healthy volunteers when using the same assay. However, six healthy volunteer studies reported higher syndecan 1 values than after pancreatic surgery and 24 healthy volunteer studies reported higher syndecan 1 values than the lowest syndecan 1 value in sepsis. Similar findings applied to other glycocalyx biomarkers. CONCLUSION Glycocalyx damage biomarkers values are essentially defined by syndecan 1. Syndecan 1 levels, however, are markedly affected by assay type and show biologically implausible values in normal, post-operative, or septic subjects.
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Affiliation(s)
- Fumitaka Yanase
- Department of Intensive Care, Austin Hospital, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Australia
| | - Thummaporn Naorungroj
- Department of Intensive Care, Austin Hospital, Melbourne, Australia
- Department of Intensive Care, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Melbourne, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Australia
- Centre for Integrated Critical Care, Department of Medicine and Radiology, University of Melbourne, Melbourne, Australia
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Halford B, Piazza MB, Liu D, Obineme C. Chlamydia ascites: a call for sexually transmitted infection testing. BMJ Case Rep 2018; 11:11/1/e226437. [PMID: 30580299 DOI: 10.1136/bcr-2018-226437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 26-year-old gravida 2, para 2-0-0-2 woman with a recent uncomplicated vaginal delivery 10 weeks prior presented to our hospital with 5 weeks of abdominal swelling and discomfort. Four weeks after delivery, the patient began having right upper quadrant pain and was found to have cholelithiasis. She underwent an elective laparoscopic cholecystectomy 6 weeks prior to admission, but started to develop worsening abdominal swelling 1 week postoperatively. Abdominal distension and shifting dullness were present on examination. CT of the abdomen and pelvis was remarkable for moderate-volume ascites and mild enhancement of the pelvic peritoneum. Paracentesis removed 2.46 L of ascites fluid with 76% lymphocytic predominance. Results for Chlamydia trachomatis were positive in urine, cervical swab and ascitic fluid. Doxycycline was prescribed for a diagnosis of pelvic inflammatory disease exudative ascites. Since discharge, she has completed her antibiotic course and reports resolution of all symptoms without recurrence of ascites.
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Affiliation(s)
- Brittne Halford
- Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - David Liu
- Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chuma Obineme
- Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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10
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Selective matrix metalloproteinase inhibition increases breaking strength and reduces anastomotic leakage in experimentally obstructed colon. Int J Colorectal Dis 2017; 32:1277-1284. [PMID: 28717842 DOI: 10.1007/s00384-017-2857-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Colonic obstruction causes loss of collagen and impairment of anastomotic integrity by matrix metalloproteinases (MMPs). Unexpectedly, pharmacological MMP inhibition increased anastomotic leakage (AL) in obstructed colon possibly due to the non-selective nature of these compounds and the experimental model applied. We therefore studied the effects of selective MMP inhibition on the healing of anastomoses in colon obstructed by a novel laparoscopic technique. METHODS Left colon was obstructed in 38 male Sprague-Dawley rats (226-284 g). After 12 h, stenoses were resected and end-to-end anastomoses constructed. Baseline breaking strength was determined in 6 animals on day 0. The remaining 32 rats were randomized to daily treatment with the selective MMP-8, MMP-9, and MMP-12 inhibitor AZD3342 (n = 16) or vehicle (n = 16). On day 3, anastomoses were evaluated for AL and breaking strength. Isolated anastomotic wound tissue was analyzed on total collagen and pepsin-insoluble and pepsin-soluble collagen by hydroxyproline. The soluble collagens were further differentiated into native, measured by Sircol, and fragmented forms. RESULTS Baseline breaking strength was maintained with AZD3342 but decreased by 25% (P = 0.023) in the vehicle group. The anastomotic breaking strength of AZD3342-treated rats was 44% higher (P = 0.008) than the vehicle-treated rats. Furthermore, the AL rate was reduced (P = 0.037) with AZD3342 compared with vehicle treatment. AZD3342 treatment influenced neither the total or insoluble collagen concentrations nor the degree of fragmentation of the soluble collagen triple helices. CONCLUSION Selective MMP inhibition increased anastomotic breaking strength and reduced AL after resection of colonic obstruction.
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Lee DJK, Ye M, Sun KH, Shelat VG, Koura A. Laparoscopic versus Open Omental Patch Repair for Early Presentation of Perforated Peptic Ulcer: Matched Retrospective Cohort Study. Surg Res Pract 2016; 2016:8605039. [PMID: 27722200 PMCID: PMC5046012 DOI: 10.1155/2016/8605039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/02/2016] [Accepted: 08/15/2016] [Indexed: 02/05/2023] Open
Abstract
Introduction. The aim of this study was to compare the outcomes between laparoscopic and open omental patch repair (LOPR versus OR) in patients with similar presentation of perforated peptic ulcer (PPU). The secondary aim was to evaluate the outcomes according to the severity of peritonitis. Methods. All patients who underwent omental patch repair at two university-affiliated institutes between January 2010 and December 2014 were reviewed. Matched cohort between LOPR and OR groups was achieved by only including patients that had ulcer perforation <2 cm in size and symptoms occurring <48 hours. Outcome measures were defined in accordance with length of stay (LOS), postoperative complications, and mortality. Results. 148 patients met the predefined inclusion criteria with LOPR performed in 40 patients. Outcome measures consistently support laparoscopic approach but only length of hospital stay (LOS) achieved statistical significance (LOPR 4 days versus OR 5 days, p < 0.01). In a subgroup analysis of patients with MPI score >21, LOPR is also shown to benefit, particularly resulting in significant shorter LOS (4 days versus 11 days, p < 0.01). Conclusion. LOPR offers improved short-term outcomes in patients who present within 48 hours and with perforation size <2 cm. LOPR also proved to be more beneficial in high MPI cases.
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Affiliation(s)
- Daniel Jin Keat Lee
- Department of Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828
| | - MaDong Ye
- Department of Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828
| | - Keith Haozhe Sun
- Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Vishalkumar G. Shelat
- Department of Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433
| | - Aaryan Koura
- Department of Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433
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Floras T, Philippou A, Bardakostas D, Mantas D, Koutsilieris M. The growth endocrine axis and inflammatory responses after laparoscopic cholecystectomy. HORMONES 2016. [DOI: 10.1007/bf03401405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Inflammation-induced atrial fibrillation: Pathophysiological perspectives and clinical implications. Heart Lung 2015; 44:59-62. [PMID: 25453387 DOI: 10.1016/j.hrtlng.2014.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/15/2014] [Accepted: 10/16/2014] [Indexed: 11/19/2022]
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Systemic Inflammatory Response during Laparotomy. Int J Inflam 2014; 2014:674303. [PMID: 25161799 PMCID: PMC4138928 DOI: 10.1155/2014/674303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 07/10/2014] [Indexed: 12/04/2022] Open
Abstract
Background. The aim of this study was to analyze the influence of laparotomy on the systemic inflammatory response in human patients suffering from secondary peritonitis. Study Design. A prospective study investigating the levels of white blood cells, C-reactive protein, platelets, interleukin-six, and tumor necrosis factor-alpha during laparotomy in five patients who suffered from secondary peritonitis. Six venous blood samples were collected perioperatively from each patient. The data were summarized by descriptive statistics and presented in a box plot. The hypothesis was that laparotomy increases the systemic inflammatory response, as has been described in animal models in previous studies. Results. The median age of the patients in this study was 84 years, the male to female ratio was 2 : 3, and the mortality rate was 80%. The most common cause of generalized peritonitis was ischemia of the colon. Analysis of the data showed no significant changes in the level of plasma inflammatory mediators during the surgical procedure, except for the platelet count which showed a significant decrease (P = 0.001). Conclusions. In contrast to experience with animal models, laparotomy in human patients with secondary peritonitis did not significantly increase the systemic inflammatory response. Furthermore, it contributed in significantly decreasing some of the systemic inflammatory mediators.
