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Gas-related impact of pneumoperitoneum on systemic wound healing

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Abstract

Introduction

The aim of the present study was to investigate the gas-dependent effects of pneumoperitoneum on wound healing distant from the abdomen.

Materials and methods

Dorsal skin incisions were performed in 54 male Sprague–Dawley rats. A CO2 or a helium pneumoperitoneum of 3 mmHg was maintained before, with an overall duration of 30 min (each n = 18). Rats in the control group received laparotomy only (n = 18). Animals were killed after 5 and 10 days. The infiltration of macrophages (CD 68), expression of matrix metalloproteinase 13 (MMP-13) and collagen I/III ratios were analysed in the dorsal skin wounds.

Results

Both after 5 and 10 days, infiltration of macrophages and expression of MMP-13 were greatest after helium pneumoperitoneum. After 5 days, collagen I/III ratio was significantly increased in the helium group. After 10 days, collagen I/III ratio was lowest in the CO2 group.

Conclusion

Our results suggest beneficial effects on systemic wound healing for helium pneumoperitoneum as compared to CO2.

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References

  1. Polat C, Arikan Y, Vatansev C, Akbulut G, Yilmaz S, Dilek FH, Gokce O (2002) The effects of increased intraabdominal pressure on colonic anastomoses. Surg Endosc 16:1314–1319

    Article  PubMed  CAS  Google Scholar 

  2. Kologlu M, Sayek I, Kologlu LB, Eng C, Onat D (1999) Effect of persistently elevated intraabdominal pressure on healing of colonic anastomoses. Am J Surg 178:293–297

    Article  PubMed  CAS  Google Scholar 

  3. Murray JA, Cornwell EE 3rd, Velmahos GC, Rivkind AI, Hedman T, Abrahams JH, Katkhouda N, Berne TV, Demetriades D (2001) Healing of traumatic diaphragm injuries: comparison of laparoscopic versus open techniques in an animal model. J Surg Res 100:189–191

    Article  PubMed  CAS  Google Scholar 

  4. Rosch R, Stumpf M, Junge K, Ardic D, Ulmer F, Schumpelick V (2004) Impact of pressure and gas type on anastomotic wound healing in rats. Langenbecks Arch Surg 389:261–266

    Article  PubMed  Google Scholar 

  5. Zieren J, Zieren HU, Jacobi CA, Wenger FA, Muller JM (1998) Prospective randomized study comparing laparoscopic and open tension-free inguinal hernia repair with Shouldice’s operation. Am J Surg 175:330–333

    Article  PubMed  CAS  Google Scholar 

  6. Kockerling F, Rose J, Schneider C, Scheidbach H, Scheuerlein H, Reymond MA, Reck T, Konradt J, Bruch HP, Zornig C, Barlehner E, Kuthe A, Szinicz G, Richter HA, Hohenberger W (1999) Laparoscopic colorectal anastomosis: risk of postoperative leakage. Results of a multicenter study. Laparoscopic Colorectal Surgery Study Group (LCSSG). Surg Endosc 13:639–644

    Article  PubMed  CAS  Google Scholar 

  7. Hartley JE, Mehigan BJ, Qureshi AE, Duthie GS, Lee PW, Monson JR (2001) Total mesorectal excision: assessment of the laparoscopic approach. Dis Colon Rectum 44:315–321

    Article  PubMed  CAS  Google Scholar 

  8. Thaler K, Dinnewitzer A, Mascha E, Arrigain S, Weiss EG, Nogueras JJ, Wexner SD (2003) Long-term outcome and health-related quality of life after laparoscopic and open colectomy for benign disease. Surg Endosc 17:1404–1408

    Article  PubMed  CAS  Google Scholar 

  9. Kollmorgen CF, Thompson GB, Grant CS, van Heerden JA, Byrne J, Davies ET, Donohue JH, Ilstrup DM, Young WF (1998) Laparoscopic versus open posterior adrenalectomy: comparison of acute-phase response and wound healing in the cushingoid porcine model. World J Surg 22:613–619

    Article  PubMed  CAS  Google Scholar 

  10. Robbins SB, Pofahl WE, Gonzalez RP (2001) Laparoscopic ventral hernia repair reduces wound complications. Am Surgeon 67:896–900

    PubMed  CAS  Google Scholar 

  11. Hansen JB, Smithers BM, Schache D, Wall DR, Miller BJ, Menzies BL (1996) Laparoscopic versus open appendectomy: prospective randomized trial. World J Surg 20:17–20

