Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Laparotomy”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 109 records · Page 6Linked to original sources
PubMed1989

Management of unruptured ectopic gestation by linear salpingostomy: a prospective, randomized clinical trial of laparoscopy versus laparotomy.

This study was designed to compare prospectively the parameters of morbidity, cost, length of hospital stay, and fertility outcome after linear salpingostomy by laparoscopy versus laparotomy. Entry criteria included stable vital signs, hematocrit greater than 30%, age over 18 years, and desire for future fertility. All patients underwent diagnostic laparoscopy. Sixty patients with unruptured ectopic gestations of 5 cm or smaller were randomized to either laparoscopy (N = 30) or laparotomy (N = 30). Postoperative follow-up included serial measurements of serum beta-hCG titers at 3-day intervals and hysterosalpingography at 12 weeks. The laparoscopy and laparotomy groups were similar in age, height, weight, gravidity, gestational age, hematocrit, ectopic pregnancy size, and preoperative beta-hCG levels. The estimated blood loss was significantly (P less than .001) lower in patients undergoing laparoscopy, and was not affected by vasopressin injection. Two patients in the laparoscopy group required laparotomy for hemostasis, and two patients undergoing laparotomy had wound infection. One patient in each group had persistent trophoblastic activity. Baseline serum beta-hCG levels and the rate and magnitude of postoperative beta-hCG decline were similar in both groups. The length of hospital stay was significantly (P less than .001) shorter after laparoscopic salpingostomy (1.4 +/- 0.1 days) than after laparotomy (3.3 +/- 0.2 days). Postoperative hysterosalpingography showed patency of the involved tube in 16 of 20 (80%) and 17 of 19 (89%) of patients in the laparoscopy and laparotomy groups, respectively. Pregnancy rates were ten of 18 (56%) and 11 of 19 (58%) in these groups, respectively, and all pregnancies were conceived within 6 months of surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Laparotomy in the re-evaluation of patients with advanced Hodgkin's disease.

Twelve patients with advanced nodular sclerosis Hodgkin's disease were extensively reassessed following the completion of planned chemotherapy. The evaluation culminated in an exploratory laparotomy. Eight patients with no evidence of abdominal involvement on noninvasive tests also had no Hodgkin's disease found during laparotomy. Four patients had intra-abdominal Hodgkin's disease suspected prior to laparotomy based on the results of the noninvasive procedures. At laparotomy, benign abnormalities were present in three patients; only one had residual Hodgkin's disease. No patient with a negative laparotomy has developed recurrent abdominal Hodgkin's disease, but two patients developed supradiaphragmatic recurrences. The patient with persistent Hodgkin's disease had his treatment regimen successfully altered. These data suggest that patients with negative preoperative findings do not benefit further from a laparotomy. However, in selected patients with suspicious intra-abdominal findings, the results of laparotomy may alter future management.

Abdominal Neoplasms↗
PubMed1997

Treating adnexal masses. Operative laparoscopy vs. laparotomy.

OBJECTIVE: To compare operative laparoscopy vs. laparotomy for the treatment of adnexal masses. STUDY DESIGN: A retrospective review of all surgical cases who underwent operative laparoscopy or laparotomy for an adnexal mass during 1988-1995 at one multispecialty group practice. Preoperative screening for women over 45 included a CA-125 and ultrasound. If a malignant mass was encountered, it was immediately staged by laparotomy with the assistance of a surgical oncologist. During the study period 121 patients underwent ovarian cystectomy and 284 patients, oophorectomy. RESULTS: Laparoscopy was successfully completed in 118 of 127 (93%) oophorectomy and 71 of 72 (98%) of ovarian cystectomy patients. The incidence of malignant lesions at operative laparoscopy was 2%. The hospital stay for ovarian cystectomy was significantly shorter for laparoscopy (0.8 vs. 3.1 days). Hospital stay for oophorectomy was significantly shorter for laparoscopy (0.8 vs. 4.1 days). Ovarian cystectomy by laparotomy resulted in slightly more total complications than did laparoscopy (8% vs. 1%). Oophorectomy by laparotomy resulted in significantly more total complications than did oophorectomy by laparoscopy (29% vs. 3%). The mean total charge for laparoscopic oophorectomy was $5,873 versus $7,007 for laparotomy. The mean total charge for laparoscopic ovarian cystectomy was $4,507 vs. $5,541 for laparotomy. CONCLUSION: Treatment of adnexal masses by operative laparoscopy can be performed safely, with reduced morbidity and patient disability, and at a reduced cost. By having an oncologist backup in house, we have been able to convert most procedures to the laparoscopic approach.