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Cho JY, Han HS, Yoon YS, Hwang DW, Jung K, Kim YK. Postoperative complications influence prognosis and recurrence patterns in periampullary cancer. World J Surg 2014; 37:2234-41. [PMID: 23722466 DOI: 10.1007/s00268-013-2106-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The present study was performed to elucidate the influence of postoperative complications on the prognosis and recurrence patterns of periampullary cancer after pancreaticoduodenectomy (PD). METHODS Clinical data were reviewed from 200 consecutive patients who had periampullary cancer and underwent PD between October 2003 and July 2010, and survival outcomes and recurrence patterns were analyzed. Postoperative complications were classified according to a modification of Clavien's classification. RESULTS Overall, 86 major complications of grade II or higher occurred in 71 patients. The patients were classified into two groups according to the presence of postoperative complications of grade II or higher: group Cx-, absence of complications (n = 129); and group Cx+, presence of complications (n = 71). There were no differences in gender, mean age, tumor node metastasis stage, biliary drainage, type of resection, and radicality between the two groups (P > 0.05). The 3-year overall and disease-free survival rates of the group Cx+ patients (31.0 and 22.3 %, respectively) were significantly lower than those of the group Cx- patients (49.0 and 40.0 %; P = 0.003 and 0.002, respectively). The multivariate analysis showed that postoperative complications (P = 0.001; RR = 1.887; 95 % confidence interval [CI] 1.278-2.785), a T stage of T3 or T4 (P = 0.001; RR = 2.503; 95 % CI 1.441-4.346), positive node metastasis (P = 0.001; RR = 2.093; 95 % CI, 1.378-3.179), R1 or R2 resection (P = 0.023; RR = 1.863; 95 % CI 1.090-3.187), and angiolymphatic invasion (P = 0.013; RR = 1.676; 95 % CI 1.117-2.513) were independent prognostic factors for disease-free survival. Regarding recurrence patterns, group Cx+ patients exhibited more distant recurrences than did group Cx- patients (P = 0.025). CONCLUSIONS Postoperative complications affect prognosis and recurrence patterns in patients with periampullary cancer after PD.
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Affiliation(s)
- Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Republic of Korea.
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Immunogenic alteration in laparoscopic common bile duct exploration. J Surg Res 2014; 187:302-9. [DOI: 10.1016/j.jss.2013.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 09/25/2013] [Accepted: 10/15/2013] [Indexed: 11/22/2022]
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Sista F, Schietroma M, Santis GD, Mattei A, Cecilia EM, Piccione F, Leardi S, Carlei F, Amicucci G. Systemic inflammation and immune response after laparotomy vs laparoscopy in patients with acute cholecystitis, complicated by peritonitis. World J Gastrointest Surg 2013; 5:73-82. [PMID: 23717743 PMCID: PMC3664294 DOI: 10.4240/wjgs.v5.i4.73] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 02/06/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate acute cholecystitis, complicated by peritonitis, acute phase response and immunological status in patients treated by laparoscopic or open approach.
METHODS: From January 2002 to May 2012, we conducted a prospective randomized study on 45 consecutive patients (27 women, 18 men; mean age 58 years). These subjects were taken from a total of 681 patients who were hospitalised presenting similar preoperative findings: acute upper abdominal pain with tenderness, involuntary guarding under the right hypochondrium and/or in the flank; fever higher than 38 °C, leukocytosis greater than 10 × 109/L or both, and ultrasonographic evidence of calculous cholecystitis possibly complicated by peritonitis. These patients had undergone cholecystectomy for acute calculous cholecystitis, complicated by bile peritonitis. Randomly, 23 patients were assigned to laparoscopic cholecystectomy (LC), and 22 patients to open cholecystectomy (OC). Blood samples were collected from all patients before operation and at days 1, 3 and 6 after surgery. Serum bacteraemia, endotoxaemia, white blood cells (WBCs), WBC subpopulations, human leukocyte antigen-DR (HLA-DR), neutrophil elastase, interleukin-1 (IL-1) and IL-6, and C-reactive protein (CRP) were measured at 0, 30, 60, 90, 120 and 180 min, at 4, 6, 12, 24 h, and then daily (8 A.M.) until post-op day 6.
RESULTS: The two groups were comparable in the severity of peritoneal contamination as indicated by the viable bacterial count (open group = 90% of positive cultures vs laparoscopic group = 87%) and endotoxin level (open group = 33.21 ± 6.32 pg/mL vs laparoscopic group = 35.02 ± 7.23 pg/mL). Four subjects in the OC group (18.1%) and 1 subject (4.3%) in the LC group (P < 0.05) developed intra-abdominal abscess. Severe leukocytosis (range 15.8-19.6/mL) was observed only after OC but not after LC, mostly due to an increase in neutrophils (days 1 and 3, P < 0.05). This value returned to the normal range within 3-4 d after LC and 5-7 d after OC. Other WBC types and lymphocyte subpopulations showed no significant variation. On the first day after surgery, a statistically significant difference was observed in HLA-DR expression between LC (13.0 ± 5.2) and OC (6.0 ± 4.2) (P < 0.05). A statistically significant change in plasma elastase concentration was recorded post-operatively at days 1, 3, and 6 in patients from the OC group when compared to the LC group (P < 0.05). In the OC group, the serum levels of IL-1 and IL-6 began to increase considerably from the first to the sixth hour after surgery. In the LC group, the increase of serum IL-1 and IL-6 levels was delayed and the peak values were notably lower than those in the OC group. Significant differences between the groups, for these two cytokines, were observed from the second to the twenty-fourth hour (P < 0.05) after surgery. The mean values of serum CRP in the LC group on post-operative days (1 and 3) were also lower than those in the OC group (P < 0.05). Systemic concentration of endotoxin was higher in the OC group at all intra-operative sampling times, but reached significance only when the gallbladder was removed (OC group = 36.81 ± 6.4 ρg/mL vs LC group = 16.74 ± 4.1 ρg/mL, P < 0.05). One hour after surgery, microbiological analysis of blood cultures detected 7 different bacterial species after laparotomy, and 4 species after laparoscopy (P < 0.05).
CONCLUSION: OC increased the incidence of bacteraemia, endotoxaemia and systemic inflammation compared with LC and caused lower transient immunological defense, leading to enhanced sepsis in the patients examined.
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Schietroma M, Piccione F, Carlei F, Sista F, Cecilia EM, Amicucci G. Peritonitis from perforated peptic ulcer and immune response. J INVEST SURG 2013; 26:294-304. [PMID: 23514054 DOI: 10.3109/08941939.2012.762073] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Elevated intra-abdominal pressure during the laparoscopy may promote bacteremia, endotoxemia, and systemic inflammatory response. In patients with generalized peritonitis from perforated peptic ulcer (PPU), we sought to compare acute phase response, immunologic status, and bacterial translocation from laparoscopic and open approach. STUDY DESIGN From July 2005 to September 2011, 115 consecutive patients underwent peptic ulcer repair for PPU: 58 cases laparoscopic peptic ulcer repair (LR) and 57 cases open peptic ulcer repair (OR). Bacteremia, endotoxemia, white blood cells population, human leukocyte antigen-DR (HLA-DR), neutrophil-elastase, interleukin-1 and 6 (IL-1 and IL-6), and C-reactive protein (CRP) were investigated. RESULTS Patients characteristics and grade of peritoneal contamination were similar in the two groups. One hour after intervention, bacteremia was significantly higher in the "open" group than in the laparoscopic group (p < .001). A significantly higher concentration of systemic endotoxin was detected intraoperatively in the "open" group of patients in comparison to the laparoscopic group (p < .0001). Laparotomy caused a significant increase in neutrophil concentration, neutrophil-elastase, IL-1 and IL-6, CRP, and decrease of HLA-DR. We recorded six cases (10.3%) of intra-abdominal abscess in the "open" group and one (1.7%) in laparoscopic group (p < .001). CONCLUSIONS OR, in case of peritonitis after PPU, increased the incidence of bacteremia, endotoxemia, and systemic inflammation compared with LR. Early enhanced postoperative systemic inflammation may cause lower transient immunologic defense after laparotomy (decrease of HLA-DR), leading to enhanced sepsis in these patients.
