Peritoneal acidosis mediates immunoprotection in laparoscopic surgery

Background. We have shown previously that abdominal insufflation. with CO2 increases serum levels of IL-10 and TNF alpha and increases survival among animals with lipopolysaccharide (LPS)-induced sepsis, even after a laparotomy. We demonstrated previously that the effect of CO2 is not from changes in systemic PH, although the peritoneum is locally acidotic during abdominal insufflation with CO2. even when systemic pH is corrected. We hypothesized that acidification of the peritoneum via means other than CO2 insufflation would produce alterations in the inflammatory response similar to those associated with CO2 pneumoperitoneum. Methods. In total, 42 rats were randomized into 7 groups (n = 6): 1) LPS only, 2) anesthesia control, 3) helium pneumoperitoneum, 4) CO2 prieumaperitoneum, 5) buffered mild acid lavage, 6) buffered strong acid lavage, and 7) buffered strong acid lavage + helium pneumoperitoneum. Animals received anesthesia with vaporized isoflurane (except the LPS-only group) and their respective abdominal treatment (Pneumoperitoneum and/or lavage) for 30 min followed immediately by stimulation with systemic LPS (I mg/kg, M. Blood was harvested via cardiac puncture 60 min after LPS injection, and serum levels of IL-10 and TNF alpha levels were determined by enzyme-linked immunosorbent assay. Results. Mean peritoneal pH decreased (P < .05) after CO2 Pneumoperitoneum, buffered strong acid lavage, and buffered strong acid lavage + helium pneumoperitoneum, and it decreased (P =. 1) after helium pneumoperitaneum alone and buffered mild acid lavage. IL-10 levels were increased (P < .01), and TNF alpha levels decreased (P <. 001) among animals with acidic peritoneal cavities compared with animals with pH-normal peritoneal cavities. Decreasing peritoneal PH correlated with both increasing IL-10 levels (r = -.465, P < .01) and decreasing TNFa levels (r = 0.448, P < .01). Among animals with peritoneal acidosis, there were no differences in levels of IL-10 or TNF alpha regardless of insufflation status (P > .05 for both cylokines). Conclusions. Acidification of the peritoneal cavity whether by abdominal insufflation or by peritoneal acid lavage increases serum IL-10 and decreases serum TNF alpha levels in response to systemic LPS challenge. The degree of peritoneal acidification correlates with the degree of inflammatory response reduction. These results support the hypothesis that pneumoperitoneum-mediated attenuation of the inflammatary response after laparoscopic surgery occurs via a mechanism of peritoneal cell acidification.