Validation and reduction of the oxidative stress following laparoscopic operations - A prospective randomized controlled study

Objective: To validate ischemia-reperfusion mechanism during laparoscopic cholecystectomy, and to assess the reduction of oxidative stress by an intermittent sequential pneumatic compression (ISPC) device. Summary Background: Increased intraperitoneal pressure during laparoscopic operations may lead to decreased cardiac output and visceral perfusion, and possible ischemia-reperfusion effects. Using the ISPC device was shown to improve cardiac output and visceral perfusion during pneumoperitoneum (PP). Methods: Twenty patients undergoing elective laparoscopic cholecystectomy were enrolled in a randomized prospective controlled study and divided into 2 groups: 1) Study group (10 patients), activation of ISPC together with creation of PP; and 2) control group, without ISPC. Lipid peroxidation and glutathione levels (as indicators of oxidative stress) as well as liver and renal function tests. were measured before and at the end of PP, and again at 30 minutes. 4 hours, and 24 hours afterward, together with hemodynamic and respiratory parameters. Results: There was no significant difference between both groups concerning liver enzymes and bilirubin, nor in hemodynamic parameters. In the control group, increased lipid peroxide levels were noted 4 hours after PP termination, in comparison to pre-PP levels (590.4-649.2 mmol/L. P = 0.002). In the study group (ISPC), such changes were not inspected. Decreased total glutathione levels were noted in the control group, 30 Minutes following CO2 evacuation. Conclusions: Our study validates the ischemia-reperfusion mechanism following laparoscopic surgery. The use of an ISPC device decreased the oxidative stress (secondary to relative ischemia-reperfusion insult) following PP, probably due to improved cardiac output and visceral perfusion.