SYSTEMIC STRESS-RESPONSE AFTER LAPAROSCOPIC OR OPEN CHOLECYSTECTOMY -A RANDOMIZED TRIAL

Background Surgical injury induces a systemic endocrine-metabolic resp onse which is proportional to the severity of surgical stress. Laparos copic cholecystectomy is associated with a favourable clinical outcome compared with open cholecystectomy suggesting that surgical injury is reduced. Methods In a randomized clinical trial of 41 patients underg oing laparoscopic cholecystectomy and 42 patients undergoing open chol ecystectomy, the neuroendocrine and metabolic stress responses were co mpared. Plasma levels of cortisol, adrenaline, noradrenaline, glucose, interleukin (IL) 6 and C-reactive protein (CRP) were measured before, during and at 4, 8 and 24 h after operation. Results Plasma levels of cortisol and catecholamines increased during and after both laparosco pic and open cholecystectomy; however, their postoperative responses w ere significantly higher (P < 0.05) after open cholecystectomy. Glucos e, IL-6 and CRP levels also increased after operation and were signifi cantly higher (P < 0.05) in the open cholecystectomy group. Conclusion The neuroendocrine stress response and inflammatory response followin g laparoscopic cholecystectomy were significantly reduced compared wit h those after open cholecystectomy.