    Article  PubMed  CAS  Google Scholar 

  12. Willis S, Ulmer F, Fell T, Butz N, Tittel A, Schumpelick V (2005) Laparoscopic colectomy versus open colectomy for sigmoid diverticular disease in routine surgery. Viszeralchirurgie 27–32

  13. Agalar F, Hamaloglu E, Daphan C, Tarim A, Onur R, Renda N, Sayek I (2000) Effects of CO2 insufflation and laparotomy on wound healing in mice. Aust NZ J Surg 70:739–742

    Article  CAS  Google Scholar 

  14. Wickens JC, Whelan RL, Allendorf JD, Donahue J, Buxton E, McKee A, Panageas K, Gleason N, Lee S, Bessler M (1998) Wound tensile strength and contraction rate are not affected by laparotomy or pneumoperitoneum. Surg Endosc 12:1166–1170

    Article  PubMed  CAS  Google Scholar 

  15. Neuberger TJ, Andrus CH, Wittgen CM, Wade TP, Kaminski DL (1996) Prospective comparison of helium versus carbon dioxide pneumoperitoneum. Gastrointest Endosc 43:38–41

    PubMed  CAS  Google Scholar 

  16. Rademaker BM, Bannenberg JJ, Kalkman CJ, Meyer DW (1995) Effects of pneumoperitoneum with helium on hemodynamics and oxygen transport: a comparison with carbon dioxide. J Laparoendosc Surg 5:15–20

    PubMed  CAS  Google Scholar 

  17. Kuntz C, Wunsch A, Bodeker C, Bay F, Rosch R, Windeler J, Herfarth C (2000) Effect of pressure and gas type on intraabdominal, subcutaneous, and blood pH in laparoscopy. Surg Endosc 14:367–371

    Article  PubMed  CAS  Google Scholar 

  18. Fernandez-Cruz L, Saenz A, Taura P, Sabater L, Astudillo E, Fontanals J (1998) Helium and carbon dioxide pneumoperitoneum in patients with pheochromocytoma undergoing laparoscopic adrenalectomy. World J Surg 22:1250–1255

    Article  PubMed  CAS  Google Scholar 

  19. Chekan EG, Nataraj C, Clary EM, Hayward TZ, Brody FJ, Stamat JC, Fina MC, Eubanks WS, Westcott CJ (1999) Intraperitoneal immunity and pneumoperitoneum. Surg Endosc 13:1135–1138

    Article  PubMed  CAS  Google Scholar 

  20. Jacobi CA, Ordemann J, Halle E, Volk HD, Muller JM (1999) Impact of laparoscopy with carbon dioxide versus helium on local and systemic inflammation in an animal model of peritonitis. J Laparoendosc Adv Surg Tech A 9:305–312

    Article  PubMed  CAS  Google Scholar 

  21. Nagelschmidt M, Gerbecks D, Minor T (2001) The impact of gas laparoscopy on abdominal plasminogen activator activity. Surg Endosc 15:585–588

    Article  PubMed  CAS  Google Scholar 

  22. Rosch R, Junge K, Binnebösel M, Mirgarth N, Klinge U, Schumpelick V (2006) Improved abdominal wall wound healing by helium pneumoperitoneum. Surg Endosc (in press)

  23. Junqueira LC, Cossermelli W, Brentani R (1978) Differential staining of collagens type I, II and III by Sirius Red and polarization microscopy. Arch Histol Jpn 41:267–274

    PubMed  CAS  Google Scholar 

  24. Armstrong DG, Jude EB (2002) The role of matrix metalloproteinases in wound healing. J Am Podiatr Med Assoc 92:12–18

    PubMed  Google Scholar 

  25. Jackson PG, Evans SR (2000) Intraperitoneal macrophages and tumor immunity: a review. J Surg Oncol 75:146–154

    Article  PubMed  CAS  Google Scholar 

  26. Gutt CN, Heinz P, Kaps W, Paolucci V (1997) The phagocytosis activity during conventional and laparoscopic operations in the rat. A preliminary study. Surg Endosc 11:899–901

    Article  PubMed  CAS  Google Scholar 

  27. Neuhaus SJ, Watson DI, Ellis T, Lafullarde T, Jamieson GG, Russell WJ (2001) Metabolic and immunologic consequences of laparoscopy with helium or carbon dioxide insufflation: a randomized clinical study. ANZ J Surg 71:447–452

