Comparative evaluation of the inflammatory mediators in patients undergoing laparoscopic versus conventional cholecystectomy

Background: Injury induces systemic inflammatory response. The degree of re sponse is proportionate to the trauma. Methods: Patients with ultrasound-proven gall stones posted for operation w ere randomized into two groups. Laparoscopic cholecystectomy was performed in one group while the other group underwent conventional cholecystectomy. Peripheral venous blood samples for inflammatory mediators, namely tumour n ecrosis factor, C-reactive protein, oxygen release from monocytes and polym orphonuclear leucocytes were drawn I day before surgery and repeated on the first and third days after surgery. Partial pressure of arterial oxygen wa s also measured in both groups. Only patients who met selection criteria an d had uncomplicated postoperative courses were included in the study. There was a total of 40 patients for the final analysis, 20 in each group. Results: There was no significant difference (P > 0.1) in age, sex or body mass index in both groups of patients. The level of all of the inflammatory mediators was elevated on the first postoperative day; however, the elevat ion was significantly less following laparoscopic cholecystectomy compared to conventional cholecystectomy (P < 0.01). Although the values came down o n the third postoperative day, they remained above the respective controls. Postoperative hypoxaemia was significantly more in patients of conventiona l than laparoscopic cholecystectomy (P < 0.001). Conclusions: Trauma-induced inflammatory response is significantly less fol lowing laparoscopic cholecystectomy compared to conventional cholecystectom y. It appears to be related to degree of trauma.