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C. A. Jacobi, MD; J. Ordemann, MD; H. U. Zieren, PhD; H. D. Volk, Prof; A. Bauhofer, PhD; E. Halle, PhD; J. M. Müller, Prof

Arch Surg. 1998;133:258-262.

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 (TNF-) 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- 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- plasma levels and decrease of ex vivo production of TNF- 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.

From the Department of Surgery (Drs Jacobi, Ordemann, Zieren, and Müller), the Institute of Medical Immunology (Dr Volk), and the Institute of Microbiology (Dr Halle), University of Berlin, Berlin, Germany; and the Institute of Theoretical Surgery (Dr Bauhofer), University of Marburg, Marburg, Germany.

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