Evaluation of immune response in patients after open or laparoscopic cholecystectomy
Schietroma, M.; Carlei, F.; Lezoche, E.; Agnifili, A.; Enang, G.N.; Mattucci, S.; Minervini, S.; Lygidakis, N.J.
Hepato-Gastroenterology 48(39): 642-646
2001
ISSN/ISBN: 0172-6390 PMID: 11462893 Document Number: 1599
Background/Aims: Laparoscopic cholecystectomy is a so called mini-invasive surgical procedure, and on this basis, we investigated whether and how the immune response is modified in patients after laparoscopic cholecystectomy compared to patients who underwent open cholecystectomy. Methodology: In a prospective, nonrandomized trial, 35 patients underwent laparoscopic cholecystectomy and 31 open cholecystectomy. Immune activity (neutrophils, total lymphocytes, lymphocyte subpopulations, human leukocyte antigen (HLA-DR), interleukin 6, skin Multitest) was evaluated before surgery and respectively, 1, 3, and 6 days postoperatively. Results: One day after surgery, an increase in interleukin 6 (P<0.01) was noted in patients who had undergone open cholecystectomy, while this parameter was almost unchanged in patients with laparoscopic cholecystectomy. Moreover, skin tests showed a hypo or anergic response in the majority (81.8%) of open cholecystectomy patients compared to laparoscopic cholecystectomy patients (10.5%), (P<0.01). Finally, monocyte antigen HLA-DR was also reduced in open cholecystectomy patients (P<0.05). In this group, we noted 2 cases (6.45%) of respiratory tract infection. Conclusions: Even though laparoscopic cholecystectomy requires a longer surgery, it reduces postoperative pain, and hospitalization. It also facilitates rapid recovery, a return to normal activity, avoids postoperative immunosuppression and shows a better postoperative morbidity compared to open surgery.
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