Adnexal Diseases↗
PubMed1976

[Studies on biotechnical ovulation synchronization in young sows. 2. Report: effect of laparotomy on ovarian findings after Zn-metallibur, 750 IU PMS, with and without 500 IU HCG].

A group of 72 gilts, aged between eight and nine months, were treated 20 days each by administration of 5 g Suisynchronprämix (Zinc Metallibur/Sui), followed by 24-hour treatment with 750 IU PMS (Prolosanserum). Fifty per cent of the group received 500 IU per animal of HCG (Gonabion) at 11 a.m., on the fourth day after Sui. All animals were artificially inseminated at 3.30 p.m. on the fifth day after Sui. and at 7.30 a.m. on the sixth day after Sui. Laparotomy was performed on 50 per cent of the HCG-treated and untreated animals in the afternoon of the sixth day after Sui. Animals with no recordable ovulation had to undergo another laparotomy in the morning of the seventh day. The above approach resulted in regrouping by four therapeutic categories: 1. HCG with laparotomy, 2. No HCG, 3. HCG with no laparotomy, 4. No HCG and no laparotomy. In the afternoon of the sixth day after Sui (51-56 hours after HCG) ovulation had begun in all 17 measurable animals of the first group, but only in one of 18 animals of the second. The animals were slaughtered between the seventh and twelfth days after Sui, and the following ovulation percentages were established: 100 per cent in the first group, 83.3 per cent in the second, 55.6 per cent in the third, and 72.2 per cent in the fourth. The animals that had been given HCG treatment (Groups 1 and 3) were found to be superior in terms of percentual ovulation to the untreated animals (Groups 2 and 4). However, Group 2 was the only group that had been exposed to the extraordinary stress of two laparotomies, and this should be borne in mind for evaluation. Ovarian cysts (more than 10 mm) began to develop on the eighth day on the laparotomised groups (1 and 2) and on the tenth day on the non-laparotomized groups (3 and 4). Cysts developed in 41.1 per cent of all animals in Group 1, 38.9 per cent in Group 2, 27.8 per cent in Group 3, and 22.2 per cent in Group 4. Therefore, cyst formation is thought to have been stimulated by laparotomy. Ovocyte tests suggested fertilisation of all animals in the first group. The embryonation rates of the second, third, and fourth groups are discussed with reference to the dates of insemination.

Animals↗
PubMed1984

Second-look laparotomy in fallopian tube carcinoma.

From August 1974 through August 1980, eight patients with primary fallopian tube carcinoma underwent second-look laparotomies at The University of Texas M.D. Anderson Hospital and Tumor Institute. Prior to the second-look laparotomies all patients were clinically free of disease. Initial treatment consisted of surgery and chemotherapy for four of these patients, surgery and radiation therapy for two patients, and surgery, radiation therapy, and chemotherapy for two patients. The second-look laparotomies showed five patients were free of disease, one patient had microscopic residual disease, and two patients had persistent macroscopic disease. Recurrences following negative second-look laparotomies developed in two patients. One recurrence occurred at 41 months after the procedure and the other 69 months afterward. Both patients lived more than 5 years after the second-look laparotomies were performed. Three patients with negative findings at second-look procedures and the patient with microscopic residual disease remain clinically free of disease 34, 53, 74, and 50 months after the laparotomies, respectively. Following additional chemotherapy, the two patients who evidenced macroscopic disease at the second-look procedure died 16 and 32 months following the second-look laparotomies. The second-look findings can be used to predict disease behavior and may have a role in the management of patients with fallopian tube carcinoma.

Adult↗
PubMed2006

Negative laparoscopy is highly predictive of negative second-look laparotomy following chemotherapy for ovarian, tubal, and primary peritoneal carcinoma.