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Schietroma M, Piccione F, Carlei F, Clementi M, Bianchi Z, De Vita F, Amicucci G. Peritonitis from Perforated Appendicitis: Stress Response after Laparoscopic or Open Treatment. Am Surg 2012. [DOI: 10.1177/000313481207800541] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Elevated intra-abdominal pressure during laparoscopy may promote systemic inflammatory response. In patients with generalized peritonitis from perforated appendicitis, we sought to compare acute phase response and immunologic status from laparoscopic and open approach. One hundred and forty-seven consecutive patients underwent appendectomy for perforated appendicitis (73 patients had laparoscopic appendectomy and 74 patients had open appendectomy. Bacteremia, endotoxemia, white blood cells, peripheral lymphocytes subpopulation, human leukocyte antigen-DR (HLA-DR), neutrophil-elastase, interleukin-1 and 6 (IL-1 and 6), and C-reactive protein were investigated. One hour after intervention, bacteremia was significantly higher in the open group compared with the laparoscopic group ( P < 0.05). A significantly higher concentration of systemic endotoxin was detected intraoperatively in the open group of patients in comparison with the laparoscopic group ( P < 0.05). Laparotomy caused a significant increase in neutrophil concentration, neutrophil-elastase, IL-1 and 6, and C-reactive protein and a decrease of HLA-DR. We recorded 6 cases (8.1%) of intra-abdominal abscess in the open group and one (1.3%) in the laparoscopic group ( P < 0.05). Open appendectomy, in case of peritonitis, increased the incidence of bacteremia, endotoxemia, and systemic inflammation compared with laparoscopic appendectomy. Early enhanced postoperative systemic inflammation may cause lower transient immunologic defense after laparotomy (decrease of HLA-DR), leading to enhanced sepsis in these patients.
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20
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Moehrlen U, Lechner A, Bäumel M, Dostert K, Röhrl J, Meuli M, Männel DN, Hamacher J. Immune cell populations and cytokine production in spleen and mesenteric lymph nodes after laparoscopic surgery versus conventional laparotomy in mice. Pediatr Surg Int 2012; 28:507-13. [PMID: 22426493 DOI: 10.1007/s00383-012-3070-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE There is evidence that open as well as minimally invasive abdominal surgery impair post-operative innate and acquired immune function. To compare the impact of these approaches as well as the one of different peritoneal gas exposures on immune function, we investigated cellular as well as cytokine-based immune parameters in mesenteric lymph nodes and the spleen postoperatively. METHODS Mice (n = 26) were randomly assigned to the 4 study groups: (1) sham controls undergoing anesthesia alone, (2) laparotomy, and (3) air, or (4) carbon dioxide pneumoperitoneum. Mice were sacrificed 48 h after the intervention, and their spleens and mesenteric lymph nodes were harvested. Cytokine production (TNF-α, IL-6, IL-10, and IFN-γ), splenic T cell subpopulations (cytotoxic T cells, T helper cells, and regulatory T cells) were analyzed. RESULTS TNF-α production of splenocytes 16 h after ex vivo lipopolysaccharides (LPS) stimulation was significantly increased in the laparotomy group compared to all other groups. In contrast, TNF-α production of lymph node cells and IL-6 production of splenocytes after ex vivo LPS stimulation did not differ significantly between the groups. The numbers of regulatory T cells (Treg) in the spleen differed between groups. A significant reduction in Treg cell frequency was detected in the CO(2) insufflation group compared to the laparotomy and the air insufflation group. CONCLUSION Our findings demonstrate a distinct difference in immune effector functions and cellular composition of the spleen with regard to splenic TNF-α production and increased numbers of Treg cells in the spleen. These findings are in line with a higher peritoneal inflammatory status consequent to peritoneal air rather than CO(2) exposure. Treg turned out to be key modulators of postoperative dysfunction of acquired immunity.
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Affiliation(s)
- Ueli Moehrlen
- Department of Pediatric Surgery, University Children's Hospital Zurich, Steinwiesstr. 75, 8032, Zurich, Switzerland.
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Casaroli AA, Mimica LMJ, Fontes B, Rasslan S. The effects of pneumoperitoneum and controlled ventilation on peritoneal lymphatic bacterial clearance: experimental results in rats. Clinics (Sao Paulo) 2011; 66:1621-5. [PMID: 22179170 PMCID: PMC3164415 DOI: 10.1590/s1807-59322011000900020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 06/02/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the effect of pneumoperitoneum, both alone and in combination with controlled ventilation, on peritoneal lymphatic bacterial clearance using a rat bacterial peritonitis model. METHOD A total of 69 male Wistar rats were intraperitoneally inoculated with an Escherichia coli solution (10(9) colony-forming units (cfu)/mL) and divided into three groups of 23 animals each: A (control group), B (pneumoperitoneum under 5 mmHg of constant pressure), and C (endotracheal intubation, controlled ventilation, and pneumoperitoneum as in Group B). The animals were sacrificed after 30 min under these conditions, and blood, mediastinal ganglia, lungs, peritoneum, liver, and spleen cultures were performed. RESULTS Statistical analyses comparing the number of cfu/sample in each of the cultures showed that no differences existed between the three groups. CONCLUSION Based on our results, we concluded that pneumoperitoneum, either alone or in association with mechanical ventilation, did not modify the bacterial clearance through the diaphragmatic lymphatic system of the peritoneal cavity.
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Nakajima J, Sasaki A, Otsuka K, Obuchi T, Nishizuka S, Wakabayashi G. Risk factors for early postoperative small bowel obstruction after colectomy for colorectal cancer. World J Surg 2010; 34:1086-90. [PMID: 20151126 DOI: 10.1007/s00268-010-0462-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Small bowel obstruction (SBO) after colectomy leads to markedly lower patient quality of life, longer hospital stays, and increased hospitalization costs. From a systemic treatment point of view, early postoperative SBO is one of the major concerns of the surgery because it often delays chemotherapy in advanced cases. The goal of this single-center study was to evaluate the risk factors for early postoperative SBO. METHODS Univariate and multivariate analyses were performed for 1,004 patients who underwent open colectomy (OC, 421 patients) or laparoscopic-assisted colectomy (LAC, 583 patients) for colorectal cancer between January 1997 and December 2008. RESULTS The overall early postoperative SBO were 45 cases (4.5%). Univariate analysis of the risk factors for early postoperative SBO showed no statistical significance between respective risk factors and occurrence of SBO for age >70 years, body mass index >25 kg/m(2), ASA score > or =3, pT stage T4, pN stage > or =N1, pM stage M1, or increased blood loss. Multivariate analysis demonstrated that OC (odds ratio (OR), 2.62; 95% confidence interval (CI), 1.34-5.13; P = 0.005), and rectal cancer (OR, 2.12; 95% CI, 1.1-4.1; P = 0.025) were independent risk factors for postoperative SBO after colectomy for colorectal cancer. Regarding the causes of SBO, paralytic obstruction was more frequent in the LAC group, and adhesive obstruction was more frequent in the OC group. CONCLUSIONS Early postoperative SBO cases are more likely to occur with OC and rectal cancer. LAC is an effective surgical procedure from the perspective of reducing the incidence of early postoperative SBO after colectomy for colorectal cancer.
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Affiliation(s)
- Jun Nakajima
- Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, 020-8505, Japan.
