Diminished interleukin-6 and C-reactive protein responses to laparoscopic versus open cholecystectomy

Background: Cytokines and their inhibitors are thought to be involved in ma ny of the pathophysiological changes associated with trauma and infection. The magnitude of the trauma and the degree of tissue damage have an impact on the trauma response. The purpose of the study was to examine cytokine an d hormonal responses to elective cholecystectomy and the extent to which th ese responses are influenced by the surgical procedure employed. Methods: Sixteen patients, ASA grades I and II,were studied: 8 of them unde rwent laparoscopic cholecystectomy while the remaining 8 were operated on u sing the open technique. Systemic concentrations of tumour necrosis factor alpha (TNF), interleukin-1 beta (IL-1), interleukin-6 (IL-6), cortisol, epi nephrine and norepinephrine were measured before and during the operation a nd subsequently for up to 48 h postoperatively. The degree of pain and fati gue were recorded during the study period. Results: The preoperative levels of cytokines and hormones were all similar in the groups. Concentrations of TNF and IL-1 were detected only sporadica lly. The rise in plasma IL-6 was less marked following laparoscopic than af ter open cholecystectomy. However, the hormonal response was quite similar in the two groups. Pain and fatigue scores were lower (P<0.05-0.01) in the laparoscopic group than in the open surgery group. Conclusion: In summary, cholecystectomy, irrespective of whether it was per formed using the laparoscopic or open technique, was followed by a trauma r esponse and increased pain and fatigue. However, Me magnitude of stress, pa in and fatigue was less pronounced in laparoscopic cholecystectomy patients . Concentrations of IL-6 seem to be more sensitive when it comes to delinea ting the trauma response than systemic norepinephrine and epinephrine level s.