HUBUNGAN ANTARA PENINGKATAN KADAR KORTISOL DARAH SEBAGAI RESPON TERHADAP STRESS DENGAN KADAR INTERLEUKIN-10 (IL-10) DAN DERAJAT ADHESI PASCA LAPAROSKOPI DAN LAPAROTOMI (Penelitian Eksperimental pada Kelinci yang Dilakukan Abrasi Ileum)

Abstract

Background : Intraperitoneal adhesions after abdominal and pelvic surgery procedures occurred almost in 95% of cases and more than 40% of cases of intestinal obstruction due to adhesions intraperitoneal, 60-70% of which occur in the gut halus.5,6 1% of which occur in the first year, if the operation is done , is also a high risk of recurrence ranged from 8.7% -53%. Intraperitoneal adhesions are the most common cause laparotomy, due to a long surgery, or intraoperative complications. Intraperitonium adhesions can cause pain, infertility, bowel obstruction, and mortality and require huge costs, and extend the period of treatment. . In the early phase of peritoneal inflammation, the cells are in trauma will produce proinflammatory cytokines and mediators produced by cells mesothel residing in the peritoneum and the blood vessel wall which will accelerate the adhesion after laparotomy, through the formation of fibrin deposits which will cover the wound . After the inflammatory phase subsides, there is increased production of anti- inflammatory cytokines, which inhibit the formation of adhesions. One of the cytokines is interleukin-10 (IL-10). IL-10 is a cytokine secreted by monocytes, who have pleiotrofik effect on the immune system and inflammation. IL-10 was first known for its ability to inhibit activation and effector function of T cells, monocytes and macrophages. Interleukin-10 is thought to suppress the pro-inflammatory mediators and cytokines that activate peritoneal fibrinolytic processes, reduce neovascularization process, reduce the migration and proliferation of fibroblasts and collagen production thus formed fibrin deposits can been destroyed and prevent the formation of fibrous adhesions permanen. This research will prove the relationship between serum levels of cortisol in response to stress with increased levels of IL-10 and the degree of adhesion after laparotomy and laparoscopy Material and Method : This study is an experimental laboratory, with a post- test design approach using experimental animals as objects of research on 12 New Zealand rabbits after adaptation for 1 week were divided into 2 groups. The first group ( K1) was performed laparotomy with abration the ilium , group-2 ( K2) was performed laparoscopy with abration the ilium too.. All groups taken its blood sample befpre and 6 hours after operation to be assessed levels of cortisol with ELISA kit. 6 days after operation (day of 7th) , all group determinate and performed laparotomy, than assessed the degree of adhesion and the level of IL-10 from its peritoneal fluid. Statistical tests were used to assess defferences in the level of cortisol, IL-10 and degree do adhesion between laparotomy and laparoscopy. Data analysis was done using SPSS. Result : There was significant difference in the level of cortisol, IL-10 and degree of adhesion among groups ( p = 0.021, p < 0.001, p = 0.002 ). There were negatif correlation ( high ) between the level of blood cortisol with IL-10 ( r = - 0.805, p = 0.0 ) and significant negative correlation between the level of IL-10 with the degree of adhesion ( r = -0,833, p = o.oo1 ). Conclusion : Laparoscopic surgery can minimize the effects of systemic stress and immune response, so as to lower the incidence of adhesion. Key words : Degrees of adhesion, cortisol, IL-10, laparotomy , laparoscopy.