IMPACT OF LAPAROSCOPIC SURGERY ON STRESS RESPONSES, IMMUNOFUNCTION, AND RISK OF INFECTIOUS COMPLICATIONS

Open laparotomy is followed by profound changes in endocrine metabolic function and various host defense mechanisms, impaired pulmonary func tion, and hypoxemia, all of which may be important for the development of postoperative infectious complications. Laparoscopic surgery, howe ver, leads to a reduced inflammatory response (C-reactive protein and interleukin-6), a reduced immunomodulatory response, improvement in pu lmonary function, and less hypoxemia, whereas classic endocrine metabo lic responses are less influenced or not influenced compared with simi lar open operation. The clinical implications of laparoscopic surgery on postoperative infectious complications have not been assessed in la rge-scale prospective, randomized studies, except in appendectomy, in which a reduced incidence of wound infection has been demonstrated. Da ta from cholecystectomy and colorectal surgery suggest a reduction in wound complications, whereas the sparse data on intraperitoneal infect ions and sepsis are not conclusive. Thus, laparoscopic surgery modifie s the injury response and reduces the risk of infectious complications . If integrated into an accelerated rehabilitation program, further im provement may result. The impact of these findings on prophylactic ant ibiotic regimens cannot be assessed from available data and requires e valuation in prospective clinical studies.