OBJECTIVE: To determine the negative predictive value of second-look laparoscopy compared to laparotomy for assessment of pathologic complete response (CR) in patients with epithelial ovarian, tubal, and peritoneal carcinoma who achieved a clinical CR. METHODS: Data were analyzed from patients who participated in two sequential phase II clinical trials following primary cytoreductive surgery. Both trials required surgical evaluation for pathologic CR in those patients who achieved clinical CR. Protocol specified that assessment begin with laparoscopy; if negative, conversion to laparotomy was required. Collection of peritoneal washings was performed laparoscopically. RESULTS: One hundred thirty-six patients entered the 2 sequential clinical trials. Ninety-nine patients achieved clinical CR and 95 underwent second-look surgery (SLO). Seventy patients began SLO with laparoscopy and converted to planned laparotomy after biopsies were negative. Eighteen cases were positive based on laparoscopy with frozen section. Five additional patients had peritoneal washings and/or permanent pathology positive based on laparoscopic findings, yielding a positive SLO rate of 32.9%. Four of the 52 patients who underwent laparotomy (7.7%) were found to have persistent disease that was not detected on laparoscopic biopsy or washings and represent false-negative laparoscopy; all four patients had disease at peritoneal-based sites. The sensitivity and negative predictive value for intraoperative diagnosis of persistent disease by laparoscopy were 66.6% and 82.7%, respectively. The sensitivity and negative predictive value of laparoscopic peritoneal biopsies and washings compared to laparotomy, as determined by final pathology, were 85.2% and 91.5%, respectively. CONCLUSION: A negative second-look laparoscopy with negative peritoneal pathology and cytology is 91.5% predictive of negative laparotomy and is associated with a low complication rate even in the setting of prior extensive cytoreductive surgery. The small increase in sensitivity and negative predictive value afforded by laparotomy does not warrant the increased morbidity.

Adult↗
PubMedDate not supplied

Repeat laparotomy as a preclinical diagnostic and therapeutic method for treating ovarian carcinoma.

One hundred forty-two cases of epithelial ovarian carcinoma were treated from 1972 to 1976 in the Department of Obstetrics and Gynaecology, University Central Hospital, Turku, Finland. Repeat laparotomy was performed on 37 of the patients about six months after total extirpative surgery (group I). In addition, a second laparotomy was performed on 14 patients after partial surgery or exploratory laparotomy (group II). All patients were given external radiation therapy combined with cytostatic treatment prior to the repeat laparotomies. A preclinical carcinoma was detected in six of the 37 patients in group I. Two of them are asymptomatic after five years of follow-up. In group II, total surgery after initial partial or exploratory laparotomy succeeded in half of the cases. Serous and endometroid carcinomas appeared to respond best to conservative therapy preceding repeat laparotomy.

Female↗
PubMed1994

Pelvic adhesion formation after pelvic lymphadenectomy: comparison between transperitoneal laparoscopy and extraperitoneal laparotomy in a porcine model.

Compared to extraperitoneal laparotomy, the transperitoneal approach is associated with increased enteric morbidity. Recently, transperitoneal laparoscopy has been employed as a method to surgically stage patients with gynecologic malignancies. The objective of this study was to investigate pelvic adhesion formation in a porcine model after pelvic lymphadenectomy performed via transperitoneal laparoscopy (LS) compared to extraperitoneal laparotomy (EP). Ten adult, female hogs underwent LS and 10 underwent EP. A complete pelvic lymphadenectomy was performed in each animal. Three weeks after the lymphadenectomy, the animals underwent exploratory laparotomy, and the adhesions were quantified. Nineteen animals were evaluable. The adhesion scores for the laparoscopy group (N = 10, mean = 0.075 +/- 0.17) were not statistically different from those of the laparotomy group (N = 9, mean = 0.28 +/- 0.52, P > 0.5). Eight of 10 (80%) and 5 of 9 (56%) animals in the LS and EP groups, respectively, had no adhesions after pelvic lymphadenectomy. Adhesion formation is one of many critical issues concerning the utility of pretreatment surgical staging, especially for cancer of the cervix. It is remarkable that only 20% of the animals undergoing laparoscopy in this study had de novo adhesions after pelvic lymph node dissection and that the mean total adhesion score was not statistically different from the extraperitoneal laparotomy. Therefore, transperitoneal laparoscopic pelvic lymphadenectomy may not induce the degree of adhesion formation associated with the transperitoneal laparotomy technique.

Animals↗
PubMed2002

Effect of prophylactic intracerebroventricular injection of methylprednisolone on nitrogen and catecholamine excretion in the urine after laparotomy in rats.

