Comparative Evaluation of the Inflammatory Mediators in Patients Undergoing Laparoscopic Versus Conventional Cholecystectomy

(Ortho), Dr Narendra K. Chaudhary MS; Verma, Geetika; Gupta, Rajiv; Bose, Shambhunath; Ganguly, N. K.

doi:10.1046/j.1440-1622.1999.01575.x

Cited by 26 publications

(16 citation statements)

References 17 publications

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“…The length of CPB may have also an important impact on the immune response, but the one patient in group A who had a CPB time Ͼ134 minutes did not show an enhanced immune response compared with those with shorter perfusion times. In contrast to Chaudhary et al, 8 who could demonstrate a relationship between the size of the skin incision and the immune response, we were not able to show a statistically significant difference in this regard between the sternotomy and limited thoracotomy approach.…”

Section: Discussioncontrasting

confidence: 99%

“…3,4 Because different off-pump approaches have been introduced for CABG, [5][6][7] there are only a few clinical trials available that compare the immune response in patients undergoing conventional CABG plus CPB with off-pump CABG. Furthermore, the influence of the extent of the approach to the heart on the immune response has not been clarified yet, inasmuch as Chaudhary et al 8 could show a significant difference in the release of inflammatory mediators when laparoscopic and traditional cholecystectomy are compared. Apart from a publication by De Paulis et al, 9 who compared PTCA, MIDCAB, and conventional single CABG procedures regarding troponin I, creatine kinase, and C-reactive protein, the present study evaluated for the first time the standard sternotomy approach and off-pump surgery with a limited access approach to the heart by focusing on the humoral immune response, such as complement cascade activation by C5a and C3d, the release of TNF receptors p55 and p75, inflammatory interleukins, such as IL-6 and IL-8, and the anti-inflammatory mediator IL-10.…”

Section: Discussionmentioning

confidence: 99%

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Humoral Immune Response During Coronary Artery Bypass Grafting : A Comparison of Limited Approach, "Off-Pump" Technique, and Conventional Cardiopulmonary Bypass

Diegeler¹,

Doll²,

Rauch³

et al. 2000

Circulation

163

117

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Background-The introduction of limited approaches to the heart and the avoidance of cardiopulmonary bypass (CPB) aim to reduce the invasiveness of CABG by decreasing the systemic release of inflammatory cytokines, such as tumor necrosis factor (TNF)-␣, interleukin (IL)-6, and IL-8, as well as the anti-inflammatory agent IL-10. This study compares the humoral immune response in patients undergoing CABG with standard, minimally invasive, and "off-pump" techniques. Methods and Results-Thirty patients were divided into 3 operative groups: full sternotomy approach plus CPB (group A); full sternotomy approach, off pump (group B); and limited left anterior thoracotomy, off pump (group C). Plasma levels of TNF-␣ receptors p55 and p75, IL 6, IL-8, and IL-10 were taken at baseline, during CPB, and at 4, 24, and 48 hours and 6 days after surgery. A significant increased release of activated complement factors C5a and C3d, IL-8, and IL-10 was observed in patients subjected to CPB (group A) during the initial period and for a short time after perfusion (PϽ0.05). TNF-␣ receptors p55 and p75 showed a prolonged elevation (up to 48 hours) in the CPB group compared with the 2 off-pump groups. IL-6 showed no different release among the 3 surgical groups throughout the entire period. There was no significant difference in any parameter measured in relation to the type of operative approach. Conclusions-There is an inflammatory, as well as an anti-inflammatory, response during CABG that is related to the general surgical trauma.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Humoral Immune Response During Coronary Artery Bypass Grafting : A Comparison of Limited Approach, "Off-Pump" Technique, and Conventional Cardiopulmonary Bypass

