Effects of laparoscopic and conventional (open) cholecystectomy on human leukocyte antigen-DR expression in peripheral blood monocytes: Correlations with immunologic status

It is well known that surgery significantly decreases immune responses. Lap aroscopic cholecystectomy (LC) is a "miniinvasive" surgical procedure; and on the basis of this consideration we have investigated if and how the immu ne response is modified in patients after laparoscopic cholecystectomy comp ared to patients who underwent open cholecystectomy. Immune activity [neutr ophils, total lymphocytes count, lymphocytes subpopulations, human leukocyt e antigen-DR (HLA-DR)] was evaluated in 53 patients 1 day before surgery an d respectively, 1, 3, and 6 days after surgery; 26 patients underwent "open " cholecystectomy and 27 LC. A day after surgery, patients with open cholec ystectomy showed a significant increase (p < 0.05) in plasma neutrophils, w hile they were almost unchanged in LC patients. Monocyte antigen HLA-DR was reduced in patients with "open" cholecystectomy. We recorded two cases (7. 6%) of respiratory tract infection in the "open" group. In conclusion, LC s trongly reduces postoperative (p.o.) pain and hospitalization, and it promo tes earlier recovery and return to normal activity, avoiding p.o. immunosup pression, mostly due to conservation of HLA-DR activity, with less p.o. mor bidity compared to that seen with open surgery.