The effects of pneumoperitoneum and controlled ventilation on peritoneal lymphatic bacterial clearance: experimental results in rats

Abstract

OBJECTIVE:To evaluate the effect of pneumoperitoneum, both alone and in combination with controlled ventilation, on peritoneal lymphatic bacterial clearance using a rat bacterial peritonitis model.METHOD:A total of 69 male Wistar rats were intraperitoneally inoculated with an Escherichia coli solution (109 colony-forming units (cfu)/mL) and divided into three groups of 23 animals each: A (control group), B (pneumoperitoneum under 5 mmHg of constant pressure), and C (endotracheal intubation, controlled ventilation, and pneumoperitoneum as in Group B). The animals were sacrificed after 30 min under these conditions, and blood, mediastinal ganglia, lungs, peritoneum, liver, and spleen cultures were performed.RESULTS:Statistical analyses comparing the number of cfu/sample in each of the cultures showed that no differences existed between the three groups.CONCLUSION:Based on our results, we concluded that pneumoperitoneum, either alone or in association with mechanical ventilation, did not modify the bacterial clearance through the diaphragmatic lymphatic system of the peritoneal cavity.

Emergency laparoscopic ileo-colic resection and primary intracorporeal anastomosis for Crohn’s acute ileitis with free perforation and faecal peritonitis: first ever reported laparoscopic treatment

“…Although peritonitis used to be commonly considered a contraindication to laparoscopy, because of the theoretical concern that the CO2 pneumoperitoneum that may enhance bacteraemia and endotoxemia due to the increased intraperitoneal pressure (Nordentoft et al 2000 ), the latest guidelines by EAES and most of the clinical and experimental studies support the concept that laparoscopy and minimally invasive surgery are able to produce a less inflammatory response with a less risk of kidney and lung failure, less trauma and tissue damage than open surgery (Uzunkoy et al 2012 ; Pitombo 2008 ; Montalto et al 2012 ; Metzelder et al 2008 ; Hsieh et al 2011 ; Horattas et al 2003 ; Hanly et al 2003 ; Casaroli et al 2011 ; Barbaros et al 2004 ; Kesici et al 2011 ; Collet e Silva et al 2000 ; Neudecker et al 2002 ). In fact, over the past few years there has been an increasing number of studies on the use of laparoscopy in the treatment of peritonitis reporting favourable results (Sauerland et al 2006 ; Branicki 2002 ; Di Saverio 2014 ; Cueto 1997 ; Agresta et al 2006 ; Kirshtein 2003 ; Agresta et al 2004 ; Sangrasi et al 2013 ; Agresta et al 2012 ).…”

“…Historically, the presence of faecal peritonitis has been considered as a contraindication to laparoscopy, because of the theoretical risk of malignant hypercapnia, due to an increased absorption of carbon dioxide in the presence of severe intra-abdominal infection and inflammation of the peritoneum, and, secondly, because of the risk of toxic shock syndrome by increased passage of toxins and bacteria into the circulation favoured by the high intraperitoneal pressure. Recently, this controversial issue has been further investigated and the benefits of laparoscopy have been demonstrated also in case of peritonitis (Uzunkoy et al 2012 ; Pitombo 2008 ; Montalto et al 2012 ; Metzelder et al 2008 ; Hsieh et al 2011 ; Horattas et al 2003 ; Hanly et al 2003 ; Casaroli et al 2011 ; Barbaros et al 2004 ).…”

Pneumological research in Clinics

“…Casaroli et al ( 19 ) report that a pneumoperitoneum procedure, both alone and in combination with controlled ventilation, did not modify the peritoneal lymphatic bacterial clearance in a rat bacterial peritonitis model. Ferreira et al ( 20 ) note that an elevated lower inflection point and the sigmoidal shape of the pressure-volume curves suggest that respiratory system compliance decreased near the end-expiratory lung volume in idiopathic pulmonary fibrosis patients undergoing general anesthesia and mechanical ventilation.…”