INFLUENCE OF LAPAROSCOPIC AND CONVENTIONAL CHOLECYSTECTOMY UPON CELL-MEDIATED-IMMUNITY

Surgery, trauma and anaesthesia induce a state of transient immunosupp ression. Laparoscopic cholecystectomy has several well documented adva ntages over traditional cholecystectomy and provokes a lower acute pha se response, thought to be a result of the smaller wound size. The inf luence of laparoscopic cholecystectomy (21 patients) and conventional open cholecystectomy (13 patients) upon components of the cell-mediate d immune system was investigated. Cell-mediated immunity was studied b y in vitro assays of T lymphocyte proliferation to different mitogens, and by natural killer cell cytotoxicity using a standard Cr-51 releas e assay. Blood samples were taken before and 24 h after the start of t he operation. In the sample taken after operation there was significan t depression ofT lymphocyte proliferation to phytohaemagglutinin (stim ulation index 149.4 versus 33.3, P<0.002), staphylococcal enterotoxin B (85.2 versus 52.6, P=0.01) and toxic shock syndrome toxin (48.4 vers us 14.8, P=0.08) in the group of patients who underwent open surgery, but not in the group treated by laparoscopic surgery. There was a smal l but statistically insignificant decrease of natural killer cell cyto toxicity in both groups of patients. These findings suggest that lapar oscopic cholecystectomy causes less depression of cell-mediated immuni ty than open cholecystectomy.