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Silva RA, Garotti JER, Silva RSB, Navarini A, Pacheco AM. Analysis of the bactericidal effect of ozone pneumoperitoneum. Acta Cir Bras 2009; 24:124-7. [PMID: 19377781 DOI: 10.1590/s0102-86502009000200009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Accepted: 01/19/2009] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To assess the bactericidal action of ozone pneumoperitonium, and to compare the results with CO2. METHODS It was used 36 Wistar rats. The animals, under anesthesia, were inoculated with 2ml of E. coli ATCC at a concentration of 10(10)UFC, and 1ml of BaSO4, into the peritoneal cavity. They were divided into three groups: Group 1, CO2 pneumoperitoneum was performed for 15 minutes; Group 2, ozone pneumoperitoneum was performed for 5 minutes at a concentration of 42microg/ml, and Group 3, ozone pneumoperitoneum was performed for 5 minutes at a concentration of 62microg/ml. Six animals from each group were sacrificed after the experiment, and the remaining 6 observed for 24 hours. Material was collected from the cavity of all animals for microbiological study. RESULTS Ozone presented a greater bactericidal effect than CO2 in those animals sacrificed immediately after pneumoperitoneum. In the animals studied 24 hours after pneumoperitoneum evidenced no difference in bactericidal effect between the two gases. Moreover, no difference in mortality was observed. CONCLUSION Ozone has a more potent bactericidal effect than carbon dioxide gas, although this did not influence survival of the animals.
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Prospective randomized comparison of clinical results between hand-assisted laparoscopic and open splenectomies. Surg Endosc 2009; 24:25-32. [PMID: 19551441 DOI: 10.1007/s00464-009-0528-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Revised: 02/13/2009] [Accepted: 04/19/2009] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although some studies have compared laparoscopic and hand-assisted laparoscopic splenectomy (HALS) in splenomegaly cases, no study has analyzed the differences between HALS and open splenectomy (OS). This study aimed to compare the HALS and OS techniques in splenomegaly cases. METHODS This prospective study included 27 patients undergoing splenectomy for splenic disorders at the Department of General Surgery, Istanbul Medical Faculty between February and October 2007. Open splenectomy was performed for 14 patients and HALS for the remaining 13 patients. RESULTS The end points compared included incision length, operative time, intraoperative blood loss, postoperative drain output and duration, postoperative pain scores, length of postoperative hospitalization, and perioperative complications. The authors found benefits of HALS over OS for incision length, postoperative pain score, postoperative drain output and duration, and hospital stay. The main advantages of the HALS technique over OS were less postoperative pain (p = 0.0002), shorter hospital stay (p = 0.004), and shorter abdominal incision (p = 0.012). CONCLUSIONS For splenomegaly, HALS significantly facilitates the surgical procedure and reduces the hospital stay while maintaining the advantages of OS such as tactile sense as well as easy and atraumatic manipulation of enlarged spleens.
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Laparoscopic surgery induced interleukin-6 levels in serum and gut mucosa: implications of peritoneum integrity and gas factors. Surg Endosc 2008; 23:370-6. [PMID: 18443862 DOI: 10.1007/s00464-008-9948-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Revised: 02/08/2008] [Accepted: 04/05/2008] [Indexed: 12/16/2022]
Abstract
BACKGROUND The peritoneum serves as an integral part of host immunity, and the homeostasis of intraperitoneal environment is held to be beneficial for patient recovery after abdominal surgery. How minimal invasive access to the abdomen by laparoscopy and incisions would alter the intraperitoneal immune response is not fully defined. This study examined the levels of IL-6 in serum and gut mucosa following laparoscopic surgery with reference to the peritoneum integrity and gas factors. METHODS BALB/c mice were divided into three groups (ten animals in each group) that underwent different abdominal surgical treatments: laparotomy (open group), laparoscopy with atmospheric air (air group) or carbon dioxide pneumoperitoneum (CO(2) group). A 3-cm incision of the skin and muscle was made in all animals except the peritoneum was left intact in the latter two animal groups in order to cancel out the incisional tissue injury present in laparotomy. Four hours after surgery, serum, and jejunal mucosa were extracted for IL-6 measurement by enzyme-linked immunosorbent assay (ELISA). RESULTS Open laparotomy resulted in significant elevation of serum IL-6 level when compared to the laparoscopic procedures in the descending order of open > air > CO(2) groups. For the mucosal IL-6 level, both the open and air groups were significantly higher than the CO(2) group. Data from multivariate analysis revealed that breaching or incision of the peritoneum was an important factor for the elevated levels of IL-6 in serum (p < 0.001) and jejunal mucosa (p = 0.032). CONCLUSION The present study suggests that laparoscopic techniques to minimize the size of the peritoneal incision as well as exposure to atmospheric air can potentially reduce postoperative stress responses associated with abdominal surgery and prompt early recovery.
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Salgado Júnior W, Santos JSD, Cunha FDQ. Development of a lethal model of peritonitis for assessment of laparoscopic and laparotomic treatments in rats. Acta Cir Bras 2008; 22:39-42. [PMID: 17293948 DOI: 10.1590/s0102-86502007000100007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2006] [Accepted: 10/23/2006] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Development of a lethal model of peritonitis to assess the results of treating that peritonitis using videolaparoscopy and laparotomy. METHODS We developed a model of peritonitis in rats using cecal ligation (CLP) against a 2-mm diameter rigid mold and puncture. Two experiments were performed: determination of seven-day lethality; and analysis of white cell counts, blood cultures and cytokines (Interleukin-1 beta, Tumor Necrosis Factor-alpha and IL-6). The animals were divided into four groups: I--Sham surgery; II--CLP; III--CLP + Videolaparoscopy; and IV--CLP + Laparotomy . RESULTS Seven-day lethality was 0% in group I, 80% in the group II (p<0.05), 60% in group III , and 20 % in group IV. There was a significant reduction in leukocyte counts and higher levels of serum IL-1 beta, TNF-alpha and IL-6 in the group II compared to controls. The percentages of positive blood cultures were higher after videolaparoscopic compared to laparotomic treatment. CONCLUSION The experimental model provoked a lethal form of peritonitis and that videolaparoscopic treatment had more bacteraemia than laparotomy.
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Affiliation(s)
- Wilson Salgado Júnior
- Gastroenterology Division, Department of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo, 14048-900 Ribeirão Preto, SP, Brazil.
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Salgado W, Santos JSD, Cunha FQ. The Effect of Laparoscopy Access and Antibiotics on the Outcome of Severe Bacterial Peritonitis in Rats. J Laparoendosc Adv Surg Tech A 2008; 18:5-12. [DOI: 10.1089/lap.2007.0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Wilson Salgado
- Departments of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - José S. Dos Santos
- Departments of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Fernando Q. Cunha
- Department of Pharmacology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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McGee MF, Schomisch SJ, Marks JM, Delaney CP, Jin J, Williams C, Chak A, Matteson DT, Andrews J, Ponsky JL. Late phase TNF-alpha depression in natural orifice translumenal endoscopic surgery (NOTES) peritoneoscopy. Surgery 2007; 143:318-28. [PMID: 18291252 DOI: 10.1016/j.surg.2007.09.032] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Revised: 09/12/2007] [Accepted: 09/12/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND Natural orifice translumenal endoscopic surgery (NOTES) allows access to the peritoneal cavity without skin incisions. Contamination of the peritoneal cavity by enteric contents may render NOTES more physiologically and immunologically invasive than previously thought. Measurement of interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha) is a validated method to quantify surgical stress. The physiologic and immunologic impact of NOTES is unknown. METHODS A total of 37 swine underwent abdominal exploration via transgastric NOTES peritoneoscopy, laparoscopy (LX), laparotomy (OPEN), or sham surgery (CONTROL) and were allowed to survive. TNF-alpha, IL-1beta, and IL-6 plasma levels were determined at the start and completion of surgery, and at 1 hour, 2 days, and 14 days postoperatively. RESULTS At surgical completion, OPEN animals demonstrated higher TNF-alpha levels than all groups. TNF-alpha levels were similar for all groups at 1 hour and 2 days. NOTES animals had significantly reduced plasma levels of TNF-alpha than all other groups on postoperative days 7 and 14. Controlling for baseline cytokine variability, analysis was repeated using normalized data, which confirmed significantly reduced TNF-alpha levels for NOTES compared with all groups at 14 days. Subset analysis excluding LX and OPEN complications revealed lower NOTES TNF-alpha levels at 7 and 14 days compared with all groups. IL-1beta and IL-6 levels were undetectable in 66.8% and 70.5% of samples, respectively, without significant trends. CONCLUSIONS Diagnostic NOTES peritoneoscopy demonstrated similar levels of systemic proinflammatory cytokine TNF-alpha compared with diagnostic laparoscopy and exploratory laparotomy in the immediate postoperative period despite gross intraperitoneal contamination. None of the surgical groups, however, produced a measurable, consistent trend in IL-1beta or IL-6. Consistently reduced levels of TNF-alpha in NOTES animals in the late postoperative period indicates an immunomodulatory effect of the NOTES surgical technique not present in laparoscopy or laparotomy.
