A RANDOMIZED COMPARISON OF ACUTE-PHASE RESPONSE AND ENDOTOXEMIA IN PATIENTS WITH PERFORATED PEPTIC-ULCERS RECEIVING LAPAROSCOPIC OR OPEN PATCH REPAIR

BACKGROUND: In patients with peritonitis from perforated peptic ulcers , we compared acute stress responses, endotoxemia, and bacteremia foll owing laparoscopic or open surgery. PATIENTS AND METHODS: Consecutive patients with peritonitis from perforated peptic ulcers were randomize d to receive laparoscopic sutured or open omental repair. Undiluted pe ritoneal fluid was obtained at surgery for quantitative bacterial and endotoxin (Limulus Amoebocyte Lysate) assay. Serial blood samples were taken at 0, 30, 60, 90, 120, and 180 minutes, and at 12, 24, 48, 72, and 120 hours for determinations of quantitative bacterial and endotox in assays, interleukin-6 (IL-6), C-reactive protein (CRP), and cortiso l. RESULTS: Twenty-two patients were randomized: laparoscopy group (n = 12), open repair group (n = 10). Conversions were required in 3 pati ents assigned to laparoscopy, leaving 9 patients for analysis. The two groups were comparable in their demographic data, median duration of perforation (13.5 hours versus 10 hours), severity of peritoneal conta mination as indicated by viable bacterial count (5.9 x 10(2) versus 1. 5 x 10(2) colony forming unit/ml) and endotoxin concentration in perit oneal fluid (27.2 versus 24.6 EU/mL). No significant endotoxemia or ba cteremia was detected in these patients. Median interleukin-6 was high est at 0 hour (1520 versus 962 pg/mL) and fell rapidly following surge ry. C-reactive protein peaked at 24 hours and plateaued thereafter. Co rtisol was highest intraoperatively and fell thereafter. No difference was noted between the two treatment groups with respect to these infl ammatory markers (IL-6 P = 0.19, CRP P = 0.14, cortisol P = 0.56, mult ivariate analysis of variance). CONCLUSION: Endotoxemia and bacteremia are insignificant in most patients with perforated peptic ulcers. In patients with perforated peptic ulcers, laparoscopic patch repair does not reduce acute stress responses when compared with open surgery. (C ) 1998 by Excerpta Medica, Inc.