Effects of low and standard intra-abdominal pressure on systemic inflammation and immune response in laparoscopic adrenalectomy: A prospective randomised study

Mario Schietroma, Beatrice Pessia, Derna Stifini, Laura Lancione, Francesco Carlei, Emanuela Marina Cecilia, Gianfranco Amicucci, Mario Schietroma, Beatrice Pessia, Derna Stifini, Laura Lancione, Francesco Carlei, Emanuela Marina Cecilia, Gianfranco Amicucci

Abstract

Background: The advantages of laparoscopic adrenalectomy (LA) over open adrenalectomy are undeniable. Nevertheless, carbon dioxide (CO2) pneumoperitoneum may have an unfavourable effect on the local immune response. The aim of this study was to compare changes in the systemic inflammation and immune response in the early post-operative (p.o.) period after LA performed with standard and low-pressure CO2 pneumoperitoneum.

Materials and methods: We studied, in a prospective randomised study, 51 patients consecutively with documented adrenal lesion who had undergone a LA: 26 using standard-pressure (12-14 mmHg) and 25 using low-pressure (6-8 mmHg) pneumoperitoneum. White blood cells (WBC), peripheral lymphocyte subpopulation, human leucocyte antigen-DR (HLA-DR), neutrophil elastase, interleukin (IL)-6 and IL-1, and C-reactive protein (CRP) were investigated.

Results: Significantly higher concentrations of neutrophil elastase, IL-6 and IL-1 and CRP were detected p.o. in the standard-pressure group of patients in comparison with the low-pressure group (P < 0.05). A statistically significant change in HLA-DR expression was recorded p.o. at 24 h, as a reduction of this antigen expressed on the monocyte surface in patients from the standard group; no changes were noted in low-pressure group patients (P < 0.05).

Conclusions: This study demonstrated that reducing the pressure of the pneumoperitoneum to 6-8 mmHg during LA reduced p.o. inflammatory response and averted p.o. immunosuppression.

Keywords: Immune response; laparoscopic adrenalectomy (LA); standard-pressure/low-pressure pneumoperitoneum.

Figures

Figure 1
Figure 1
HLA-DR expression (mean ± SD) in the standard-pressure (SP) versus low-pressure (LP) pneumoperitoneum laparoscopy. *P < 0.05 (6 h and 24 h)
Figure 2
Figure 2
Plasma elastase concentration (mean ± SD) in the standard-pressure (SP) versus low-pressure (LP) pneumoperitoneum laparoscopy *P < 0.05 (6 h and 24 h), *P < 0.05
Figure 3
Figure 3
IL-1 β levels in standard-pressure (SP) versus low-pressure (LP) pneumoperitoneum laparoscopy. There were significant differences between the two groups: r > 0.78, P < 0.05 (Mann-Whitney U tests and Pearson correlation coefficient)
Figure 4
Figure 4
IL-6 levels in standard-pressure (SP) versus low-pressure (LP) pneumoperitoneum laparoscopy. There were significant differences between the two groups: r > 0.78, P < 0.05 (Mann-Whitney U tests and Pearson correlation coefficient)
Figure 5
Figure 5
Plasma concentration (mean ± SD) of CRP in standard-pressure (SP) versus low-pressure (LP) pneumoperitoneum laparoscopy. There were significant differences between the two groups: r > 0.71, P < 0.05 (Mann-Whitney U tests and Pearson correlation coefficient)

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