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Affiliation(s)
- Michael F McGee
- Case Advanced Surgical Endoscopy Team (CASE-T) Laboratory, Departments of Surgery and Gastroenterology, Case Medical Center, Case Western Reserve University, Cleveland, Ohio 44106, USA
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van Grevenstein WMU, Aalbers AGJ, Ten Raa S, Sluiter W, Hofland LJ, Jeekel H, van Eijck CHJ. Surgery-Derived Reactive Oxygen Species Produced by Polymorphonuclear Leukocytes Promote Tumor Recurrence: Studies in an In Vitro Model. J Surg Res 2007; 140:115-20. [PMID: 17196986 DOI: 10.1016/j.jss.2006.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Revised: 10/06/2006] [Accepted: 10/06/2006] [Indexed: 01/22/2023]
Abstract
Tissue injury induces the acute phase response, aimed at minimizing damage and starting the healing process. Polymorphonuclear leukocytes (PMNs) respond to the presence of specific chemoattractants and begin to appear in large numbers. The aim of this study was to investigate the influence of reactive oxygen species (ROS) produced by PMNs on the interaction between colon carcinoma cells and mesothelial cells. An experimental human in vitro model was designed using Caco-2 colon carcinoma cells and primary cultures of mesothelial cells. Tumor cell adhesion to a mesothelial monolayer was assessed after preincubation of the mesothelium with stimulated PMNs and unstimulated PMNs. Mesothelial cells were also incubated with xanthine/xanthine oxidase (X/XO) complex producing ROS after which adhesion of Caco-2 cells was investigated and the expression of adhesion molecules (ICAM-1, VCAM-1, and CD44) by means of enzyme immunoassay. In the control situation the average adhesion of Caco-2 cells to the mesothelial monolayers was 23%. Mesothelial monolayers incubated with unstimulated PMNs showed a 25% increase of tumor cell adhesion (P < 0.05). The adhesion of tumor to the monolayers incubated with the N-formyl-methionyl-leucyl-phenylalanine-stimulated PMNs increased with 40% (P < 0.01). Incubation of the mesothelium with X/XO resulted in an enhancement of adhesion of Caco-2 cells of 70% and an up-regulation of expression of ICAM-1, VCAM-1, and CD44. This study reveals an increase of tumor cell adhesion to the mesothelium induced by incubating the mesothelial monolayers with PMNs. PMNs are producing a number of products, like proteolytic enzymes, cytokines, and ROS. These factors up-regulate the expression of adhesion molecules and in that way stimulate the adhesion of tumor to the mesothelium.
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Boo YJ, Kim WB, Kim J, Song TJ, Choi SY, Kim YC, Suh SO. Systemic immune response after open versus laparoscopic cholecystectomy in acute cholecystitis: a prospective randomized study. Scandinavian Journal of Clinical and Laboratory Investigation 2007; 67:207-14. [PMID: 17366000 DOI: 10.1080/00365510601011585] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Laparoscopic surgery is thought to reduce the postoperative immunologic effects of surgical trauma. The aim of this study is to evaluate the influence of surgical trauma on systemic inflammation and the immune response in acute cholecystitis. MATERIAL AND METHODS Thirty-three patients with acute calculous cholecystitis were assigned to laparoscopic cholecystectomy (LC, n=18) or open cholecystectomy (OC, n=15). Blood samples were obtained preoperatively and on postoperative day 1 (24 h after surgery) and day 3 (72 h after surgery), and blood concentration of C-reactive protein (CRP), leukocyte subpopulations, as well as levels of tumor necrosis factor-alpha (TNF-alpha) ex vivo secretion by peripheral blood mononuclear cells (PBMCs) were measured in both groups. RESULTS Hospitalization was significantly shorter in the LC group than in the OC group (LC group: 3.7+/-1.2 days versus OC group: 6.3+/-2.7 days, p=0.010). There was no postoperative morbidity in the LC group, but two patients in the OC group had postoperative complications. Postoperative TNF-alpha ex vivo secretion by PBMCs and PBMC counts in the OC group were significantly lower than those in the LC group (p=0.002). The CRP level declined by postoperative day 3, but was significantly less in the OC group than in the LC group (p<0.001). Postoperative monocyte counts significantly decreased in the OC group compared with those in the LC group (p=0.001). CONCLUSIONS A laparoscopic approach appears to cause less surgical trauma and immunosuppression than open surgery in patients with acute cholecystitis.
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Affiliation(s)
- Y-J Boo
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
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Ascon DB, Lopez-Briones S, Liu M, Ascon M, Savransky V, Colvin RB, Soloski MJ, Rabb H. Phenotypic and Functional Characterization of Kidney-Infiltrating Lymphocytes in Renal Ischemia Reperfusion Injury. THE JOURNAL OF IMMUNOLOGY 2006; 177:3380-7. [PMID: 16920979 DOI: 10.4049/jimmunol.177.5.3380] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
T and B lymphocytes have been implicated in the pathogenesis of renal ischemia reperfusion injury (IRI). The trafficking of lymphocytes into kidneys during IRI has been postulated to underlie this effect, but has not been rigorously studied. We therefore characterized the lymphocyte populations infiltrating into mouse kidneys 3 and 24 h after renal IRI. Immunohistochemistry and flow cytometry staining of kidney lymphocytes showed increased trafficking of CD3+ T cells and CD19+ B cells in both sham-operated and IRI mice 3 h after renal IRI. In the IRI mice, increased infiltration of NK1.1+ and CD4+ NK1.1+ cells compared with normal and sham-operated mice was observed 3 and 24 h after renal IRI, respectively. After 24 h of renal IRI, the decreased percentages of CD3+, CD19+, and NK1.1+ populations in the IRI mice compared with control groups were observed. Increased TNF-alpha and IFN-gamma production of kidney infiltration CD3+ T cells in IRI mice but not sham-operated mice was found. Unexpectedly, isolation and transfer of kidney-infiltrating lymphocytes 24 h after renal IRI into T cell-deficient mice reduced their functional and histological injury after renal IRI, suggesting that kidney-infiltrating lymphocytes could have a protective function. These quantitative, qualitative, and functional changes in kidney lymphocytes provide mechanistic insight into how lymphocytes modulate IRI, as well as demonstrating that abdominal surgery alone leads to lymphocyte changes in kidney.
