THE METABOLIC RESPONSE TO CHOLECYSTECTOMY - INSULIN-RESISTANCE AFTER OPEN COMPARED WITH LAPAROSCOPIC OPERATION

Objective. To study the changes in insulin sensitivity and plasma conc entrations of interleukin-6 (IL-6) after open compared with laparoscop ic cholecystectomy. Design: Prospective open study. Setting: Universit y hospital, Sweden. Subjects: 12 otherwise healthy patients undergoing either open (n = 6) or laparoscopic (n = 6) cholecystectomy. Main out come measure: Relative insulin sensitivity (compared with preoperative ) on the day after operation. Changes in IL-6 concentrations postopera tively. Results. The mean (SEM) relative reduction in insulin sensitiv ity was significantly smaller after laparoscopic (18 (5)%) compared wi th the open operation, (58 (4)%) (p < 0.01). There was a significant i ncrease in plasma concentrations of IL-6 postoperatively, but there wa s no difference between the groups. Conclusion. Insulin sensitivity is less affected 24 hours after laparoscopic than after open cholecystec tomy, which in this study was not accompanied by a simultaneous differ ence in the IL-6 response. The small postoperative reduction of insuli n sensitivity may be a contributing factor to the clinical benefit of improved wellbeing observed after laparoscopic surgery.