THE LAPAROSCOPIC APPROACH REDUCES THE ENDOCRINE RESPONSE TO ELECTIVE CHOLECYSTECTOMY

The purpose of this study was to prospectively determine and compare t he effect of laparoscopic cholecystectomy (LC) versus open cholecystec tomy (OC) on the neuroendocrine response to surgical trauma. Twenty-th ree evenly matched patients were assigned to either OC (11) or LC (12) . Plasma concentrations of norepinephrine (NEPI), epinephrine (EPI), d opamine (DOPA), total catecholamine (TCAT), cortisol, and glucose were measured before and up to 9 hours after skin incision. Compared with preoperative values, significant (P < 0.05) increases in the plasma co ncentrations of catecholamines, cortisol, and glucose occurred shortly after skin incision following both LC and OC. Compared to post-incisi on values for OC patients, the increases in NEPI (3-9 hrs), EPI (2-9 h rs), DOPA (1-9 hrs), cortisol (4-9 hrs) and glucose (4-9 hrs) were sig nificantly (P < 0.05) less following LC. Levels of these stress indica tors returned to baseline by 4-5 hrs after LC but remained elevated fo r 9 hrs after OC. The laparoscopic approach results in a significantly reduced neuroendocrine response to surgical trauma following cholecys tectomy. The laparoscopic technique may be the best surgical approach in critically ill patients requiring cholecystectomy or other intraabd ominal procedures.