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Affiliation(s)
- Dolores B Ascon
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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Hiki N, Shimizu N, Yamaguchi H, Imamura K, Kami K, Kubota K, Kaminishi M. Manipulation of the small intestine as a cause of the increased inflammatory response after open compared with laparoscopic surgery. Br J Surg 2006; 93:195-204. [PMID: 16392101 DOI: 10.1002/bjs.5224] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Laparoscopic surgery of the gastrointestinal tract involves a reduced immune response compared with open surgery. The aim of this study was to assess manual handling of the gut in open procedures as the principal cause of the enhanced immune response. METHODS Eighteen Landrace pigs underwent gastrectomy by three different methods: conventional open wound with bowel manipulation, laparoscopically assisted gastrectomy, and gastrectomy without manipulation using a combination of open wound and laparoscopic surgical devices. Local inflammatory changes were assessed by ascites formation, intestinal adhesion development and intestinal inflammatory gene expression. Associated systemic inflammatory changes were determined by measuring portal and systemic plasma endotoxin levels, plasma inflammatory cytokine levels, liver inflammatory gene expression and transaminase levels. RESULTS Significantly more postoperative intra-abdominal fluid and adhesions were seen in the open group. The expression of inflammatory cytokines was significantly greater in the intestine and liver in the open group. Portal and systemic levels of endotoxin, inflammatory cytokines and transaminases were also higher. CONCLUSION Manual handling of organs during gastrectomy is an important contributor to the molecular and humoral inflammatory response to surgery, supporting the use of minimally invasive techniques in gastrointestinal surgery.
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Affiliation(s)
- N Hiki
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Japan.
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Strickland AK, Martindale RG. The increased incidence of intraabdominal infections in laparoscopic procedures: potential causes, postoperative management, and prospective innovations. Surg Endosc 2005; 19:874-81. [PMID: 15933899 DOI: 10.1007/s00464-004-8211-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2004] [Accepted: 02/09/2005] [Indexed: 10/25/2022]
Abstract
We conducted a review of the literature to identify some potential causes for the increased incidence of intraabdominal infections seen after laparoscopic procedures. We also discuss the postoperative management of this condition and provide a prospective overview of innovations that may be helpful in such cases in the future.
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Affiliation(s)
- A K Strickland
- Department of Surgery, Medical College of Georgia, 1120 15th St, Augusta, GA 30912-4004, USA.
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Jacobi CA, Hartmann J, Ordemann J. Immunologie, minimal invasive Chirurgie und Karzinom. Visc Med 2005. [DOI: 10.1159/000083359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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El-Hakim A, Chiu KY, Sherry B, Bhuiya T, Smith AD, Lee BR. PERITONEAL AND SYSTEMIC INFLAMMATORY MEDIATORS OF LAPAROSCOPIC BOWEL INJURY IN A RABBIT MODEL. J Urol 2004; 172:1515-9. [PMID: 15371882 DOI: 10.1097/01.ju.0000131002.29322.7d] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Assaad El-Hakim
- Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA
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Novitsky YW, Litwin DEM, Callery MP. The net immunologic advantage of laparoscopic surgery. Surg Endosc 2004; 18:1411-9. [PMID: 15791361 DOI: 10.1007/s00464-003-8275-x] [Citation(s) in RCA: 175] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2004] [Accepted: 06/03/2004] [Indexed: 01/10/2023]
Abstract
The trauma of surgery evokes a variety of physiologic and immunologic alterations that should contribute to host defense. However, an exaggerated response to injury may result in immunosuppression and lead to significant postoperative morbidity and mortality. Laparoscopic surgery may result in less induced surgical trauma than conventional open surgery. Decreased postoperative pain and speedy functional recovery of laparoscopic patients may be attributable to the reduced inflammatory response and minimal immunosuppression. Inflammation, an early protective homeostatic immune response to injury, is characterized by the production of proinflammatory cytokines and by activation of cellular and humoral immune mechanisms. Postoperative levels of the inflammatory cytokines have been consistently lower after laparoscopic procedures, indicating a smaller degree of surgical insult and acute inflammatory reaction. Surgical stress derails the functions of both polymorphonuclear and mononuclear cells, which may lead to an increased risk of postoperative infection. Comparative studies of cellular immunity after laparoscopic and conventional surgery demonstrate immunologic advantage conferred by laparoscopy. Exaggerated activation of peritoneal immunity may lead to a relative local immunosuppression, resulting in ineffective intraperitoneal bacterial clearance and serious postoperative infections. Functions of the peritoneal macrophages are better preserved when laparotomy is avoided. Decreased perioperative stress may be particularly important for oncologic patients. Laparoscopic approaches may result in diminished perioperative tumor dissemination and better cancer outcomes. Although laparoscopy is "minimally invasive," systemic immune responses still are undeniably activated. However, laparoscopic surgery appears to induce a smaller injury, resulting in proportionally decreased immunologic changes. In addition to improved cosmesis and faster functional recovery, a patient undergoing laparoscopic surgery may benefit most from a net immunologic advantage.
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Affiliation(s)
- Y W Novitsky
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA
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Shakhar G, Ben-Eliyahu S. Potential prophylactic measures against postoperative immunosuppression: could they reduce recurrence rates in oncological patients? Ann Surg Oncol 2004; 10:972-92. [PMID: 14527919 DOI: 10.1245/aso.2003.02.007] [Citation(s) in RCA: 237] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Removing the primary tumor is indispensable for eliminating the major pool of metastasizing cells, but the surgical procedure itself is suspected of promoting metastases. This adverse effect is attributed to several mechanisms acting in synergy, including mechanical release of tumor cells, enhanced angiogenesis, secretion of growth factors, and immunosuppression. Here we provide new insights into mechanisms of postoperative immunosuppression and assess the assumptions underlying the hypothesis that, by suppressing cell-mediated immunity (CMI), surgery may render the patient vulnerable to metastases that otherwise could have been controlled. METHODS An extensive review of relevant articles in English identified by using the MEDLINE database and cross-referencing. RESULTS Current literature suggests that (1) CMI can control minimal residual disease, especially if surgery is performed early; (2) major surgery transiently but markedly suppresses CMI through multiple mechanisms now better understood; (3) surgical stress promotes experimental metastasis through immunosuppression, but the clinical evidence remains indirect because of ethical limitations. CONCLUSIONS Minimizing postoperative immunosuppression seems feasible, may limit recurrence, and should be introduced into the broader array of considerations when planning oncological surgeries. In the short run, physicians could try to avoid immunosuppressive anesthetic approaches, inadvertent hypothermia, excessive blood transfusions, and untended postoperative pain. When feasible, minimally invasive surgery should be considered. In the long run, clinical trials should evaluate prophylactic measures, including perioperative immunostimulation and several antagonists to cytokines and hormones specified herein.
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Affiliation(s)
- Guy Shakhar
- Neuroimmunology Research Unit, Department of Psychology, Tel Aviv University, Tel Aviv, Israel
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Jacobi C, Ordemann J. Immunologische Veränderungen während minimal invasiver Chirurgie. Visc Med 2004. [DOI: 10.1159/000083349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Horattas MC, Haller N, Ricchiuti D, Ricchiutti D. Increased transperitoneal bacterial translocation in laparoscopic surgery. Surg Endosc 2003; 17:1464-7. [PMID: 12802657 DOI: 10.1007/s00464-001-8289-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2002] [Accepted: 10/22/2002] [Indexed: 12/26/2022]
Abstract
BACKGROUND The indications for laparoscopic surgery have expanded to include diseases possibly associated with peritonitis such as appendicitis, perforated peptic ulcers, and diverticulitis. The safety of carbon dioxide (CO2) pneumoperitoneum in the presence of peritonitis has not been proved. Our previous investigations demonstrated increased bacteremia associated with CO2 insufflation. In effort to clarify the relative effects of intraabdominal pressure and type of gas, this study was designed to measure bacterial translocation with different gases at different pressures of pneumoperitoneum. METHODS For this study, 110 rats were given intraperitoneal bacterial innoculations with Escherichia coli and equally divided into five groups of 20 animals each. The study groups included a control group with no pneumoperitoneum administered (n = 30), insufflation at a commonly used pressure of 14 mmHg with helium (n = 20) and CO2 (n = 20), and low insufflation at 3 mmHg with helium (n = 20) and CO2 (n = 20) in an effort to minimize influences related to pressure. Blood cultures were checked at 15-min intervals for the first 45 min, then hourly thereafter for a total of 165 min after peritoneal inoculation with 2 x 10(7) E. coli. RESULTS There is increased risk of bacterial translocation in comparing groups that underwent pneumoperitoneum with those that did not in the rat peritonitis model. Furthermore, these findings are dependent on the presence or absence of gas, but not necessarily on the type of gas used for insufflation. In the low-pressure groups of both gases (helium and CO2), bacterial translocation was significantly increased, as compared with the control group. Low pressure also was associated with increased bacterial translocation, as compared with high pressure, but beyond 30 min of insufflation, no significant differences were apparent. CONCLUSIONS The risk of bacterial translocation in the E. coli rat peritonitis model is increased with insufflation using CO2 or helium, and this effect is more significant at lower pressures (3 mmHg) than at higher pressures (14 mmHg). However, no clinically applicable conclusions regarding the relative effects from type of gas or insufflation pressures could be confirmed.