Diegeler¹,

Doll²,

Rauch³

et al. 2000

Circulation

163

117

View full text Add to dashboard Cite

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“…Chaudhary et al [10] showed that the levels of inflammatory mediators such as tumor necrosis factor, CRP, oxygen release from monocytes and polymorphonuclear leukocytes were significantly lower following laparoscopic cholecystectomy compared to conventional cholecystectomy. We also had reported that the levels of acute-phase reactants (ceruloplasmin, fibrinogen, ESR, alphal-antitrypsin, haptoglobin, and CRP) were significantly lower in patients who underwent laparoscopic cholecystectomy than in those who underwent open cholecystectomy [11].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic versus Open Appendectomy: Analysis of Systemic Acute-Phase Responses in a Prospective Randomized Study

Karadayı¹,

Turan²,

Canbay³

et al. 2003

Visc Med

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Background: The aim of this randomized study was to assess the postoperative acute-phase response of laparoscopic appendectomy and to compare its results with those of open appendectomy. Methods: 81 patients admitted to our emergency service with acute appendicitis were randomized to laparoscopic and open appendectomy groups. Preoperative and postoperative values for acute-phase reactants of white blood-cell count, erythrocyte sedimentation rate, C-reactive protein, and fibrinogen in blood samples were recorded. We also collected data concerning age and gender, total anesthesia time, operation time, time of oral intake, and hospital stay time of the study groups. Results: Although total anesthesia time was significantly longer in the laparoscopic group than in the open group (p < 0.05), there was no significant difference in operation time between both groups (p > 0.05). We found oral intake and hospital stay time to be significantly lower in the laparoscopic appendectomy group than in the open appendectomy group (p < 0.05). The acute-phase reactant levels were significantly lower in the laparoscopic appendectomy group than in the open appendectomy group (p < 0.05). Conclusion: Laparoscopic appendectomy causes relatively less trauma and less tissue damage than the open procedure and appears to have distinct advantages over open appendectomy.

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“…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].…”

Section: Clinical Trials Comparing the Impact Of Laparoscopic And Conmentioning

confidence: 99%

“…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]. Redmond et al [34]as well as Walker et al [44]found significantly lower levels of leukocytes and different leukocyte subsets after laparoscopic cholecystectomy, while other groups could not detect any difference between the groups with regard to the cellular parameters during the postoperative course.…”

Section: Clinical Trials Comparing the Impact Of Laparoscopic And Conmentioning

confidence: 99%

Immunologic Changes during Minimally Invasive Surgery

Jacobi¹,

Wenger²,

Opitz³

et al. 2002

Dig Surg

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Although recent experimental and clinical trials have documented that postoperative inflammation and changes in different immunologic parameters are less pronounced after laparoscopic approaches in comparison to open surgery, it still remains unclear what influence the pneumoperitoneum itself has on immunologic defense and function. This is mainly due to the endpoints of the different studies which investigate changes in the so-called immunologic parameters (cell subunits, C-reactive protein, cytokines, catecholamines or other stress hormones in plasma samples) rather than analyzing immunologic functions, such as cell activation, production of proteins, cell proliferation or in vivo immune defenses. So far, especially in clinical trials, no correlation has been demonstrated between the changes in immunologic parameters and relevant postoperative clinical endpoints, such as postoperative complications. Thus further clinical prospective randomized studies with relevant clinical endpoints and additional investigations of immunologic parameters are needed to prove the consequences of either minimally invasive surgery or open procedures on postoperative immune functions.

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Comparative Evaluation of the Inflammatory Mediators in Patients Undergoing Laparoscopic Versus Conventional Cholecystectomy

Abstract: Trauma-induced inflammatory response is significantly less following laparoscopic cholecystectomy compared to conventional cholecystectomy. It appears to be related to degree of trauma.

Cited by 26 publications

References 17 publications

Humoral Immune Response During Coronary Artery Bypass Grafting : A Comparison of Limited Approach, "Off-Pump" Technique, and Conventional Cardiopulmonary Bypass

Humoral Immune Response During Coronary Artery Bypass Grafting : A Comparison of Limited Approach, "Off-Pump" Technique, and Conventional Cardiopulmonary Bypass

Laparoscopic versus Open Appendectomy: Analysis of Systemic Acute-Phase Responses in a Prospective Randomized Study

Immunologic Changes during Minimally Invasive Surgery

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