Totally extraperitoneal endoscopic repair of recurrent inguinal hernia (Br J Surg 2001; 88: 884–6)

Abstract

Randomized clinical trial of the effect of open versus laparoscopically assisted colectomy on systemic immunity in patients with colorectal cancer (Br J Surg 2001; 88: 801±7) SirThe authors conclude that the systemic immune response is activated equally after both procedures. Previous publications from our clinic and from others suggest otherwise. In 1994 Kloosterman et al. 1 were one of the ®rst groups to demonstrate signi®cant differences between laparoscopic and conventional cholecystectomy. They studied monocyte human leucocyte antigen (HLA)-DR expression as a parameter for trauma induced immune suppression. Sietses et al. 2 con®rmed these results in a randomized clinical study comparing both techniques for Nissen fundoplication. In both studies a signi®cant difference was noticed in the postoperative expression of the HLA-DR antigen on monocytes, favouring the laparoscopic approach. Wake®eld et al. 3 demonstrated that reduced HLA-DR expression on monocytes and slow restoration to preoperative values after surgical intervention is associated with an increased incidence of infection. These differences, however, were only found 1 day after surgery.The measurements in this trial were performed 3 days after surgery, and therefore probably too late to demonstrate any differences between the two techniques.