LOCAL AND SYSTEMIC INFLAMMATION AFTER LAP AROTOMY VERSUS LAPAROSCOPY IN A SEPSIS MODEL IN RATS

Background: Laparoscopic techniques are frequently used in patients wi th peritonitis or intra-abdominal inflammatory diseases although incre ased intraperitoneal pressure may cause sepsis by promoting bacteraemi a and systemic inflammatory response. Methods: This experimental study investigates the influence of laparotomy and laparoscopy on bacteraem ia, tumour necrosis factor (TNF)-alpha and endotoxin plasma levels. St andardized foecal inoculum was injected intraperitoneally and rats und erwent either laparotomy (n = 20), laparoscopy (n = 20), or no further manipulation in the control group (n = 20). Results: One hour after i ntervention, bacteraemia was significantly higher in both the laparoto my or laparoscopy groups than in the control group (P = 0.01). Foecal inoculum caused a significant increase in TNF-alpha and endotoxin plas ma levels 1 h after intervention with the significantly highest levels after laparotomy (P < 0.05). In addition, the mean number of intraper itoneal abscesses were also significantly higher (P < 0.05) after lapa ratomy (n = 10) than after laparoscopy (n = 8) or in the control group (n = 5). Conclusions: Laparotomy and laparoscopy increased the incide nce of bacteraemia and systemic inflammation compared to control group . However, inflammatory response and intraperitoneal abscess formation were significantly higher in the laparotomy group than in the laparos copy group.