ACUTE-PHASE IS THE ONLY SIGNIFICANTLY REDUCED COMPONENT OF THE INJURYRESPONSE AFTER LAPAROSCOPIC CHOLECYSTECTOMY

The objective demonstration of improved postoperative recovery suggest s that (he surgical injury response induced by the laparoscopic approa ch is less intense than that after open surgery, Twenty-five patients diagnosed as having noncomplicated gallstones were studied prospective ly. They were operated by laparoscopy (group I, n = 12) or open surger y (group II, n = 13). Analgesia requirements (p < 0.026) and postopera tive stay (p < 0.001) were significantly less in group I. Cholecystect omy performed by either technical options induced a significant increa se over basal values of glucose, lactate, white blood cell count, prol actin, ACTH, cortisol, interleukin 6, C-reactive protein, and PCO2, Bo th surgical procedures induced a significant reduction of total protei ns, albumin, prealbumin, free fatty acids hemoglobin, hematocrit, and pH. There were no differences between the levels of growth hormone, in sulin, glucagon, or PO2 during any of the periods studied. Comparison of tile results of the two cholecystectomy techniques showed that lapa roscopic cholecystectomy induced a significantly less intense acute-ph ase response (area under the curve) of interleukin 6 (17 +/- 17 versus 47 +/- 26 pg/ml x hr x 10(2); p < 0.003), C-reactive protein (16 +/- 13 versus 35 +/- IG mg/dl x hr x 10(2);li < 0.001), and prealbumin (16 +/- 2.7 versus 13.8 +/- 2.3 mg/dl x hr x 10(2); p < 0.05). The surgic al injury response after laparoscopic cholecystectomy is similar to th at after open cholecystectomy, but the acute-phase response component is less intense, This finding mag he a consequence of the reduced size of the operative wound with laparoscopic cholecystectomy.