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Affiliation(s)
- M C Horattas
- Akron General Medical Center, Northeastern Ohio Universities College of Medicine, 400 Wabash Avenue, Akron, Ohio 44307, USA
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Aldana JPA, Marcovich R, Singhal P, Reddy K, Morgenstern N, El-Hakim A, Smith AD, Lee BR. Immune response to laparoscopic bowel injury. J Endourol 2003; 17:317-22. [PMID: 12885358 DOI: 10.1089/089277903322145503] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE 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. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSIONS 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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Affiliation(s)
- Joel Patrick A Aldana
- Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York, USA
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Chang CK, Zdon MJ. Inhibition of tumor necrosis factor-alpha and inducible nitric oxide synthase correlates with the induction of IL-10 in septic rats undergoing laparotomy and laparoscopy. Surg Laparosc Endosc Percutan Tech 2002; 12:247-51. [PMID: 12193819 DOI: 10.1097/00129689-200208000-00009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Proinflammatory mediators are implicated in the mediation of host response to surgical stress. Greater inflammatory response has been reported after open surgery than after laparoscopic surgery in animal models. This study investigated the inflammatory response of tumor necrosis factor alpha (TNF) and inducible nitric oxide synthase (iNOS) and the anti-inflammatory response of interleukin (IL)-10 after laparotomy and laparoscopy in a rat endotoxic shock model. Rats received lipopolysaccharide (LPS) intraperitoneally and underwent laparotomy (n = 5), laparoscopy (n = 5), or no surgical intervention (n = 5). A control group received anesthesia only (n = 5). Serum TNF levels peaked at 2 hours after LPS injection and were significantly suppressed in animals undergoing laparotomy and laparoscopy ( < 0.05). Serum IL-10 levels were higher at 2 hours in the laparotomy and laparoscopy groups but were higher only in the laparotomy group at 4 hours after LPS injection ( < 0.05). Hepatic iNOS mRNA and protein were significantly inhibited at 4 and 8 hours in the laparotomy and laparoscopy groups in comparison with the animals receiving LPS only ( < 0.05). The induction of IL-10 correlated with the suppression of TNF and iNOS suggests that IL-10 may play a role in downregulating TNF and iNOS in septic rats undergoing laparotomy and laparoscopy.
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Affiliation(s)
- Cheow K Chang
- Department of Surgery, Mount Sinai Hospital Medical Center, California Avenue at 15th Street, Chicago, IL 60608, USA.
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Abstract
Laparoscopic surgery (LS) has improved our knowledge of some aspects of surgical physiopathology. Other advantages include a lower incidence of postoperative infections, as evidenced by a lower inflammatory response which is related to a better preserved immune response to infection. But, the differential aspects of LS may influence the intraperitoneal environment and, in case of infection, must be evaluated in two different situations: during clean and potentially-contaminated surgery or in the presence of established infection. The most important differential factors of LS are the pneumoperitoneum and the use of CO2. The influence of both these on the evolution of an intraperitoneal infecton has been of interest in recent years. Our department developed an experimental study with mice to evaluate the local and systemic inflammatory response to perioperative intra-abdominal contamination with a known inoculum of Escherichia coli. The animals were distributed in four groups: control, laparotomy, laparoscopy with CO2 pneumoperitoneum, and laparoscopy with wall traction. Peritoneal liquid and blood cultures such as peritoneal and systemic cytokine levels were analyzed. The results showed a better tolerance to perioperative contamination in LS groups while the CO2 pneumoperitoneum had no influence. But, in the presence of peritonitis, an elevated CO2 pneumoperitoneum can be dangerous and the operative time is an important factor to be considered. The literature is reviewed on the relationship between LS and surgical infection.
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Affiliation(s)
- C Balagué Ponz
- General Surgery Service, Hospital Clinic, Barcelona, Spain. cbp
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Jacobi CA, Sterzel A, Braumann C, Halle E, Stösslein R, Krähenbühl L, Müller JM. The impact of conventional and laparoscopic colon resection (CO2 or helium) on intraperitoneal adhesion formation in a rat peritonitis model. Surg Endosc 2001; 15:380-6. [PMID: 11395820 DOI: 10.1007/s004640000359] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2000] [Accepted: 08/30/2000] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although postoperative intra-abdominal adhesion formation has been shown to be less with laparoscopic procedures than with open surgery, the extent of intraperitoneal adhesion formation after open and laparoscopic colon resection in patients with intra-abdominal infection remains unclear. METHODS A standardized fecal inoculum was intraperitoneally applied in 72 rats to induce peritonitis. The rats were randomized into four groups. The three experimental groups underwent laparoscopic resection of the cecum with carbon dioxide (n = 20) or helium (n = 20) insufflation at a pressure of 8 mmHg, or conventional open cecum resection (n = 20). In the control group, no further manipulations were performed after induction of the peritonitis (n = 12). Blood samples were taken during the perioperative course to determine the plasma levels of tumor necrosis factor-alpha (TNF-alpha) and interleukin-10 (IL-10). The number of intraperitoneal adhesions and the bacterial species of peritoneal swabs were determined in each animal. RESULTS The adhesions were increased in all operation groups as compared with the control group. The number of adhesions was significantly greater after conventional resection than after laparoscopic approaches (p < 0.01). The overall adhesion score was significantly lower in the helium group (p < 0.05) than in the two other operation groups. There was no difference between the laparotomy and carbon dioxide groups. Whereas postoperative TNF-alpha plasma levels were decreased, IL-10 levels were significantly greater in the helium group than in the other three groups. CONCLUSIONS Intraperitoneal infection is reducing the benefit of laparoscopic surgery regarding postoperative adhesions. Although laparoscopic resection showed an advantage in the number of adhesions with both gases, the total adhesion score was lowest in the helium group.
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Affiliation(s)
- C A Jacobi
- Department of General, Visceral, Vascular, and Thoracic Surgery, Charite, Humboldt-University of Berlin, Schumann Strasse 20/21, D-10098 Berlin, Germany.
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Agalar F, Hamaloglu E, Daphan C, Tarim A, Onur R, Renda N, Sayek I. Effects of CO2 insufflation and laparotomy on wound healing in mice. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 2000; 70:739-42. [PMID: 11021489 DOI: 10.1046/j.1440-1622.2000.01890.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The aim of the present study was to evaluate the effects of laparotomy and CO2 insufflation on wound healing in a murine incisional wound healing model. METHODS Seventy-two male Swiss Albino mice were randomly allocated into three groups of control, laparotomy and CO2 insufflation. A transverse skin incision of 15 mm was made in the dorsum of each mouse, and four interrupted mattress sutures with 4.0 polypropylene thread were laid for wound closure. A median laparotomy was performed in the laparotomy group. CO2 insufflation was performed with an intra-abdominal pressure of 9 mmHg. The retained gas was evacuated from the abdominal cavity at the end of a 60-min period. Mice were killed on the 3rd, 7th and 15th postoperative days. The wound tensile strength and 5-hydroxyproline concentration in the wound tissue were measured. RESULTS Tensile strength of the incised skin increased as the post-incision period progressed. There was no significant difference between the tensile strengths of the incised skin of control, laparotomy and CO2 insufflation groups throughout the observation period. The skin 5-hydroxyproline concentrations of all groups were not significantly different at the 3rd postoperative day. But laparotomy and CO2 insufflation groups had lower 5-hydroxyproline concentrations at the 7th and 15th postoperative days, when compared to controls (P < 0.02 for 7th and 15th days). CONCLUSION CO2 insufflation and laparotomy reduce the 5-hydroxyproline concentration of the wound, suggesting a diminished wound healing capacity.
