Gut oxygenation and oxidative damage during and after laparoscopic and open left-sided colon resection: a prospective, randomized, controlled clinical trial.

BACKGROUND: Pneumoperitoneum (PP), established for laparoscopic (LPS) operation, has been associated with potential detrimental effects, such as mesenteric ischemia-reperfusion injury. The objective of the trial was to measure intestinal tissue oxygen pressure (PtiO2) and oxidative damage during laparoscopic (LPS) and open colon surgery and during the postoperative course.

METHODS: Forty patients candidate to left-sided colectomy were randomized to undergo open or LPS resection (20 patients/group). During the operation, PtiO2 was measured at established changes of PP pressure (from 0-15 mmHg) and for 6 days postoperatively. PtiO2 was determined by a polarographic microprobe implanted in the colon wall. Ischemia-reperfusion injury was assessed by plasma malondialdehyde (MDA). ClinicalTrial.gov registration number: NCT01040013.

RESULTS: LPS was associated with a higher PtiO2 at the beginning of surgery (73.9±9.4 vs. 64.3±6.4 in open; P=0.04) and at the end of the operation (57.7±7.9 vs. 53.1±4.7 in open; P=0.03). PtiO2 decreased significantly during mesentery traction vs. beginning in both groups (respectively 58.7±13.2 vs. 73.9±9.4 in LPS and 55.3±6.4 vs. 64.3±6.4 in open group; minimum P=0.02). During LPS, there was a significant decrease of PtiO2 only when PP was increased to 15 mmHg (63.2±7.5 vs. 76.6±10.7 at 10 mmHg; P=0.03). PtiO2 also was significantly better in the LPS group during the first 3 days after operation (minimum P=0.04 vs. open). MDA significantly increased in both groups after mesentery traction and at the end of operation vs. baseline levels with no difference between techniques.

CONCLUSIONS: LPS seems to be associated with a better intra- and postoperative PtiO2. High-pressure PP may impair PtiO2.