Effects of Laparoscopic and Conventional (Open) Cholecystectomy on Human Leukocyte Antigen‐DR Expression in Peripheral Blood Monocytes: Correlations with Immunologic Status RID="" ID="" This International Society of Surgery (ISS)/Société Internationale de Chirurgie (SIC) article was presented at the 37th World Congress of Surgery International Surgical Week (ISW97), Acapulco, Mexico, August 24–30, 1997.

Abstract

It is well known that surgery significantly decreases immune responses. Laparoscopic cholecystectomy (LC) is a "miniinvasive" surgical procedure; and on the basis of this consideration we have investigated if and how the immune response is modified in patients after laparoscopic cholecystectomy compared to patients who underwent open cholecystectomy. Immune activity [neutrophils, total lymphocytes count, lymphocytes subpopulations, human leukocyte antigen-DR (HLA-DR)] was evaluated in 53 patients 1 day before surgery and respectively, 1, 3, and 6 days after surgery; 26 patients underwent "open" cholecystectomy and 27 LC. A day after surgery, patients with open cholecystectomy showed a significant increase (p < 0.05) in plasma neutrophils, while they were almost unchanged in LC patients. Monocyte antigen HLA-DR was reduced in patients with "open" cholecystectomy. We recorded two cases (7.6%) of respiratory tract infection in the "open" group. In conclusion, LC strongly reduces postoperative (p.o.) pain and hospitalization, and it promotes earlier recovery and return to normal activity, avoiding p.o. immunosuppression, mostly due to conservation of HLA-DR activity, with less p.o. morbidity compared to that seen with open surgery.

Effects of low and standard intra-abdominal pressure on systemic inflammation and immune response in laparoscopic adrenalectomy: A prospective randomised study

“…Although laparoscopy is ‘minimally invasive’, systemic immune response is still invariably activated. [ 23 ] Overall, responses to surgery in general are reflected in terms of cytokine function and cellular messenger systems — although cytokine levels do not directly reflect immune status, they give us a framework to understand systemic immunity in terms of underlying immune activation. Because alterations are proportional to the extent of the injury, the physiological response to minimally invasive surgery may, intuitively, be different than those for traditional open surgery.…”

“…The inflammatory and immune response has been studied in several clinical trials after laparoscopic procedures for benign[ 23 25 36 37 38 39 40 ] and neoplastic disease. [ 41 42 43 ] The advantages of laparoscopy, commonly reported in trials assessing laparoscopic surgery,[ 24 ] are believed to be secondary to less trauma to the abdominal wall with the laparoscopic approach, which results in a lower inflammatory response.…”

“…sepsis is strongly correlated with lower expression of the HLA-DR of peripheral monocytes. [ 23 ] Because HLA-DR expression is not significantly affected by age, sex, or race, this antigen can be considered of crucial significance in the p.o. monitoring of surgical patients.…”

“…[ 20 21 ] Many studies have evaluated the effect of the degree of surgical trauma and different anaesthetic agents on immune response. [ 17 18 22 23 24 25 26 ] There have, however, been only a few studies conducted that compared standard-pressure and low-pressure CO 2 pneumoperitoneum laparoscopy with respect to immune response. [ 27 28 ] Moreover, we could not find any effect of various degrees of intra-abdominal pressure during LA.…”

Immunologic Changes during Minimally Invasive Surgery

“…Prospective randomized and non-randomized trials have compared the postoperative changes in immunologic and inflammatory parameters of different surgical procedures [6, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46](table 1, 2). Most studies were performed in patients undergoing cholecystectomy, mainly showing a less pronounced postoperative increase in C-reactive protein, IL-1 and IL-6 for the laparoscopic approach, while the results of the systemic cellular changes differed between the different studies [9, 10, 13, 18, 22, 25, 27, 30, 32, 34, 39, 44].…”