    Article  PubMed  CAS  Google Scholar 

  28. Hanly EJ, Fuentes JM, Aurora AR, Bachman SL, De MA, Marohn MR, Talamini MA (2006) Carbon dioxide pneumoperitoneum prevents mortality from sepsis. Surg Endosc 20:1482–1487

    Article  PubMed  CAS  Google Scholar 

  29. Rosch R, Stumpf M, Junge K, Drinjakovic D, Schachtrupp A, Afify M, Schumpelick V (2005) Influence of pneumoperitoneum on small bowel anastomoses: a histological analysis in the rat model. J Invest Surg 18:63–69

    Article  PubMed  CAS  Google Scholar 

  30. Thomson IA, Fitch W, Hughes RL, Campbell D (1983) Effect of increased concentrations of carbon dioxide during halothane anaesthesia on liver blood flow and hepatic oxygen consumption. Br J Anaesth 55:1231–1237

    Article  PubMed  CAS  Google Scholar 

  31. Portera CA, Love EJ, Memore L, Zhang L, Muller A, Browder W, Williams DL (1997) Effect of macrophage stimulation on collagen biosynthesis in the healing wound. Am Surgeon 63:125–131

    PubMed  CAS  Google Scholar 

  32. Browder W, Williams D, Lucore P, Pretus H, Jones E, McNamee R (1988) Effect of enhanced macrophage function on early wound healing. Surgery 104:224–230

    PubMed  CAS  Google Scholar 

  33. Eljaafari A, Duperrier K, Mazet S, Bardin C, Bernaud J, Durand B, Gebuhrer L, Betuel H, Rigal D (1998) Generation of stable monocyte-derived dendritic cells in the presence of high concentrations of homologous or autologous serum: influence of extra-cellular pH. Hum Immunol 59:625–634

    Article  PubMed  CAS  Google Scholar 

  34. Grinstein S, Swallow CJ, Rotstein OD (1991) Regulation of cytoplasmic pH in phagocytic cell function and dysfunction. Clin Biochem 24:241–247

    Article  PubMed  CAS  Google Scholar 

  35. Wood GC, Keech MK (1960) The formation of fibrils from collagen solutions. 1. The effect of experimental conditions: kinetic and electron-microscope studies. Biochem J 75:588–598

    PubMed  CAS  Google Scholar 

  36. Vanamee P, Porter KR (1951) Observations with the electron microscope on the solvation and reconstitution of collagen. J Exp Med 94:255–266

    Article  PubMed  CAS  Google Scholar 

  37. Nigra TP, Martin GR, Eagle H (1973) The effect of environmental pH on collagen synthesis by cultured cells. Biochem Biophys Res Commun 53:272–281

    Article  PubMed  CAS  Google Scholar 

  38. Bard JB, Hulmes DJ, Purdom IF, Ross AS (1993) Chick corneal development in vitro: diverse effects of pH on collagen assembly. J Cell Sci 105(Pt 4):1045–1055

    PubMed  CAS  Google Scholar 

  39. Paraskeva PA, Ridgway PF, Jones T, Smith A, Peck DH, Darzi AW (2005) Laparoscopic environmental changes during surgery enhance the invasive potential of tumours. Tumour Biol 26:94–102

    Article  PubMed  CAS  Google Scholar 

  40. Vaalamo M, Mattila L, Johansson N, Kariniemi AL, Karjalainen-Lindsberg ML, Kahari VM, Saarialho-Kere U (1997) Distinct populations of stromal cells express collagenase-3 (MMP-13) and collagenase-1 (MMP-1) in chronic ulcers but not in normally healing wounds. J Invest Dermatol 109:96–101

    Article  PubMed  CAS  Google Scholar 

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Acknowledgement

We are grateful to Mrs. Ellen Krott for her most excellent and careful assistance during this investigation.

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Authors and Affiliations

  1. Department of Surgery, University Hospital Aachen, Aachen, Germany

    R. Rosch, K. Junge, M. Binnebösel, N. Mirgartz, U. Klinge & V. Schumpelick

  2. Department of Surgery, RWTH-Aachen, Pauwelsstr. 30, 52074, Aachen, Germany

    R. Rosch

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  1. R. Rosch
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  2. K. Junge
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  3. M. Binnebösel
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Correspondence to R. Rosch.

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Rosch, R., Junge, K., Binnebösel, M. et al. Gas-related impact of pneumoperitoneum on systemic wound healing. Langenbecks Arch Surg 393, 75–80 (2008). https://doi.org/10.1007/s00423-006-0136-3

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  • DOI: https://doi.org/10.1007/s00423-006-0136-3

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