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Laparoscopic surgery induced interleukin-6 levels in serum and gut mucosa: implications of peritoneum integrity and gas factors

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Abstract

Background

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.

Methods

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).

Results

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 < 0.001) and jejunal mucosa (p = 0.032).

Conclusion

The present study suggests that laparoscopic techniques to minimize the size of the peritoneal incision as well as exposure to atmospheric air can potentially reduce postoperative stress responses associated with abdominal surgery and prompt early recovery.

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Acknowledgements

The work was supported by grants from the Research Grants Council of Hong Kong (HKU732002M) and the research seed fund from the CRCG committee of the University of Hong Kong. The authors would like to thank the superb assistance of Dr. Jana Wo and Mr. Jensen To on animal surgery.

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Authors and Affiliations

  1. Department of Surgery, LKS Faculty of Medicine, Queen Mary Hospital, University of Hong Kong Medical Centre, 102 Pokfulam Road, Pokfulam, Hong kong

    John M. Luk, Peter H. Tung, Kwong-Fai Wong, Kwong-Leung Chan, Simon Law & John Wong

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  1. John M. Luk
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  2. Peter H. Tung
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  3. Kwong-Fai Wong
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  4. Kwong-Leung Chan
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Correspondence to Simon Law.

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Luk, J.M., Tung, P.H., Wong, KF. et al. Laparoscopic surgery induced interleukin-6 levels in serum and gut mucosa: implications of peritoneum integrity and gas factors. Surg Endosc 23, 370–376 (2009). https://doi.org/10.1007/s00464-008-9948-2

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  • DOI: https://doi.org/10.1007/s00464-008-9948-2

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