PERITONEAL HOST DEFENSES ARE LESS IMPAIRED BY LAPAROSCOPY THAN BY OPEN OPERATION

There is a growing body of evidence that laparoscopic surgery is physi ologically less injurious than open surgery. We hypothesized that the open technique results in a greater impairment of peritoneal and syste mic defense mechanisms than does the laparoscopic technique. Nissen fu ndoplication, standardized in technique and duration, was performed in 16 pigs, The procedure was performed through a standard midline incis ion (OPEN, n = 8) or with laparoscopic technique and CO2 pneumoperiton eum (LAP, n = 8). The peritoneal cavity was instilled with 400 cc of n ormal saline, either alone (not contamined, n = 8) or containing 10(9) E, coli/ml (contaminated, n = 8), Quantitative cultures, cell count, and flow cytometry were performed on blood and peritoneal fluid sample s obtained at timed intervals. We found that host defense processes we re better preserved after LAP than by OPEN surgery. Peritoneal and sys temic monocyte class II antigen expression, and serum tumor necrosis f actor-alpha activity was greater in the OPEN group compared with the L AP group, but peritoneal bacterial clearance was more efficient in the LAP group. These data may illustrate a potential benefit of laparosco pic surgery in cases of peritoneal contamination.