Granulocyte elastase and systemic cytokine response after laparoscopic-assisted and open resections in Crohn's disease

PURPOSE: The aim of this study was to assess whether systemic proinflammato ry cytokines (IL-6), anti-inflammatory cytokines (IL-4, IL-10), acute phase proteins (C-reactive protein), or granulocyte elastase are valuable indica tors for determining the degree of surgical trauma after open vs. laparosco pic-assisted resections in Crohn's disease. METHOD: Eleven patients in each group (open and laparoscopic-assisted surgery) mere matched for indication , surgical procedure, and Crohn's disease activity index. Serum IL-4, IL-6, and IL-10 were measured using enzyme-linked immunosorbent assay. Serum C-r eactive protein was determined by immunoturbidimetric assay. Plasma granulo cyte elastase was determined by immunoactivation immunoassay. Blood was sam pled preoperatively, six hours after the operation, and at postoperative Da ys 1 to 5. RESULTS: IL-4 was not detectable in any sample analyzed. Serum I L-6 and IL-10 levels peaked postoperatively in both groups without signific ant differences between laparoscopic-assisted (185.6 +/- 54.1 pg/ml and 112 .1 +/- 19.4 pg/ml, respectively; mean +/- standard error of the mean) and o pen surgery (431.1 +/- 240.4 pg/ml and 196.7 +/- 56.5 pg/ml, respectively). Serum C-reactive protein levels also rose postoperatively with a peak on t he second day, but showed similar values after laparoscopic-assisted (107.1 +/- 12.1 mg/l) and open (128.3 +/- 17.5 mg/l) surgery. Plasma granulocyte elastase levels peaked on the first and second postoperative day and were f ound elevated almost throughout the five-day observation period. Comparison between the groups revealed significantly (P < 0.02) lower values after la paroscopic-assisted (Day 1, 46.5 +/- 8.9 mu g/l; Day 2, 41.9 +/- 5.9 mu g/l ) when compared with open surgery (Day 1, 89.7 +/- 13.8 mu g/l; Day 2, 91.4 +/- 14). CONCLUSIONS: Serum IL-6 and IL-10 may not be ideal measures for e valuation of the degree of tissue trauma in laparoscopic-assisted and open resections in Crohn's disease, probably because of interference with diseas e-specific cytokine interactions. In contrast, granulocyte elastase has to be considered a strong marker discriminating the different severity of surg ical trauma induced by laparoscopic-assisted vs. open resection in Crohn's disease.