Laparoscopic surgery-induced changes in oxidative stress markers in human plasma

Background: The induction of the pneumoperitoneum increases intraabdominal pressure (IAP), causing splanchnic ischemia, whereas its deflation normaliz es IAP and splanchnic blood flow. This procedure appears to represent an is chemia-reperfusion model in humans. Methods: Thirty laparoscopic cholecystectomies (LC) were performed in 30 pa tients with a mean age of 54.6 +/- 15.6 years. A group of 20 patients mean age, 57.3 +/-9.65 who underwent open cholecystectomy (OC) was also studied. Vein plasma levels of thiobarbituric acid-reactive substances (TBARS), a m arker of free radical production; plasma total antioxidant status (TAS); an d uric acid (UA) levels were measured preoperatively, 5 min after deflation of the pneumoperitoneum or at the end of operation, and 24 h postoperative ly. Aspartate amino transferase (AST), alanine aminotransferase (ALT), and total bilirubin (TBL) levels were measured preoperatively and 24 h after th e operation. Results: In the LC group, significant elevations in the concentration of TB ARS were observed in the early postoperative measurements in comparison wit h the preoperative measurements. TAS and UA levels were decreased significa ntly 24 h postoperatively compared to preoperative levels. The postoperativ e levels of AST, ALT, and TBL increased significantly in comparison with th e preoperative levels. In the OC group, no alterations in the Concentration of TBARS were observed in the postoperative period. The other parameters h ad changes similar to those recorded for the LC group. Conclusions: Free radical-induced lipid peroxidation associated with a decr ease in plasma antioxidant capacity and UA levels as well as altered hepati c function is observed after deflation of the pneumoperitoneum. These resul ts suggest that free radicals are generated at the end of a laparoscopic pr ocedure, possibly as a result of an ischemia-reperfusion phenomenon induced by the inflation and deflation of the pneumoperitoneum.