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The peritoneum serves as an integral part of host immunity, and the homeostasis of intraperitoneal environment is held to be beneficial for patient recovery after abdominal surgery. How minimal invasive access to the abdomen by laparoscopy and incisions would alter the intraperitoneal immune response is not fully defined. This study examined the levels of IL-6 in serum and gut mucosa following laparoscopic surgery with reference to the peritoneum integrity and gas factors. BALB/c mice were divided into three groups (ten animals in each group) that underwent different abdominal surgical treatments: laparotomy (open group), laparoscopy with atmospheric air (air group) or carbon dioxide pneumoperitoneum (CO2 group). A 3-cm incision of the skin and muscle was made in all animals except the peritoneum was left intact in the latter two animal groups in order to cancel out the incisional tissue injury present in laparotomy. Four hours after surgery, serum, and jejunal mucosa were extracted for IL-6 measurement by enzyme-linked immunosorbent assay (ELISA). Open laparotomy resulted in significant elevation of serum IL-6 level when compared to the laparoscopic procedures in the descending order of open > air > CO2 groups. For the mucosal IL-6 level, both the open and air groups were significantly higher than the CO2 group. Data from multivariate analysis revealed that breaching or incision of the peritoneum was an important factor for the elevated levels of IL-6 in serum (p

The repair of indirect inguinal hernia (IH) is one of the most common pediatric surgical procedures, and open surgery (OS) is the standard treatment. The aim of this study was to determine whether the recently developed laparoscopic repair (LR) of IH is superior to OS.Between February 2003 and February 2004, we randomly assigned 97 consecutive IH patients at our institution into OS and LR groups. Fourteen patients were excluded from the study for various reasons, leaving study population of 83 patients. After operation, multiple dressings were placed to blind observers to the operation type. Two pain scales, the children and Infants Postoperative Pain were used to assess postoperative pain. Acetaminophen (15 mg/kg/dose every 6 h) was given at a fixed pain score. Analgesic doses were compared. Parents also provided assessments of their children's recovery and wound appearance.The amount of acetaminophen taken by the OS group (n = 42) was 1.05 +/- 1.248 doses per patient, whereas the amount taken by the LR group (n = 41) was 0.54 +/- 0.84 dose per patient (p = 0.032; 95% confidence interval 0.45-0.976). Laparoscopy detected 11 more bilateral hernias (p = 0.006). Although the operative times did not differ significantly for bilateral hernias (39.08 +/- 13.37 min vs 34.0 +/- 11.31 min, p = 0.623), it did differ for unilateral hernias (18.38 +/- 5.71 vs 23.25 +/- 6.26 min, p = 0.001). Five contralateral hernias were detected in the OS group on follow-up, but none were found in the LR group (p = 0.026). The scores given by parents for recovery and wound appearance were higher in the LR group (p = 0.05).As compared with IH patients who undergo open surgery, those who have a laparoscopic repair suffer less pain, and their recovery and wound cosmesis are more satisfactory. With LR, contralateral hernias can be detected and repaired in a single operative procedure. This procedure takes slightly longer for unilateral than for bilateral hernias.

This study aimed to evaluate the laparoscopic repair of childhood hernias and to identify technical refinements for improvements.The records of 49 boys and 13 girls who underwent laparoscopic hernia repair in the authors' institution between July 2002 and July 2003 were reviewed. Their mean age was 4.5 years (range, 3 months to 15 years). No hernia opening was found in two patients, whereas 17 bilateral hernias (28%, 17/60) were found laparoscopically. Two bilateral hernias were diagnosed preoperatively. Four patients had the operation for recurrent hernias after open procedures.Over a mean follow-up period of 7.5 months (range, 3-15 months), there was one recurrence (1%, 1/79), but no other complication. With saline injection administered extraperitoneally, laparoscopic hernia repair can be performed safely for boys. Use of the "needle" sign avoided damage to the testicular vessel and vas. Placement of the needle medial to a prominent inferior epigastric artery and the presence of a "complete ring" sign prevented recurrence. The use of reusable 3-mm ports and round polypropylene stitches lowered the cost of the operation and improved the cosmesis for the patients. For recurrent hernias after open repair, the laparoscopic method was as simple as fresh hernia repair.Laparoscopic hernia repair allows detection and repair of contralateral hernias during the same operation. With refinements in technique, the procedure can be safely performed for boys, with the added advantages of lower costs, fewer recurrences, and improved cosmesis.