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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Surgery 1/2015

The degree of local inflammatory response after colonic resection depends on the surgical approach: an observational study in 61 patients

Zeitschrift:
BMC Surgery > Ausgabe 1/2015
Autoren:
Torben Glatz, Ann-Kathrin Lederer, Birte Kulemann, Gabriel Seifert, Philipp Anton Holzner, Ulrich Theodor Hopt, Jens Hoeppner, Goran Marjanovic
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

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.

Authors’ information

Not applicable.

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.
Literatur
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