Systemic inflammation and immune response after laparotomy vs laparoscopy in patients with acute cholecystitis, complicated by peritonitis

Core Tip

Core Tip: Laparoscopic techniques are being increasingly used in diffuse or localised peritonitis. However, a possible concern is that increased intra-abdominal pressure may promote bacteraemia and the systemic inflammatory response during laparoscopic surgery. The majority of reports in the literature are on experimental studies made using animal models. This study, instead, is a prospective randomized study conducted on human subjects. Experimental studies on peritonitis showed that the inflammatory response was significantly higher in the open cholecystectomy (OC) group than in the laparoscopic cholecystectomy (LC) group in the animal models, suggesting that carbon dioxide pneumoperitoneum has a protective effect against bacterial peritonitis. This study, in contrast to the previous ones, is the first work demonstrating that OC after biliary peritonitis increases the incidence of bacteraemia, endotoxaemia and systemic inflammation, compared with the LC group. The authors also demonstrated that early enhanced post-operative systemic inflammation may cause lower transient immunologic defense after laparotomy (decrease of human leukocyte antigen-DR), leading to increased sepsis in these patients.