BACKGROUND: This study was carried out to determine whether the prophylactic injection of glucocorticoid into the intracerebroventricular (i.c.v.) space reduced TNF-alpha and IL-1beta mRNA synthesis in the brain after laparotomy, resulting in a reduction of nitrogen excretion in the urine. PATIENTS AND METHODS: Male SD rats (body wt., 225-250 g, n = 114) were catheterized into the i.c.v. space on day 0. On day 4, the rats were assigned to four groups: (1) Control, (2) laparotomy (Trauma), (3) intraperitoneal (i.p.) injection of methylprednisolone (MP) plus laparotomy (IPMP), and (4) i.c.v. injection of MP plus laparotomy (ICVMP). Either 3 or 24 h after surgery, the animals were sacrificed. TNF-alpha and IL-1beta mRNA levels in tissues, including the brain cortex and hypothalamus, were measured by RT-PCR. The amounts of nitrogen and catecholamine excretion in the 24-h urine were determined. RESULTS: The i.p. injection of MP reduced TNF-alpha and IL-1beta mRNA levels in all the tissues 3 h after laparotomy compared with those of the Trauma group. The icv injection of MP prevented elevation of the TNF-alpha and IL-1beta mRNA levels in the brain (cortex, TNF-alpha, ICVMP 0.43 +/- 0.06, P < 0.05, vs Trauma; cortex, IL-1beta, ICVMP 0.25 +/- 0.09, P < 0.05, vs. Trauma; hypothalamus, TNF-alpha, ICVMP 0.31 +/- 0.04, P < 0.05, vs. Trauma; hypothalamus, IL-1beta, ICVMP 0.25 +/- 0.14, P < 0.05, vs. Trauma), but did not inhibit an increase in TNF-alpha and IL-1beta mRNA levels in the liver and skeletal muscle. Both nitrogen and catecholamine excretions in the urine were decreased by ip and by i.c.v. injection of MP compared to those of the Trauma group (nitrogen, ICVMP 559.3 +/- 52.0 mg/day, P < 0.05, vs. Trauma; catecholamine, ICVMP 13.8 +/- 1.8 microg/day, P < 0.05, vs. Trauma). CONCLUSION: A reduction in TNF-alpha and IL-1beta mRNA synthesis in the brain due to prophylactic injection of MP into the icv space reduced the catabolic response after laparotomy.

Animals↗
PubMed1993

Tubal sterilization by laparoscopy and mini-laparotomy.

Laparoscopic tubal sterilization was performed on 179 women using general anesthesia, and tubal sterilization via mini-laparotomy was performed in 52 cases using local anesthesia. The patients ranged in age from 25 to 41 years, with 73.2% between 31 and 40 years. The mean operative time of laparoscopy and mini-laparotomy were 14.2 and 11.6 minutes, respectively. Both the laparoscopy group and the mini-laparotomy group were found to be similar with regard to age, gravidity and number of abortions. Pelvic inflammatory disease (PID) was not observed in any patient during the follow-up period (3 months). Two wound infections were detected within the first week following mini-laparotomy, and these were treated on an out-patient basis by relevant antibiotics. Among the 179 patients in whom laparoscopic tubal sterilization was performed, tubal rupture occurred in 3 cases (1.67%) which were electrocoagulated easily, and unplanned laparotomy was performed in a patient in whom bowel injury during mini-laparotomy was suspected.

Adult↗
PubMed1999

Tumor proliferative index is higher in mice undergoing laparotomy vs. CO2 pneumoperitoneum.

