Acute Phase is the Only Significantly Reduced Component of the Injury Response after Laparoscopic Cholecystectomy

Abstract

The objective demonstration of improved postoperative recovery suggests that the surgical injury response induced by the laparoscopic approach is less intensive than that after open surgery. Twenty-five patients diagnosed as having noncomplicated gallstones were studied prospectively. They were operated by laparoscopy (group I, n = 12) or open surgery (group II, n = 13). Analgesia requirements (p < 0.026) and postoperative stay (p < 0.001) were significantly less in group 1. Cholecystectomy performed by either technical options induced a significant increase over basal values of glucose, lactate, white blood cell count, prolactin, ACTH, cortisol, interleukin 6, C-reactive protein, and PCO2. Both surgical procedures induced a significant reduction of total proteins, albumin, prealbumin, free fatty acids hemoglobin, hematocrit, and pH. There were no differences between the levels of growth hormone, insulin, glucagon, or PO2 during any of the periods studied. Comparison of the results of the two cholecystectomy techniques showed that laparoscopic cholecystectomy induced a significantly less intensive acute-phase response (area under the curve) of interleukin 6 (17 +/- 17 versus 47 +/- 26 pg/ml x hr x 10(2); p < 0.003), C-reactive protein (16 +/- 12 versus 35 +/-16 mg/dl x hr x 10; p < 0.004), and prealbumin (16 +/- 2.7 versus 13.8 +/- 2.3 mg/dl x hr x 10(2); p < 0.05). The surgical injury response after laparoscopic cholecystectomy is similar to that after open cholecystectomy, but the aeute-phase response component is less intense. This finding may be a consequence of the reduced size of the operative wound with laparoscopic cholecystectomy.

Early immune outcome of retroperitoneal laparoscopic radical nephrectomy for localized renal cell carcinoma: a prospective, randomized study

“…19 Laparoscopic surgery may induce less surgical trauma than conventional open procedures due to the lesser extent of injury. Many investigators have found that relatively wound-limiting interventions, such as a laparoscopic cholecystectomy for benign lesions or a laparoscopic total mesorectal excision (TME) for a malignant tumour, 20,21 are associated with a tempered systemic inflammatory response and better preservation of the postoperative immune function when compared to open techniques. Decreased postoperative pain and fast functional recovery in laparoscopic patients may also be attributed to the reduced inflammatory response and minimal immunosuppression.…”

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].…”

Successful Laparoscopy Assisted Ovariohysterectomy in Two Dogs with Pyometra.

“…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].…”