RT Journal
A1 Jacobi CA, Ordemann JJ, Zieren HU, et al
T1 INcreased systemic inflammation after laparotomy vs laparoscopy in an animal model of peritonitis
JF Archives of Surgery
JO Archives of Surgery
YR 1998
FD March 1
VO 133
IS 3
SP 258
OP 262
DO 10.1001/archsurg.133.3.258
UL http://dx.doi.org/10.1001/archsurg.133.3.258
AB Objective 
    To study the influence of laparotomy and laparoscopy on local and systemic inflammation in a rat model of peritonitis.Design 
    Bacteremia, peripheral leukocyte subpopulations, tumor necrosis factor α (TNF-α) plasma levels, and ex vivo secretion of peripheral blood mononuclear cells were investigated after laparotomy and laparoscopy in a prospective randomized experimental study.Setting 
    Surgical department of a university hospital.Animals 
    60 male inbred Wistar rats.Interventions 
    Standardized fecal inoculum was injected intraperitoneally and rats underwent laparotomy (n=20), laparoscopy (n=20), or no further manipulation (control group, n=20). Blood samples were obtained during the perioperative course to determine bacteremia, leukocytic subpopulations, TNF-α plasma levels, and ex vivo secretion. The number of intraperitoneal abscesses was determined in each animal after 1 week.Main Outcome Measure 
    The hypothesis of the experiment was that laparoscopy with carbon dioxide leads to an increase of local and systemic inflammation in comparison with the laparotomy and control groups.Results 
    One hour after intervention, bacteremia was significantly higher in the laparotomy and laparoscopy groups compared with the control group (P=.01). Fecal inoculum caused significant monocytopenia and lymphocytopenia in all groups within 1 hour after intervention (P<.05), with complete recovery on day 2 only in the laparoscopy and control groups. Laparotomy caused a significant increase in TNF-α plasma levels and decrease of ex vivo production of TNF-α compared with the other 2 groups (P<.05).Conclusions 
    Laparotomy and laparoscopy increased the incidence of bacteremia and systemic inflammation in this peritonitis model. The inflammatory response was significantly higher in the laparotomy group compared with the laparoscopy group.