Laparoscopic Preconditioning Protects Against Oxidative Injury in Cerulein-induced Pancreatitis Rats (An Experimental Study)

Background: Laparoscopic cholecystectomy, particularly in the same hospital stay, has been widely recommended to treat gallstone-pancreatitis over the last decade. Although pancreatitis produces severe oxidative injury, laparoscopy exerts an additional effect over that is produced by pancreatitis. The preconditioning phenomenon previously reported as protective in open surgery is a beneficial maneuver also in laparoscopic surgery. So in the present study we have tried to find out the effect of laparoscopic preconditioning over the pancreatitis in cerulein-induced pancreatitis rats. Methods: Acute pancreatitis was induced in 24 rats weighing between 280 and 350 g by three subcutaneous injection of 80 mu g/kg of body weight cerulein. A 1-cm midline laparotomy was performed for all rats, and then they were randomly assigned to one of the following three groups (n =8 for each): Group I (control), Group II (laparoscopy), and Group Ill (laparoscopic preconditioning [L-Pre]). After that, a catheter was placed into the peritoneum for the creation of the pneumoperitoneui-n (Pp) in all the animals except the control group. The rats of Groups II and III were subjected to 60 minutes of Pp with 15 mm Hg intraabdomirtal pressure followed by 30 minutes of deflation. The L-Pre procedure was applied to Group III immediately before the laparoscopic procedure. Blood samples were taken for biochemical assays. Pancreas tissue samples were taken for light microscope analysis. Results: The light microscopy of the pancreas tissues revealed that cerulein injection caused edema and sparse inflammatory cell infiltration mimicking the edematous pancreatitis. However, the application of laparoscopy over the pancreatitis produced significant inflammatory cell infiltration, acinus vacuolization, and necrosis (in one case) in addition to edema. But, the laparoscopic preconditioning maneuver applied before the laparoscopy significantly decreased in particular acinary vacuolization and cell infiltration. Therefore the total sum of the histopathological score of the L-Pre group was significantly less than that of the laparoscopy group. The biochemical analysis of the groups revealed that laparoscopy caused significant elevation of malondialdehyde levels and decrease of reduced glutathione values. However, the addition of preceding preconditioning produced significant amelioration of these parameters. Conclusion: Laparoscopic preconditioning may be a useful method to decrease the oxidative injury in cases undergoing cholecystectomy for biliary pancreatitis. But, it should be emphasized that this was a restricted experimental study, and further clinical studies are needed to adopt these results into clinical settings.