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Affiliation(s)
- F Agalar
- Department of General Surgery, Suleyman Demirel University Faculty of Medicine, Isparta, Turkey.
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Martineau L, Shek PN. Changes in circulating lymphocyte subpopulations and mitogen-stimulated response in a rat infusion model of intra-abdominal infection. Crit Care Med 2000; 28:2515-21. [PMID: 10921587 DOI: 10.1097/00003246-200007000-00054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To describe the alterations in circulating concentrations of immune cells as well as in in vitro mitogen-stimulated response in a recently developed rat model of intra-abdominal infection. DESIGN Randomized, controlled study. SETTING Government research facility. SUBJECTS Male Sprague-Dawley rats. INTERVENTIONS Infected animals received an intraperitoneal infusion of 6.0 x 10(8) colony forming units of Escherichia coli during 12 hrs, whereas control rats received a sterile inoculum. All experimental animals underwent laparotomy and peritoneal lavage at the end of the infusion period. Blood samples were obtained 12 hrs, 36 hrs, or 7 days after the onset of infusion. Splenocytes were concomitantly harvested and assayed for response to the mitogens phytohemagglutinin (PHA), concanavalin A (Con A), and lipopolysaccharides, as well as for production of interleukin (IL)-2. MEASUREMENTS AND MAIN RESULTS Infected rats showed a marked leukopenia (-82% for 36 hrs), with leukocyte counts returning to normal at 7 days. They also developed a marked lymphocytopenia throughout the study; this was achieved through comparable reductions in circulating T and B cells. Con A responses in both groups were similar for 7 days. In contrast, splenocytes from infected animals showed reduced responses to lipopolysaccharides (-64%) and PHA (-30%) for 36 hrs compared with control splenocytes. IL-2 production from mitogen-stimulated splenocytes was suppressed in infected rats to 66% of that of control rats for 7 days. Suppressed PHA responses were not restored to control values in the presence of IL-2. For all of the parameters assessed, control animals showed either no significant changes or relatively fewer changes than infected rats. CONCLUSIONS This model of intra-abdominal infection is associated with changes in circulating concentrations of immune cells as well as with temporary functional defects in B and T cells, consistent with those often observed in patients with peritonitis. However, the role of IL-2 in limiting the adverse effects of infection in this experimental model seems to be limited. This model may be a useful tool in furthering our understanding of the pathophysiology of intra-abdominal infections and in assessing the efficacy of new therapeutic modalities.
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Affiliation(s)
- L Martineau
- Biomedical Technology Section, Defence and Civil Institute of Environmental Medicine, West Toronto, Ontario, Canada
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Abstract
INTRODUCTION It has been observed that the metabolic response to surgical injury is less after laparoscopic surgery than after open surgery. However, the effect of laparoscopic surgery on surgical infection has not been given much attention in the surgical literature, even though it may decrease the incidence of infectious complications. The objective of this study was to assess the influence that laparoscopic surgery has on surgical infection and to highlight certain controversial aspects. METHODS A review of the literature was undertaken to examine the relationship between laparoscopic surgery and surgical infection. This was achieved primarily by using PubMed Medline as a source of material. RESULTS AND CONCLUSION Laparoscopic surgery is associated with better preservation of the immune system than open surgery. This results in a decreased incidence of infectious complications. Although carbon dioxide pneumoperitoneum affects the peritoneal response to injury, it seems to have no harmful effect in terms of intra-abdominal infection. Nevertheless, at laparoscopic operation the virulence of intestinal micro-organisms should be recognized and, while knowing the advantages of minimally invasive surgery, the surgeon should consider the complexity of this technique. Furthermore, maintenance of laparoscopic instruments should be governed by the same norms as those used in open surgery; recommendations offered by the manufacturers should be respected.
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Affiliation(s)
- E M Targarona
- Department of General Surgery, Hospital de Sant Pau and Hospital Clinic, Barcelona, Spain
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Berguer R, Bravo N, Bowyer M, Ferrick D. Measurement of intracellular gamma-interferon, interleukin-4, and interleukin-10 levels in patients following laparoscopic cholecystectomy. J INVEST SURG 2000; 13:161-7. [PMID: 10933112 DOI: 10.1080/08941930050075856] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Major surgery suppresses intracellular T-cell cytokine production. Laparoscopic surgery has been reported to have no effect on in vitro lymphocyte reactivity, but its effects on intracellular cytokine production are unknown. This study measured T-cell intracellular gamma-interferon, interleukin-4 (IL-4), and interleukin-10 (IL-10), along with serum interleukin-6 (IL-6) and cortisol levels, immediately before and 1 day after laparoscopic cholecystectomy in a cohort of six Air Force and veteran patients. Stimulated intracellular levels of gamma-interferon were slightly, but not significantly, elevated during the postoperative period in all T-cell subsets. There were no postoperative changes in stimulated IL-4 or IL-10 levels. Postoperative serum IL-6 levels, but not serum cortisol levels, were significantly elevated compared to preoperative values. In conclusion, laparoscopic surgery causes slight trauma but has no effect on T-cell intracellular interferon, IL-4, and IL-10 responses.
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Affiliation(s)
- R Berguer
- Department of Surgery, University of California Davis, Sacramento, USA.
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Jacobs S, Sobki S, Morais C, Tariq M. Effect of pentaglobin and piperacillin on survival in a rat model of faecal peritonitis: importance of intervention timings. Acta Anaesthesiol Scand 2000; 44:88-95. [PMID: 10669278 DOI: 10.1034/j.1399-6576.2000.440116.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Faecal peritonitis is a progressive pathophysiological condition which may lead to multiple organ failure and death. The reason for the associated morbidity and mortality could be attributed to the fact that some of the subtle alterations in cellular function that occur during the early stage of peritonitis are unidentified and consequently missed, leading to inadequate or delayed intervention. Recent studies have shown that early treatment with antibiotic and antisera containing antibodies to lipopolysaccharide (immunoglobulin) improve the survival rate in these patients. The present investigation was undertaken to study the effect of pentaglobin and piperacillin with particular attention to time lag of drug intervention on animal survival following experimental peritonitis. METHODS Experimental peritonitis was produced by inoculating 1 ml/kg of faecal suspension (2:1 w/v in saline) into the peritoneal cavity. Two groups of animals were treated with pentaglobin (4 ml/kg) or piperacillin (1000 mg/kg) respectively, whereas rats in another group received both drugs simultaneously. The first dose of each drug was given at 4 h, 6 h, 8 h and 12 h after faecal inoculation followed by 3 additional doses at 8-h intervals. For biochemical studies, separate groups of animals were used in which the treatment was started 4 h after faecal inoculation and the animals were killed at 12 h after the treatment. RESULTS Both piperacillin and pentaglobin prolonged survival time of animals which received the treatment within 6 h of faecal insult. The combination of pentaglobin plus piperacillin produced better results as compared to the individual effect. There was a significant decrease in serum superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) and increase in catalase following faeces-induced septicaemia, suggesting a significant increase in oxidative stress. The changes in enzyme levels were significantly attenuated by both the drugs. CONCLUSION The findings suggest that intervention with a combination of pentaglobin and antibiotics within 6 h of peritonitis might significantly improve survival rate in rat.
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Affiliation(s)
- S Jacobs
- Department of Anesthesia & Research Center, Armed Forces Hospital, Riyadh, Saudi Arabia
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