INTERLEUKIN-6 RESPONSE TO LAPAROSCOPIC AND OPEN COLECTOMY

PURPOSE: It has been postulated that cortisol and interleukin-6 play a significant role in the modulation of the early inflammatory response following surgical intervention. There are no available data on the n ormal responses of these mediators following major laparoscopic proced ures. The purpose of this study was to assess changes in cortisol (by fluorescence polarization immunoassay), interleukin-6 (by enzyme-linke d immunoassay), and interleukin-1 (by enzyme-linked immunoassay) after elective laparoscopic colon resections. METHODS: All patients undergo ing colon resection between February 1, 1992 and April 30, 1992 were e ligible for study. Selection of laparoscopic (N = 12) vs. open (N = 41 ) resection was determined by the attending surgeon. All patients rece ived a standard general anesthetic with endotracheal intubation. Corti sol, interleukin-6, and interleukin-1 were measured at preinduction, 1 hour, 2 hours, 3 hours, 4 hours, and 5 hours after the induction. Int erleukin-1 and interleukin-1 were additionally measured at 12 hours, 2 4 hours, and 72 hours after induction. Comparisons were made between t he laparoscopic patients (N 12) and age, sex, and operation-matched op en patients (N = 12). RESULTS: Cortisol levels rose in the early posto perative period in both open and laparoscopic groups with no significa nt differences occurring between the cohorts at any of the measured ti me intervals. The interleukin-6 levels of the laparoscopic cohort (N = 12) were significantly lower than those of the open cohort (N = 12) b etween 3 and 24 hours postinduction (P < 0.05). Interleukin-l levels r emained undetectable in virtually all patients irrespective of operati ve technique or postoperative interval. There was no correlation beta een peak interleukin-G level and operative times (laparoscopic, r = 0. 31; open, r = 0.38) or blood loss (laparoscopic, r = 0.10; open, r = 0 .20). CONCLUSION: The results indicate that laparoscopic colon resecti ons do not appear to alter cortisol or interleukin-1 responses when co mpared with open colon resection. There is, however, a significant blu nting of the interleukin-6 response associated with the use of laparos copic techniques for colectomy compared with standard laparotomy.