The authors declare that they have no competing interests.
TG and GM were responsible for conception and design of the study and drafted the Manuscript. AL, BK, GS and PH were responsible for collection of clinical data and assisted with analyses and interpretation. JH and UH revised the article. All authors have approved the manuscript.
Clinical data indicate that laparoscopic surgery reduces postoperative inflammatory response and benefits patient recovery. Little is known about the mechanisms involved in reduced systemic and local inflammation and the contribution of reduced trauma to the abdominal wall and the parietal peritoneum.
Included were 61 patients, who underwent elective colorectal resection without intraabdominal complications; 17 received a completely laparoscopic, 13 a laparoscopically- assisted procedure and 31 open surgery. Local inflammatory response was quantified by measurement of intraperitoneal leukocytes and IL-6 levels during the first 4 days after surgery.
There was no statistical difference between the groups in systemic inflammatory parameters and intraperitoneal leukocytes. Intraperitoneal interleukin-6 was significantly lower in the laparoscopic group than in the laparoscopically-assisted and open group on postoperative day 1 (26.16 versus 43.25 versus 40.83 ng/ml; p = 0.001). No difference between the groups was recorded on POD 2–4. Intraperitoneal interleukin-6 showed a correlation with duration of hospital stay on POD 1 (0.233, p = 0.036), but not on POD 2–4.
Patients who developed a surgical wound infection showed higher levels of intraperitoneal interleukin-6 on postoperative day 2–4 (POD 2: 42.56 versus 30.02 ng/ml, p = 0.03), POD 3: 36.52 versus 23.62 ng/ml, p = 0.06 and POD 4: 34.43 versus 19.99 ng/ml, p = 0.046). Extraabdominal infections had no impact.
The analysis shows an attenuated intraperitoneal inflammatory response on POD 1 in completely laparoscopically-operated patients, associated with a quicker recovery. This effect cannot be observed in patients, who underwent a laparoscopically-assisted or open procedure. Factors inflicting additional trauma to the abdominal wall and parietal peritoneum promote the intraperitoneal inflammation process.
Tsukada K, Katoh H, Shiojima M, Suzuki T, Takenoshita S, Nagamachi Y. Concentrations of cytokines in peritoneal fluid after abdominal surgery. Eur J Surg. 1993;159:475–9. PubMed
Veenhof AAFA, Vlug MS, van der Pas MHGM, Sietses C, van der Peet DL, de Lange-de Klerk ESM, et al. Surgical stress response and postoperative immune function after laparoscopy or open surgery with fast track or standard perioperative care: a randomized trial. Ann Surg. 2012;255:216–21. CrossRefPubMed
Luján JJ, Németh ZH, Barratt-Stopper PA, Bustami R, Koshenkov VP, Rolandelli RH. Factors influencing the outcome of intestinal anastomosis. Am Surg. 2011;77:1169–75. PubMed
Bernstein MA, Dawson JW, Reissman P, Weiss EG, Nogueras JJ, Wexner SD. Is complete laparoscopic colectomy superior to laparoscopic assisted colectomy? Am Surg. 1996;62:507–11. PubMed
Magistro C, Di Lernia S, Ferrari G, Zullino A, Mazzola M, de Martini P, et al. Totally laparoscopic versus laparoscopic-assisted right colectomy for colon cancer: is there any advantage in short-term outcomes? A prospective comparative assessment in our center. Surg Endosc. 2013;27:2613–8. CrossRefPubMed
Glatz T, Seifert G, Holzner PA, Chikhladze S, Kulemann B, Sick O, et al. A novel rodent model modifying perioperative temperature and humidity during bowel surgery and mimicking laparoscopic conditions. Surg Sci. 2012;3:353–7. CrossRef
- The degree of local inflammatory response after colonic resection depends on the surgical approach: an observational study in 61 patients
Philipp Anton Holzner
Ulrich Theodor Hopt
- BioMed Central
Neu im Fachgebiet Chirurgie
Mail Icon II