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The inflammatory response in transgastric surgery: gastric content leak leads to localized inflammatory response and higher adhesive disease.

Ramamoorthy SL, Lee JK, Luo L, Mintz Y, Cullen J, Easter DW, Savu MK, Chock A, Carethers J, Horgan S, Talamini MA - Surg Endosc (2009)

Bottom Line: There was a significant difference in the peritoneal TNFalpha levels in the SG compared with the CG, which peaked 1 h after surgery (p < 0.02).The inflammatory response was found to be a localized and not systemic event, with plasma cytokine levels remaining normal while peritoneal washings revealed a brisk, short-lived localized inflammatory response.There was a significantly higher rate of adhesive disease in the SG compared with the CG; this, however did not translate into a difference in apparent clinical outcome.

View Article: PubMed Central - PubMed

Affiliation: Center for the Future of Surgery, Department of Surgery, University of California, San Diego Medical Center, San Diego, CA, USA. sramamoorthy@ucsd.edu

ABSTRACT

Background: Risk of gastric spillage during transgastric surgery is a potential complication of NOTES procedures. The aim of this study was to determine risk outcomes from gastric spillage in a rat survival model by measuring local and systemic inflammatory markers, adhesive disease, and morbidity.

Methods: We performed a minilaparotomy with needle aspiration of 2 ml of gastric contents mixed with 2 ml of sterile saline (study group, SG) or 4 ml of sterile saline (control group, CG) injected into the peritoneal cavity of 60 male rats. Inflammatory markers (TNFalpha, IL-6, and IL-10) were analyzed at 1, 3, 6, and 24 h postoperatively by obtaining plasma levels and peritoneal washings. At necropsy, the peritoneal cavity was examined grossly for adhesions.

Results: Adhesions were seen more frequently in the SG versus the CG (100% vs. 33.3%, p < 0.014). There was a significant difference in the peritoneal TNFalpha levels in the SG compared with the CG, which peaked 1 h after surgery (p < 0.02). Both peritoneal IL-6 and IL-10 levels were higher in the SG versus the CG, which peaked 3 h after surgery (p < 0.005 and p < 0.001, respectively). All peritoneal inflammatory markers returned to undetectable levels at 24 h for both groups. Plasma cytokines were undetectable at all time intervals.

Conclusion: The inflammatory response was found to be a localized and not systemic event, with plasma cytokine levels remaining normal while peritoneal washings revealed a brisk, short-lived localized inflammatory response. There was a significantly higher rate of adhesive disease in the SG compared with the CG; this, however did not translate into a difference in apparent clinical outcome. We conclude that gastric leakage in this NOTES rodent model induces a localized inflammatory response, followed by mild to moderate adhesive disease. This may be important in human NOTES.

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Related in: MedlinePlus

IL-6 levels from peritoneal washings at various time intervals after gastric leakage
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Fig2: IL-6 levels from peritoneal washings at various time intervals after gastric leakage

Mentions: With respect to cytokine profiles after gastric content spillage, TNFα levels within the peritoneal washings peaked at 1 h after surgery and gradually returned to undetectable levels by 24 h. The mean peak peritoneal TNFα levels at 1 h after surgery in the SG was 184.4 ± 78 pg/ml vs. 39.6 ± 25 pg/ml in the CG (p < 0.02) (Fig. 1). Peritoneal IL-6 levels peaked at 3 h after surgery and returned to undetectable levels by 24 h. The mean peritoneal IL-6 levels at 3 h after surgery in the SG was 18,985.7 ± 4933.8 pg/ml vs. 130 ± 25 pg/ml in the CG (p < 0.005) (Fig. 2). Peritoneal IL-10 levels also peaked at 3 h after surgery and returned to undetectable levels by 24 h. The mean peak peritoneal IL-10 levels at 3 h after surgery in the SG was 924.2 ± 332.5 pg/ml vs. 25 ± 5 pg/ml in the CG (p < 0.001) (Fig. 3). All plasma cytokines were undetectable at all time intervals.Fig. 1


The inflammatory response in transgastric surgery: gastric content leak leads to localized inflammatory response and higher adhesive disease.