PURPOSE: Our laboratory has previously shown that tumors are more easily established and grow larger after laparotomy vs. laparoscopy. The purpose of this study was to better characterize these differences in tumor growth by assessing tumor cell proliferation via the proliferating cell nuclear antigen assay, which has been shown to be a reliable marker of cellular proliferation. METHODS: Female C3H/He mice (N = 40) were inoculated intradermally in the dorsal skin with 10(6) cultured mouse mammary carcinoma cells <1 hour before interventions. Anesthesia control mice underwent no procedure. Laparotomy group mice had a midline incision from xiphoid to pubis that was closed after 20 minutes. Insufflation group mice underwent CO2 pneumoperitoneum (4-6 mmHg) for 20 minutes. On postoperative Day 6, tumors were excised from one-third of the mice in each group, and from the remaining mice on postoperative Day 12. Sections were made and stained immunohistochemically for proliferating cell nuclear antigen, and the proliferative index of each tumor was determined by taking the average of proliferating cell nuclear antigen-positive cells in five high-power fields (x450), counted in a blinded fashion with the aid of an optical grid. RESULTS: On postoperative Day 6, the mean proliferative index for the laparotomy group was significantly higher than those for both the insufflation (P < 0.04) and the control (P < 0.001) groups. Of note, the proliferative index of the insufflation group was significantly higher than that of the control (P < 0.01) group. Similarly, on postoperative Day 12, the mean proliferative index for the laparotomy group was significantly higher than for both the insufflation (P < 0.05) and the control (P < 0.005) groups. The proliferative index in the insufflation group was also significantly higher than that of the control (P < 0.04) group. CONCLUSIONS: We have demonstrated that there is a significantly higher rate of tumor cell proliferation with the mouse mammary carcinoma cell tumor line after laparotomy than after pneumoperitoneum or anesthesia alone at two postoperative times. Additionally, insufflation alone increases postoperative tumor cell proliferation but to a lesser extent than laparotomy. The mechanism underlying these findings is unclear.

Animals↗
PubMed1998

Colon adenocarcinoma and B-16 melanoma grow larger following laparotomy vs. pneumoperitoneum in a murine model.

PURPOSE: Mouse mammary carcinoma tumors are established more easily and grow larger after sham laparotomy and open bowel resection than after CO2 pneumoperitoneum and laparoscopic-assisted bowel resection. The purpose of this study was to determine whether similar differences in tumor growth would be found when sham laparotomy and pneumoperitoneum were compared for the colon-26 mouse adenocarcinoma and B-16 mouse melanoma tumor lines. METHODS: In all three studies, a high-dose injection of tumor cells was used, which resulted in tumors in almost all control mice. In Study 1, female BALB/C mice (n = 127) were injected intradermally in the dorsal skin with 10(6) colon-26 cells in a 0.1-ml volume before interventions. In Study 2, female C57 BL/6 mice (n = 140) were inoculated similarly with 10(6) B-16 melanoma cells. Study 2 consisted of three separate trials conducted on different days. Study 3 was performed because considerable differences in mean tumor size were observed in each of these trials. In Study 3, the B16 experiment was repeated with a larger n (n = 82) on a single day. In each study, after tumor cell injections, mice were randomly assigned to one of three groups: 1) anesthesia control (no procedure); 2) full laparotomy (4-cm midline incision x 20 minutes, staple closure); or 3) CO2 pneumoperitoneum (4-6 mmHg X 20 minutes). Tumors were excised and weighed on postoperative day 12. RESULTS: In Studies 1 and 3, mean tumor sizes of the laparotomy groups were significantly larger than both the control group and pneumoperitoneum group lesions (P values by Student's t-test). In Study 2, laparotomy group tumors, although significantly larger than control group lesions, were not significantly larger than pneumoperitoneum group tumors. For all three studies, there was no significant difference between mean tumor sizes of the pneumoperitoneum and control groups. CONCLUSION: Both colon-26 adenocarcinoma and B-16 melanoma tumors grow larger after laparotomy than after pneumoperitoneum in a murine model. The mechanism of these postoperative tumor growth differences remains to be elucidated.

Adenocarcinoma↗
PubMed1997

[Comparison of local and systemic inflammation after laparotomy or laparoscopy in the rat sepsis model].

BACKGROUND: Laparoscopic techniques are frequently used in patients with peritonitis or intra-abdominal inflammatory diseases although increased intraperitoneal pressure may cause sepsis by promoting bacteraemia and systemic inflammatory response. METHODS: This experimental study investigates the influence of laparotomy and laparoscopy on bacteraemia, tumour necrosis factor (TNF)-alpha and endotoxin plasma levels. Standardized foecal inoculum was injected intraperitoneally and rats underwent either laparotomy (n = 20), laparoscopy (n = 20), or no further manipulation in the control group (n = 20). RESULTS: One hour after intervention, bacteraemia was significantly higher in both the laparotomy or laparoscopy groups than in the control group (P = 0.01). Foecal inoculum caused a significant increase in TNF-alpha and endotoxin plasma levels 1 h after intervention with the significantly highest levels after laparotomy (P < 0.05). In addition, the mean number of intraperitoneal abscesses were also significantly higher (P < 0.05) after laparatomy (n = 10) than after laparoscopy (n = 8) or in the control group (n = 5). CONCLUSIONS: Laparotomy and laparoscopy increased the incidence of bacteraemia and systemic inflammation compared to control group. However, inflammatory response and intraperitoneal abscess formation were significantly higher in the laparotomy group than in the laparoscopy group.

