MCP-1 is highly expressed in peritoneum following midline laparotomy with peritoneal abrasion in a murine model.

BACKGROUND: Monocyte chemoattractant protein-1 (MCP-1), a CC chemokine, is a potent attractant of monocytes both in vitro and in vivo. However, its role in the repair of peritoneal injury is not well established. This study characterizes MCP-1 expression in surgical wounds following peritoneal abrasion in a murine model. METHODS: Twenty-five C57 BL6 female mice underwent a 2-cm midline laparotomy with mechanical abrasion of the right peritoneal wall. The mice were sacrificed at various times ranging from 0 to 7 days. Hemotoxylin and eosin stained sections and tissue extracts were made using peritoneal samples from abraded and unabraded areas in each mouse. An enzyme-linked immunosorbent assay was performed on the specimens to quantitate MCP-1 expression. Values were compared using a t-test. RESULTS: At baseline, there was minimal expression of MCP-1 (<5 pg/mg protein). Following surgery, MCP-1 levels at abraded sites were significantly higher than those at both baseline and unabraded sites at all times up to a week following surgery. Histologic evaluation revealed peritoneal thickening and leukocytic infiltration of only abraded surfaces. CONCLUSION: MCP-1 is highly expressed in peritoneum following laparotomy with peritoneal abrasion. Elevations in MCP-1 levels are identified within 6 h of surgery and persist for up to 1 week. The histologic differences between abraded and unabraded areas may be attributable to differences in MCP-1 expression. Further studies using recombinant MCP-1 and anti-MCP-1 antibody may elucidate this relationship.

Laparoscopic splenectomy.

BACKGROUND: Laparoscopic splenectomy is currently the procedure of choice for elective splenectomy. This study reviews the initial 100 laparoscopic splenectomies completed at the Cleveland Clinic Foundation. METHODS: A retrospective review of elective laparoscopic splenectomy was performed to assess clinical outcomes at the Cleveland Clinic Foundation. Patient demographics, preoperative diagnoses, operative characteristics, morbidity, and mortality were evaluated. RESULTS: Of the 169 elective splenectomies completed over a 4-year period from 1995 to 1999, 100 were attempted laparoscopically. The proportions of all splenectomies attempted laparoscopically by year were 17%, 38%, 75%, and 72%. Nearly 70% of splenectomies were performed for idiopathic thrombocytopenic purpura or malignancy. Overall, the mean blood loss was 181 ml, and the mean operative time was 170 min. Splenomegaly occurred in 31% of the patients and accounted for longer operative times. Three patients required conversion to an open procedure. Postoperative complications were seen in 13% of the patients. One patient died in the postoperative period from staphylococcal sepsis, giving a mortality rate of 1%. CONCLUSIONS: Laparoscopic splenectomy currently is the procedure of choice for elective splenectomy at our institution. As compared with traditional open splenectomy, laparoscopic splenectomy results in minimal morbidity even in the setting of splenomegaly.