Peritoneal changes due to laparoscopic surgery

Item does not contain fulltextBACKGROUND: Laparoscopic surgery has been incorporated into common surgical practice. The peritoneum is an organ with various biologic functions that may be affected in different ways by laparoscopic and open techniques. Clinically, these alterations may be important in issues such as peritoneal metastasis and adhesion formation. METHODS: A literature search using the Pubmed and Cochrane databases identified articles focusing on the key issues of laparoscopy, peritoneum, inflammation, morphology, immunology, and fibrinolysis. Results : Laparoscopic surgery induces alterations in the peritoneal integrity and causes local acidosis, probably due to peritoneal hypoxia. The local immune system and inflammation are modulated by a pneumoperitoneum. Additionally, the peritoneal plasmin system is inhibited, leading to peritoneal hypofibrinolysis. CONCLUSION: Similar to open surgery, laparoscopic surgery affects both the integrity and biology of the peritoneum. These observations may have implications for various clinical conditions.1 januari 201

Acute laparoscopic and open sigmoidectomy for perforated diverticulitis: a propensity score-matched cohort

Background: Hartmann\u2019s procedure for perforated diverticulitis can be characterised by high morbidity and mortality rates. While the scientific community focuses on laparoscopic lavage as an alternative for laparotomy, the option of laparoscopic sigmoidectomy seems overlooked. We compared morbidity and hospital stay following acute laparoscopic sigmoidectomy (LS) and open sigmoidectomy (OS) for perforated diverticulitis. Methods: This retrospective cohort parallel to the Ladies trial included patients from 28 Dutch academic or teaching hospitals between July 2010 and July 2014. Patients with LS were matched 1:2 to OS using the propensity score for age, gender, previous laparotomy, CRP level, gastrointestinal surgeon, and Hinchey classification. Results: The propensity-matched cohort consisted of 39 patients with LS and 78 patients with OS, selected from a sample of 307 consecutive patients with purulent or faecal perforated diverticulitis. In both groups, 66\ua0% of the patients had Hartmann\u2019s procedure and 34\ua0% had primary anastomosis. The hospital stay was shorter following LS (LS 7 vs OS 9\ua0days; P\ua0=\ua00.016), and the postoperative morbidity rate was lower following LS (LS 44\ua0% vs OS 66\ua0%; P\ua0=\ua00.016). Mortality was low in both groups (LS 3\ua0% vs OS 4\ua0%; P\ua0=\ua00.685). The stoma reversal rate after Hartmann\u2019s procedure was higher following laparoscopy, with a probability of being stoma-free at 12\ua0months of 88 and 62\ua0% in the laparoscopic and open groups, respectively (P\ua0=\ua00.019). After primary anastomosis, the probability of reversal was 100\ua0% in both groups. Conclusions: In this propensity score-matched cohort, laparoscopic sigmoidectomy is superior to open sigmoidectomy for perforated diverticulitis with regard to postoperative morbidity and hospital stay

Permeability of a cell membrane junction. Dependence on energy metabolism

ABSTRACT The ion permeability of the membrane junctions between Chironomus salivary gland cells is strongly depressed by treatments that are generally known to inhibit energy metabolism. These treatments include prolonged coolhag at 6°-8°C, and exposure to dinitrophenol, cyanide, oligomycin, and N-ethylmaleimide. IntraceUular injection of ATP appears to prevent depression of junctional permeability by dinitrophenol or to reverse it. Ouabain, azide, p-chloromercuriphenylsulfonic acid, reserpine, and acetazolamide fail to depress junctional permeability. Thus the ion permeability of the junctional membranes appears to depend on energy provided by oxidative phosphorylation. Possible energy-linked processes for maintaining junctional permeability are discussed, including processes involving transport of permeability-modifying species such as Ca ++