2005 Abstracts: Effect of Laparoscopic Versus Open Repair on the Outcome of Peritonitis Induced by Colonic Perforation: An Experimental Study in Pigs
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Effect of Laparoscopic Versus Open Repair on the Outcome of Peritonitis Induced by Colonic Perforation: An Experimental Study in Pigs
Ronald Matteotti, Weill-Cornell College of Medicine, New York, NY; Michel Gagner, Weill-Cornell College of Medicin, New York Presbyterian Hospital, New York, NY; Kazuki Ueda, Weill Cornell College of Medicin, New York Presbyterian Hospital, New York, NY; Ahmad Assalia, Rambam Medical Center, Department of Surgery, Haifa, Haifa, Israel
Effect of laparoscopic versus open repair on the outcome of peritonitis induced by colonic perforation:
Experimental study in pigs R. Matteotti, M. Gagner, K. Ueda, A. Assalia Surgery, Weill-Cornell College of Medicine, NY,USA Laparoscopy is increasingly utilized in the management of emergencies. Still controversial are applications for peritonitis or perforations of the alimentary tract. Intra-abdominal pressure created with pneumoperitoneum in severe peritonitis, can adversely affect hemodynamic, respiratory function, and CO2 may spread a localized infectious process, aggravate peritonitis, increase bacterial translocation, worsen sepsis and impair the immune response. The aim of our study: evaluate those responses in laparoscopic v. open repair in an animal model of sepsis. Methods: 36 pigs, four groups, laparoscopic early (LE) and late (LL), open early (OE) and late (OL). All underwent laparoscopic cecal colotomy. Group LE then underwent laparoscopic closure of colotomy after 6 hours, group LL after 16 hours; group OE and OL open closure with same time frames. Blood counts, blood cultures, immunological parameters were obtained preoperatively, on postoperative day 1 and every other day until sacrifice at day 7. Blood cultures from the portal vein were taken during the closure of colotomy and at time of sacrifice. The animals were monitored for signs of intra-abdominal infection and received antibiotic treatment. The extent of peritonitis was assessed at the closure of colotomy and at sacrifice. Results: Overall mortality rate:11%; one animal in the OE group, one in the LL group, two in the OL group (75% of deaths occurred in the open groups). The late groups showed 83.3%positive blood cultures at day 7, the early groups 50%. Bacteremia in the portal vein was found in 89 % of the open cases v. 44%in the laparoscopic cases. Blood cultures: late groups 28 %, early 6%, laparoscopic groups 6% and open groups 28% at day 7. The open groups showedmore severe peritonitis atthe closure of colotomy and at day 7. Late laparoscopy showed significantly higher white blood cell count than late open (p=0.002) and significant thrombocytopenia compared to early laparoscopy ( p=0.005). Conclusions: Laparoscopic repair of a colonic perforation demonstrates an improved outcome with regard to decreased portal vein sepsis, bacteremia, peritonitis and other parameters of infection. In contrast, an open repair aggravated sepsis and correlated with more severe bacteremia.
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