Immune function in patients undergoing open vs laparoscopic cholecystectomy
H. P. Redmond, R. W. Watson, T. Houghton, C. Condron, R. G. Watson and D. Bouchier-Hayes
Department of Surgery, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin.
BACKGROUND: Abnormal release of inflammatory mediators following surgical
injury is associated with immunological alteration, which may predispose to
sepsis. Laparoscopic surgery is associated with reduced postoperative
complications, but mechanisms are unclear. We hypothesized that early
recovery following laparoscopic surgery may relate to minimal impairment of
immune function. DESIGN: Analysis of the temporal immune responses in two
similar groups of patients randomized to open (n = 22) vs laparoscopic (n =
22) cholecystectomy. Patients were matched for age, height, weight, and
operation time. Immune parameters, including monocyte superoxide anion
(O2-) and tumor necrosis factor release, neutrophil O2- levels and
chemotaxis, total white blood cell counts, partial arterial oxygen
pressure, and serum cortisol and C-reactive protein levels were assessed
preoperatively and on postoperative days 1 and 3. RESULTS: There were
significant increases (P < .001) in monocyte release of O2- and tumor
necrosis factor, neutrophil release of O2- and chemotaxis, and white blood
cell count in the open vs laparoscopic cholecystectomy study groups, with a
concommitant decrease in partial arterial oxygen pressure. These findings
correlated with significantly higher postoperative septic complications in
the open cholecystectomy group (P < .05). There were no significant
differences in either plasma cortisol or C-reactive protein levels between
groups. All measurements were carried out in a blinded fashion.
CONCLUSIONS: This study demonstrates that laparoscopic surgery appears to
be associated with similar metabolic responses compared with open surgery,
while immune parameters vary greatly between groups. The beneficial effects
of laparoscopic surgery may relate, in part, to preservation of immune
function in the postoperative period.
