Peritoneal acidosis mediates immunoprotection in laparoscopic surgery

• Published in: Surgery Vol. 142; no. 3; pp. 357 - 364
• Main Authors: Hanly, Eric J, Aurora, Alexander A, Shih, Samuel P, Fuentes, Joseph M, Marohn, Michael R, De Maio, Antonio, Talamini, Mark A
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.09.2007; Elsevier
• Subjects: Acidosis - etiology; Acidosis - physiopathology; Animals; Biological and medical sciences; Carbon Dioxide; Disease Models, Animal; General aspects; Hydrogen-Ion Concentration; Insufflation - adverse effects; Insufflation - methods; Interleukin-10 - blood; Laparoscopy - adverse effects; Laparoscopy - methods; Lipopolysaccharides; Male; Medical sciences; Peritoneal Lavage; Peritoneum - physiopathology; Peritonitis - chemically induced; Peritonitis - immunology; Peritonitis - prevention & control; Pilot Projects; Pneumoperitoneum - chemically induced; Pneumoperitoneum - physiopathology; Random Allocation; Rats; Rats, Sprague-Dawley; Surgery; Tumor Necrosis Factor-alpha - blood; Immunoprotection; Medicine; Endoscopic surgery; Metabolic disorder; Treatment; Laparoscopic surgery; Acid base balance disorder; Acidosis; Peritoneum
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2007.02.017

Background We have shown previously that abdominal insufflation with CO2 increases serum levels of IL-10 and TNFα and increases survival among animals with lipopolysaccharide (LPS)-induced sepsis, even after a laparotomy. We demonstrated previously that the effect of CO2 is not from changes in systemic pH, although the peritoneum is locally acidotic during abdominal insufflation with CO2 even when systemic pH is corrected. We hypothesized that acidification of the peritoneum via means other than CO2 insufflation would produce alterations in the inflammatory response similar to those associated with CO2 pneumoperitoneum. Methods In total, 42 rats were randomized into 7 groups (n = 6): 1) LPS only, 2) anesthesia control, 3) helium pneumoperitoneum, 4) CO2 pneumoperitoneum, 5) buffered mild acid lavage, 6) buffered strong acid lavage, and 7) buffered strong acid lavage + helium pneumoperitoneum. Animals received anesthesia with vaporized isoflurane (except the LPS-only group) and their respective abdominal treatment (pneumoperitoneum and/or lavage) for 30 min followed immediately by stimulation with systemic LPS (1 mg/kg, IV). Blood was harvested via cardiac puncture 60 min after LPS injection, and serum levels of IL-10 and TNFα levels were determined by enzyme-linked immunosorbent assay. Results Mean peritoneal pH decreased ( P < .05) after CO2 pneumoperitoneum, buffered strong acid lavage, and buffered strong acid lavage + helium pneumoperitoneum, and it decreased ( P = .1) after helium pneumoperitoneum alone and buffered mild acid lavage. IL-10 levels were increased ( P < .01), and TNFα levels decreased ( P < .001) among animals with acidic peritoneal cavities compared with animals with pH-normal peritoneal cavities. Decreasing peritoneal pH correlated with both increasing IL-10 levels ( r = −.465, P < .01) and decreasing TNFα levels ( r = 0.448, P < .01). Among animals with peritoneal acidosis, there were no differences in levels of IL-10 or TNFα regardless of insufflation status ( P > .05 for both cytokines). Conclusions Acidification of the peritoneal cavity whether by abdominal insufflation or by peritoneal acid lavage increases serum IL-10 and decreases serum TNFα levels in response to systemic LPS challenge. The degree of peritoneal acidification correlates with the degree of inflammatory response reduction. These results support the hypothesis that pneumoperitoneum-mediated attenuation of the inflammatory response after laparoscopic surgery occurs via a mechanism of peritoneal cell acidification.