Ramamoorthy SL, Lee JK, Luo L, Mintz Y, Cullen J, Easter DW, Savu MK, Chock A, Carethers J, Horgan S, Talamini MA - Surg Endosc (2009)

IL-6 levels from peritoneal washings at various time intervals after gastric leakage
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2821621&req=5

Fig2: IL-6 levels from peritoneal washings at various time intervals after gastric leakage
Mentions: With respect to cytokine profiles after gastric content spillage, TNFα levels within the peritoneal washings peaked at 1 h after surgery and gradually returned to undetectable levels by 24 h. The mean peak peritoneal TNFα levels at 1 h after surgery in the SG was 184.4 ± 78 pg/ml vs. 39.6 ± 25 pg/ml in the CG (p < 0.02) (Fig. 1). Peritoneal IL-6 levels peaked at 3 h after surgery and returned to undetectable levels by 24 h. The mean peritoneal IL-6 levels at 3 h after surgery in the SG was 18,985.7 ± 4933.8 pg/ml vs. 130 ± 25 pg/ml in the CG (p < 0.005) (Fig. 2). Peritoneal IL-10 levels also peaked at 3 h after surgery and returned to undetectable levels by 24 h. The mean peak peritoneal IL-10 levels at 3 h after surgery in the SG was 924.2 ± 332.5 pg/ml vs. 25 ± 5 pg/ml in the CG (p < 0.001) (Fig. 3). All plasma cytokines were undetectable at all time intervals.Fig. 1

Bottom Line: There was a significant difference in the peritoneal TNFalpha levels in the SG compared with the CG, which peaked 1 h after surgery (p < 0.02).The inflammatory response was found to be a localized and not systemic event, with plasma cytokine levels remaining normal while peritoneal washings revealed a brisk, short-lived localized inflammatory response.There was a significantly higher rate of adhesive disease in the SG compared with the CG; this, however did not translate into a difference in apparent clinical outcome.

View Article: PubMed Central - PubMed

Affiliation: Center for the Future of Surgery, Department of Surgery, University of California, San Diego Medical Center, San Diego, CA, USA. sramamoorthy@ucsd.edu

ABSTRACT

Background: Risk of gastric spillage during transgastric surgery is a potential complication of NOTES procedures. The aim of this study was to determine risk outcomes from gastric spillage in a rat survival model by measuring local and systemic inflammatory markers, adhesive disease, and morbidity.

Methods: We performed a minilaparotomy with needle aspiration of 2 ml of gastric contents mixed with 2 ml of sterile saline (study group, SG) or 4 ml of sterile saline (control group, CG) injected into the peritoneal cavity of 60 male rats. Inflammatory markers (TNFalpha, IL-6, and IL-10) were analyzed at 1, 3, 6, and 24 h postoperatively by obtaining plasma levels and peritoneal washings. At necropsy, the peritoneal cavity was examined grossly for adhesions.

Results: Adhesions were seen more frequently in the SG versus the CG (100% vs. 33.3%, p < 0.014). There was a significant difference in the peritoneal TNFalpha levels in the SG compared with the CG, which peaked 1 h after surgery (p < 0.02). Both peritoneal IL-6 and IL-10 levels were higher in the SG versus the CG, which peaked 3 h after surgery (p < 0.005 and p < 0.001, respectively). All peritoneal inflammatory markers returned to undetectable levels at 24 h for both groups. Plasma cytokines were undetectable at all time intervals.

Conclusion: The inflammatory response was found to be a localized and not systemic event, with plasma cytokine levels remaining normal while peritoneal washings revealed a brisk, short-lived localized inflammatory response. There was a significantly higher rate of adhesive disease in the SG compared with the CG; this, however did not translate into a difference in apparent clinical outcome. We conclude that gastric leakage in this NOTES rodent model induces a localized inflammatory response, followed by mild to moderate adhesive disease. This may be important in human NOTES.

Show MeSH
Related in: MedlinePlus