METABOLIC RESPONSES TO CHOLECYSTECTOMY - OPEN VS LAPAROSCOPIC APPROACH

Laparoscopic cholecystectomy is considered a minor surgical procedure. In a prospective, randomized study, we compared the metabolic respons es to surgery in two groups of patients submitted to open or laparosco pic cholecystectomy. The aim of the study was to verify if the latter caused less metabolic changes. Blood samples were drawn before the ope ration (basal), 1 h and 2 h after skin incision, and on the first and second postoperative days. The following parameters were studied: cort isol, renin, and leukocytes, including subpopulations. The mean values for age, weight, height, basal neutrophil and lymphocyte counts, basa l values of cortisol and renin of patients, and sex distribution of gr oup 1 patients (open, n = 20) matched with those for group 2 (laparosc opic, n = 20), with the exception of age (p < 0.05). No differences we re detected between the two groups in terms of cortisol and renin valu es. However, the neutrophil count Ih after skin incision was statistic ally significantly higher with the laparoscopic approach (p < 0.05). T he lymphocyte count on the second postoperative day was also statistic ally significantly higher in group 2 (p < 0.05). We conclude that when a cholecystectomy is performed, the laparoscopic approach has no adva ntage over the open approach from the standpoint of the metabolic resp onses we studied. It appears that leukocytes have a more rapid return to normal values after laparoscopic cholecystectomy. Although pneumope ritoneum is known to be responsible for important cardiorespiratory ch anges, no worse response was found in the laparoscopic group than in t he open group.