LAPAROSCOPIC CHOLECYSTECTOMY DOES NOT PREVENT THE POSTOPERATIVE PROTEIN CATABOLIC RESPONSE IN MUSCLE

Objective The authors determined the effect of laparoscopic cholecyste ctomy on protein synthesis in skeletal muscle. In addition to a decrea se in muscle protein synthesis, after open cholecystectomy, the author s previously demonstrated a decrease in insulin sensitivity. This stud y on patients undergoing laparoscopic and open surgery, therefore, inc luded simultaneous measurements of protein synthesis and insulin sensi tivity. Summary Background Data Laparoscopy has become a routine techn ique for several operations because of postoperative benefits that all ow rapid recovery. However, its effect on postoperative protein catabo lism has not been characterized. Conventional laparotomy induces a dro p in muscle protein synthesis, whereas degradation is unaffected. Meth ods Patients were randomized to laparoscopic or open cholecystectomy, and the rate of protein synthesis in skeletal muscle was determined 24 hours postoperatively by the flooding technique using L-(H-2,)phenyla lanine, during a hyperinsulinemic normoglycemic clamp to assess insuli n sensitivity. Results The protein synthesis rate decreased by 28% (1. 77 +/- 0.11%/day vs. 1.26 +/- 0.08%/day, p < 0.01) in the laparoscopic group and by 20% (1.97 +/- 0.15%/day vs. 1.57 +/- 0.15%/day, p < 0.01 ) in the open cholecystectomy group. In contrast, the fail in insulin sensitivity after surgery was lower with laparoscopic (22 +/- 2%) comp ared with open surgery (49 +/- 5%). Conclusions Laparoscopic cholecyst ectomy did not avoid a substantial decline in muscle protein synthesis , despite improved insulin sensitivity. The change in the two paramete rs occurred independently, indicating different mechanisms controlling insulin sensitivity and muscle protein synthesis.