Abdominal Abscess↗
PubMed1999

Growth and neurodevelopmental outcome in extremely-low-birth-weight infants after laparotomy.

Twenty-one extremely-low-birth-weight (ELBW) and premature infants (<29 weeks' gestation and/or <1,000 g) underwent emergency laparotomy for acute intra-abdominal pathology (necrotising enterocolitis [NEC] 16, other bowel pathology 5) during the 4-year period from 1990 to 1993; 11 died. The neurodevelopmental outcome of the 10 survivors was assessed and compared with 20 living, otherwise normal controls matched for gestational age, birth weight, and year of birth to asses the effect of the abdominal event on quality of survival. Those who survived after laparotomy had a worse neurodevelopmental outcome than controls (P < 0.05). During this period, we also compared 24 infants in the ELBW category who developed NEC but did not require a laparotomy with the 16 ELBW infants with NEC who required a laparotomy. Those who required a laparotomy had worse disease and had significantly worse neurodevelopmental outcomes (P < 0.01). ELBW and premature infants who have acute intra-abdominal pathology requiring a laparotomy are thus at increased risk of neurodevelopmental problems and poor growth. Close long-term follow-up is important, and the families of such infants should be made aware before surgery of the increased risk the abdominal event has on their babies' developmental outcome if they survive.

Developmental Disabilities↗
PubMed2002

Laparotomy or laparoscopic surgery? Factors affecting the surgeons choice for the treatment of ectopic pregnancy.

PURPOSE: In this study, we aim to compare the surgeons' choice on the ectopic pregnancy cases during the last four years. The differences between laparoscopy and laparotomy cases and the factors which directed the surgeon to choose either of the surgical methods were evaluated. METHODS: Our study comprises 135 patients who were diagnosed as ectopic pregnancy and were hospitalized in the Gynecology Department of Istanbul Medical Faculty during 1996-1999. RESULTS: During 1996-1999 a total of 118 cases had been diagnosed as tubal ectopic pregnancy and had been treated surgically. Seventy three patients (62%) had been treated with laparotomy while the rest 45(38%) had been treated laparoscopically. When compared, the amount of intraabdominal free blood volume was significantly higher in laparotomy group [270.45 +/- 466.72 mL laparoscopy group - 889.75 +/- 714 mL laparotomy group, (p = 0.0001)]. When we considered haemoperitoneum amount according to the patients' parity, intraabdominal blood volume was interestingly higher in multiparas [507 +/- 599.32 mL nulliparas vs. 768.68 +/- 749.15 mL mulltiparas, (p = 0.044)]. The percent of cases with ruptured tubes was 64% for the laparotomy and 38% the laparoscopic cases; and the difference between two groups was significant (p = 0.0013). CONCLUSION: Our study implied that haemodynamic stability and less intraabdominal free blood affect the surgeons' decision between laparotomy and laparoscopy. Fewer multiparous patients are suitable for these criteria which leads to less laparoscopic surgery. These findings, which need to be clarified, lead to the idea of human factor affecting the surgeons' choice indirectly.

Adult↗
PubMed2005

Hepatic carbohydrate metabolism in rats after laparotomy and laparoscopy.

