Background: Murine post-operative ileus results from intestinal inflammation triggered by manipulation-induced mast cell activation. As its extent depends on the degree of handling and subsequent inflammation, we hypothesise that the faster recovery after minimal invasive surgery results from decreased mast cell activation and impaired intestinal inflammation.
Objective: to quantify mast cell activation and inflammation in patients undergoing conventional and minimal invasive surgery.
Methods: 1) Mast cell activation (i.e. tryptase release) and pro-inflammatory mediator release were determined in peritoneal lavage fluid obtained on consecutive time-points during open, laparoscopic and trans-vaginal gynaecological surgery. 2) LFA-1, ICAM-1 and iNOS mRNA as well as leukocyte influx were quantified in non-handled and handled jejunal muscle specimens collected during biliary reconstructive surgery. 3) Intestinal leukocyte influx was assessed by 99mTc labelled leukocyte SPECT-CT scanning before and after abdominal or vaginal hysterectomy.
Results: 1) Intestinal handling during abdominal hysterectomy resulted in an immediate release of tryptase followed by enhanced IL-6 and IL-8 levels. None of the mediators rose during minimal invasive surgery except for a slight increase in IL-8 during laparoscopic surgery. 2) Jejunal mRNA transcription for ICAM-1 and iNOS as well as leukocyte recruitment were increased after intestinal handling. 3) Leukocyte scanning 24hrs after surgery revealed increased intestinal activity after abdominal but not after vaginal hysterectomy.
Conclusions: This study demonstrates that intestinal handling triggers mast cells activation and inflammation associated with prolonged post-operative ileus. These results may partly explain the faster recovery after minimal invasive surgery and encourage future clinical trials targeting mast cells to shorten post-operative ileus.
- intestinal handling
- mast cells
- minimal invasive abdominal surgery
- postoperative ileus