Influence of Laparoscopy vs. Laparotomy on Bacterial Translocation and Systemic Inflammatory Responses in a Porcine Model with Peritonitis

ABSTRACT

Background: This study aimed to compare the effects of laparoscopy vs. laparotomy on bacterial translocation and immunologic responses in a porcine model with peritonitis caused by small bowel injuries (SBIs). Methods: Pigs with SBIs were first established, assigned into either the laparoscopy group or the laparotomy group, and then received surgical intervention. During 72 hours (72 hr) observation period, blood, and tissues of different organs were obtained for bacterial cultures; endotoxin and peripheral leukocyte were determined; serum levels of IL-6, TNF-α, and CRP were measured. Results: Blood cultures confirmed systemic bacteremia in all animals and the endotoxin level was comparable between groups at 24 hr after surgery. However, two days later, positive bacteremia was only detected in four pigs following laparoscopy and five following laparotomy. Eight and four pigs during laparoscopy (seven and six pigs during laparotomy) had translocated bacteria in mesenteric lymph nodes (MLN) and liver. The 72 hr later, bacteria in MLN, liver, lung, and kidney was found in 2, 1, 2, and 0 pig after laparoscopy, respectively (3, 2, 2, and 1 pig after laparotomy). The peripheral blood monocytes (PBMC) counts remained at a much lower level after laparoscopy than after laparotomy. Serum IL-6, TNF-α, and CRP increased notably after both procedures when compared to preoperative levels. However, significantly faster and lower regression of IL-6, TNF-α, and CRP were observed in the laparoscopy group. Conclusion: Compared with laparotomy, laparoscopy does not result in increased bacterial translocation, but decrease IL-6, TNF-α, and CRP release.

Keywords: :

• laparoscopy
• bacterial translocation
• small bowel injury
• endotoxemia
• pheumoperiteum
• cytokine
• porcine model