ABSTRACT
BACKGROUND: 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.
Subject(s)
Laparoscopy/adverse effects , Peritoneal Cavity/physiopathology , Peritoneum/physiopathology , Pneumoperitoneum, Artificial/adverse effects , Acidosis/etiology , Animals , Carbon Dioxide/administration & dosage , Carbon Dioxide/adverse effects , Cell Adhesion Molecules/metabolism , Cell Hypoxia , Cytokines/metabolism , Epithelium/pathology , Fibrinolysin/physiology , Fibrinolysis , Humans , Intercellular Signaling Peptides and Proteins/metabolism , Macrophages, Peritoneal/physiology , Mice , Neoplasm Seeding , Peritoneal Cavity/surgery , Peritoneal Neoplasms/secondary , Peritoneum/immunology , Peritoneum/surgery , Peritonitis/etiology , Peritonitis/physiopathology , Tissue Adhesions/etiology , Tissue Adhesions/physiopathology , Wound Healing/physiologyABSTRACT
BACKGROUND: Laparoscopic surgery is evolving rapidly. It involves the creation of a pneumoperitoneum, mostly using carbon dioxide. Cooling of the peritoneum, due to insufflation, might traumatize the peritoneum and disturb peritoneal fibrinolysis, important in peritoneal healing processes. The current study was performed to elucidate the effects of the temperature of insufflation gas on the peritoneal fibrinolytic response to laparoscopic surgery. METHODS: Thirty patients scheduled for laparoscopic cholecystectomy were randomized in two groups: one group in which the pneumoperitoneum was created with carbon dioxide at room temperature, and one wherein carbon dioxide at body temperature was used. Peritoneal biopsies were taken at the start and at the end of surgery. Tissue concentrations of tPA antigen, tPA activity, uPA antigen, and PAI-1 antigen were measured using ELISA techniques. RESULTS: Peritoneal PAI-1 antigen levels were significantly higher at the end of the procedure in patients operated with carbon dioxide at room temperature (p < .05). A slight, but not significant, decrease in tPA antigen and activity was observed in both groups during the procedure. Peritoneal concentrations of uPa antigen did not change during the procedure. CONCLUSIONS: The temperature of carbon dioxide used for insufflation of the abdominal cavity affects peritoneal biology. Cooling of the peritoneum by unheated carbon dioxide causes increased peritoneal PAI-1 levels, important in peritoneal healing processes.
Subject(s)
Carbon Dioxide/administration & dosage , Cholecystectomy, Laparoscopic/methods , Hot Temperature/therapeutic use , Insufflation/methods , Peritoneum/drug effects , Adult , Aged , Female , Fibrinolysis , Humans , Male , Middle Aged , Peritoneum/metabolism , Peritoneum/pathology , Plasminogen Activator Inhibitor 1/metabolism , Tissue Polypeptide Antigen/drug effects , Tissue Polypeptide Antigen/metabolism , Treatment Outcome , Urokinase-Type Plasminogen Activator/drug effects , Urokinase-Type Plasminogen Activator/metabolismABSTRACT
BACKGROUND: This study was designed to evaluate the development of malignancies after renal transplantation in a single centre. The outcome was studied in patients developing a malignant neoplasm after renal transplantation. METHODS: Malignancies are registered in a database containing relevant data about the patients with a renal transplant. This database and the files of the patients developing a malignant neoplasm, have been studied as to stage at presentation, therapy and outcome. RESULTS: In 1546 patients with 2075 renal transplantations, 240 malignancies developed in 231 recipients. Skin cancers often present with more than one lesion of the same histological type. After the first skin tumour, about half of the patients developed more lesions, of the same or a different histological type. The prognosis of skin tumours is relatively good, but most malignancies in all other categories have a poor prognosis. CONCLUSIONS: Cutaneous neoplasms tend to be multiple, but can be controlled by regular examination of the skin. Most malignant lymphomas do develop outside the lymphoproliferative system and have a poor prognosis. Patients with a solid tumour of the other tracts often present in an advanced stage of disease, which makes the outcome of treatment, if possible at all, disappointing.
