ENDOCRINE AND IMMUNE-RESPONSE TO INJURY AFTER OPEN AND LAPAROSCOPIC CHOLESTECTOMY

Background. There is clinical evidence that the surgical insult experi enced by patients who undergo laparoscopic cholecystectomy (LC) differ s significantly from that experienced by those undergoing open cholecy stectomy (OC), LC is accompanied by less pain, better ventilatory func tion and almost total absence of secondary paralytic ileus, The aim of the present study was to investigate the endocrine and immune respons e to the injury induced by both types of surgery. To this end, the rel ationship between levels of hormones of the hypothalamus-hypophysis-ad renal axis (indicators of stress) and cytokine levels was analyzed, Me thods. Blood samples from subjects undergoing either OC (n = 14) or LC (n = 14) were obtained 24 h before surgery and 24 h and 7 days after surgery. Serum concentrations of interleukin-6 (IL-6), interleukin-1 ( IL-1), interleukin-10 (IL-10) and prolactin were determined using enzy me-linked immunosorbent assay. Cortisol and GH concentrations were det ermined by radioimmunoassay, Results. Twenty-four hours after surgery, prolactin, GH and cortisol levels were higher than preoperative value s in both OC and LC groups. Seven days after surgery, cortisol and GH levels had normalized but prolactin levels were maintained. No signifi cant differences in hormone levels were detected between OC and LC gro ups. IL-6 levels were significantly higher in the OC group 7 days afte r intervention. Correlation analysis between levels of cytokines and h ormones indicated that prolactin, at concentrations exceeding physiolo gical values, regulates levels of IL-1 (p 0.3271, p < 0.05) and IL-6 ( p = 0.3765, p < 0.01),Although levels were similar in both groups, cor tisol was shown to exert weak but significant,linear control on IL-6 l evels (r = 0.4569, p < 0.001). Conclusions, A similar hormonal respons e to surgical insult was produced in patients subjected to OC and LC.I L-6 levels seem to be the most indicative of injury, Prolactin is the main hormone involved in the regulation of cytokines produced in respo nse to this type of stress and is thought to exert control over the pr oduction of IL-6.