Metabolic and inflammatory responses after open or laparoscopic cholecystectomy

Abstract

Metabolic and inflammatory responses and changes in fatigue were studied in groups of patients undergoing either laparoscopic (n = 14) or open (n = 10) elective cholecystectomy. The mean(s.e.m.) cortisol concentration was significantly (P < 0.001) increased from 342(80) and 424(91) nmol l-1 before operation to 895(46) and 966(53) nmol l-1 after surgery in patients undergoing laparoscopic and open cholecystectomy respectively. There was no difference in cortisol response between the groups. Glucose concentration was increased (P < 0.02) at the end of surgery from mean(s.e.m.) preoperative levels of 5.54(0.15) and 6.16(0.15) mmol l-1 to postoperative values of 7.46(0.29) and 8.46(0.86) mmol l-1 for the laparoscopic and open procedures respectively. The mean glucose concentration during the initial 12 h after surgery was significantly greater (P < 0.02) following open than laparoscopic cholecystectomy. The mean(s.e.m.) albumin concentration fell significantly (P < 0.01) during surgery by an equivalent extent from 38.9(0.77) and 38.5(1.10)g l-1 to 35.2(0.79) and 34.6(0.97) g l-1. The mean (95 per cent confidence interval) interleukin (IL)6 concentration peaked 4 h after surgery at 57.2 (44.6-73.4) pg ml-1 following laparoscopic and 99.3 (72.8-135.4) pg ml-1 after open cholecystectomy. Mean (95 per cent confidence interval) C-reactive protein (CRP) levels at 24 h were 17.0 (12.7-21.2) and 49.0 (25.3-93.6) mg l-1 and at 48 h 28.0 (21.4-35.4) and 70.0 (36.4-133.6) mg l-1 following laparoscopic and open operations. The differences in IL-6 and CRP level between the groups were significant (P < 0.01). Mean(s.e.m.) fatigue scores were significantly (P < 0.05) increased from preoperative values of 2.4(0.24) and 2.6(0.44) to 5.5(0.56) and 6.8(0.51) at 24 h after laparoscopic and open operations. At 48 h the mean(s.e.m.) fatigue score (5.6(0.57)) remained significantly (P < 0.05) raised only after open cholecystectomy. Hand grip strength was significantly (P < 0.05) reduced only after the open procedure, to a mean(s.e.m.) of 88(6) per cent of the preoperative value. These results demonstrate that aspects of the metabolic and acute-phase responses are attenuated following laparoscopic cholecystectomy, consistent with a reduction in tissue trauma.

Successful Laparoscopy Assisted Ovariohysterectomy in Two Dogs with Pyometra.

“…In human medicine, many comparative studies between laparoscopic surgery and open surgery have been reported [10,15,18]. The increases in the serum interleukin-6 and C-reactive protein levels during laparoscopic surgery were found to be significantly smaller than those during open surgery [10,18]. These results demonstrate that aspects of the metabolic and acute-phase responses are attenuated following laparoscopic surgery, consistent with a reduction in tissue trauma [10].…”

“…In the present cases, total skin incision length was only 6 cm, and three out of four incisions were only 1 cm. In human medicine, many comparative studies between laparoscopic surgery and open surgery have been reported [10,15,18]. The increases in the serum interleukin-6 and C-reactive protein levels during laparoscopic surgery were found to be significantly smaller than those during open surgery [10,18].…”

The effect of anaesthesia and surgery on plasma cytokine production

“…It was observed that the increase in IL-6 after various surgical procedures is related to the severity of surgical trauma [23], while IL-6 production is decreased when surgery is undertaken using laparoscopic techniques [24]. Jakeways et al [25] demonstrated significantly less increase in mean IL-6 and C-reactive protein concentrations after laparoscopic compared with open cholecystectomy. Also, different types of surgery are associated with differences in cytokine secretion pattern.…”

Effect of surgical procedures on prostate tumor gene expression profiles

“…Hanly et al 19 proposed that CO 2 -mediated attenuation of the acute phase response may be the underlying mechanism of reduced systemic inflammatory response reported in earlier laparoscopic surgeries. [20][21][22] The immune-modulatory effect of CO 2 is apparently mediated by peritoneal acidosis as acidic solutions had the same effect. 23 Therefore, we speculate that abdominal CO 2 insufflation, rather than reduced tissue trauma, may account for underexpression of stress-response genes in LRP specimens compared with ORP specimens.…”

“…The majority of patients (n519) had urinary symptoms at the time of diagnosis. The median prostate-specific antigen (PSA) prior to surgery was 20.7 ng ml 21 . The clinical stages of all patients (n535) were at or above T2a.…”