BACKGROUND: Portal venous and mesenteric blood flow are reduced by 40-60% in humans and animals during laparoscopic surgery compared to laparotomy. Little is known about whether these intraabdominal micro- and macrocirculatory changes are associated with alterations in the hepatic energy metabolism. METHODS: We operated on male Sprague-Dawley rats, performing either laparoscopy (CO2, 6 mmHg; n = 27) or laparotomy (n = 28), and compared the results with two control groups: intraperitoneal (i.p.) endotoxin administration (n = 28, positive control) and anesthesia only (n = 28, negative control). We investigated the impact of the two different surgical techniques on daily food intake, body weight gain, glycogen content in the liver, levels of blood glucose, and liver function tests (LFTs) on postoperative days 1, 2, 4, and 8. Local (hepatic) and systemic inflammatory responses (interleukin-6 and tumor necrosis factor-alpha) during the postoperative time course were also determined. Data were analyzed using the Kruskal-Wallis test or univariate analysis of variance. RESULTS: Body weight gain, food intake, liver and spleen weights, as well as LFTs [except aspartate aminotransferase (AST)] did not differ among the four groups. The significant increase in the AST level following laparoscopy compared to the anesthesia-only group was found on postoperative days 1 and 2; however, a similar difference was not detected after laparotomy or i.p. endotoxin injection. Laparoscopy showed no alterations in the hepatic glycogen stores compared to anesthesia only, whereas laparotomy and endotoxinemia significantly reduced the hepatic glycogen stores on postoperative days 2 and 4. The systemic postoperative inflammatory response did not differ between laparotomy and laparoscopy, but it was higher in both groups than in anesthesia only. In rats treated with endotoxin, the systemic inflammatory response was even higher than in the two surgical groups. The hepatic inflammatory response did not differ between the four groups. CONCLUSION: This study shows a significant postoperative decrease in the hepatic glycogen content after laparotomy and i.p. endotoxin injection but not after laparoscopy. Food intake and inflammatory response cannot explain this difference between the two surgical groups, which suggests that alterations in the postsurgical hormonal stress response are the most likely explanation for these findings.

Animals↗
PubMed2006

Inflammatory response and bacterial dissemination after laparotomy and abdominal CO2 insufflation in a murine model of peritonitis.

BACKGROUND: The immunologic repercussions due to cavity insufflation are the focus of great discussion. The aim of this study was to compare the inflammatory response and bacterial dissemination after laparotomy and abdominal CO2 insufflation in a murine model of peritonitis. METHODS: Swiss mice were inoculated intraperitoneally with 0.5 ml of a solution containing 1 x 10(8) colony-forming units (CFU)/ml of Escherichia coli and were divided into three groups as follow: control (anesthesia for 30 min), laparotomy (2.5-cm midline incision for 30 min), and CO2 pneumoperitoneum (CO2 cavity insufflation for 30 min). The number of leukocytes, CFU/ml counting, and the levels of interleukin (IL)-6, tumor necrosis factor-alpha (TNF-alpha), and IL-10 were evaluated in blood, peritoneal, and pleural fluid samples obtained at 90 min and 18 h after the procedures. RESULTS: The laparotomy group showed a greater bacterial dissemination to the blood, peritoneum, and pleural cavity and also greater neutrophil migration to the peritoneal cavity compared to the CO2 insufflated and control groups. The 24-h mortality was also significantly higher in the laparotomy group. The IL-6 levels showed a precocious rise in all groups submitted to bacterial inoculation at the 90-min time point. At the 18-h time point, IL-6 levels in the peritoneum were significantly higher in the laparotomy group than in the control or CO2 insufflated groups. At the same time, TNF-alpha levels were higher in the laparotomy and CO2 insufflated groups than in controls; IL-10 levels showed no differences among the groups. CONCLUSIONS: Our results suggest that cavity insufflation with CO2 is a more effective method of access, inducing less bacterial dissemination and also a less intense inflammatory response. Cavity insufflation with CO2 may present a good option for the surgical treatment of patients with bacterial peritonitis.

Animals↗
PubMed2006

A comparison of the effects of pneumoperitoneum and laparotomy on natural killer cell mediated cytotoxicity and Walker tumor growth in Wistar rats.

BACKGROUND: Surgical stress promotes impaired immunological function, which contributes to tumor growth. Natural killer activity (NKA) has a protective role in immunity to tumors. So, the aim of this experimental study was to assess tumor growth and (NKA) after pneumoperitoneum and laparotomy. METHODS; Sixty male Wistar rats were divided into three groups (anesthesia, CO2 pneumoperitoneum and laparotomy) plus ten controls. All experimental animals were inoculated subcutaneously with 8 x 105 Walker carcinosarcoma 256 cells. Animals were sacrificed on 1st(POD1) and 8th (POD8) postoperative day. Tumors were excised and weighed. RESULTS: On POD1 all animals had diminished NKA when compared to controls; NKA after pneumoperitoneum was significantly greater than after laparotomy. On POD8 all animals, except after laparotomy, reached NKA at controls levels. Tumor weight was significantly greater after laparotomy when compared to pneumoperitoneum. CONCLUSIONS: Pneumoperitoneum causes a less depressed NKA and less tumor growth when compared to laparotomy.

Animals↗