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Peritoneal response to pneumoperitoneum and laparoscopic surgery
- Source :
- The British journal of surgery. 89(11)
- Publication Year :
- 2002
-
Abstract
- Background It is generally believed that laparoscopic surgery inflicts less trauma to the peritoneum than open surgery. Local peritoneal fibrinolysis is a critical factor in adhesion development. The objective was to investigate fibrinolytic changes in the peritoneum during laparoscopic and open surgery. Methods At laparotomy (n = 10) peritoneal biopsies were taken at opening of the abdomen and just before closure. At laparoscopy (n = 12) opening peritoneal biopsies were taken after carbon dioxide insufflation, and closure biopsies just before exsufflation. Tissue concentrations of tissue-type plasminogen activator (tPA), plasminogen activator inhibitor type 1 (PAI-1) and the resulting tPA activity were assayed. Results Concentrations of tPA in peritoneal tissue declined during operation in both groups, but significantly so only in the laparotomy group (−53 per cent; P = 0·01). PAI-1 levels were higher in opening biopsies from the laparoscopy group (P = 0·004). There was an increase in PAI-1 concentration during laparotomy, but not during laparoscopy. At the end of the operation, there was no difference between the groups. The resulting tPA activity did not differ between groups at opening or closure. In both groups there was a significant decline during operation (laparotomy: −59 per cent, P = 0·02; laparoscopy: −63 per cent, P = 0·01). Conclusion These findings indicate that the peritoneal response to open and laparoscopic surgery is similar. The initial rise in peritoneal PAI-1 concentration during laparoscopy suggests an adverse effect of carbon dioxide insufflation, which might affect peritoneal repair.
- Subjects :
- Laparoscopic surgery
medicine.medical_specialty
medicine.medical_treatment
Gallstones
chemistry.chemical_compound
Pneumoperitoneum
Laparotomy
Fibrinolysis
Plasminogen Activator Inhibitor 1
medicine
Humans
Laparoscopy
medicine.diagnostic_test
business.industry
medicine.disease
Surgery
medicine.anatomical_structure
chemistry
Cholecystectomy, Laparoscopic
Plasminogen activator inhibitor-1
Tissue Plasminogen Activator
Abdomen
Gallbladder Neoplasms
Exsufflation
Peritoneum
business
Pneumoperitoneum, Artificial
Subjects
Details
- ISSN :
- 00071323
- Volume :
- 89
- Issue :
- 11
- Database :
- OpenAIRE
- Journal :
- The British journal of surgery
- Accession number :
- edsair.doi.dedup.....7fb8b822ded043d56940a772bdad00f3