Systemic and cell-mediated immune response after laparoscopic and open cholecystectomy in patients with chronic liver disease - A randomized, prospective study

Background: As impaired immune function observed in cirrhotic patients is k nown to increase the risk of postoperative complications, the immunological response to surgery was investigated. Methods: Twenty-eight patients with postnecrotic liver cirrhosis or chronic hepatitis C and symptomatic gallsto ne disease were randomly allocated to laparoscopic (LC) or open cholecystec tomy (OC). Changes in concentrations of cytokines (TNF-alpha, IL-1 beta, IL -6, IL-8 and IL-10) were followed and the effect of surgical trauma on the distribution of lymphocyte subpopulations (CD3, CD4, CD8, CD16 and CD19) an d NK cell cytotoxicity were measured. Results: After OC a decrease in circu lating CD3 (p < 0.05) and CD4 (p < 0.05) and an increase in CD19 (p < 0.05) cells were detected in contrast to LC after which only CD16 cells decrease d (p = 0.05). The number of CD3 cells was higher after LC than after OC (p < 0.01), whereas the number of CD19 cells was higher after OC than after LC (p < 0.01). NK cell cytotoxicity was reduced after LC (p < 0.05). In cirrh otic patients circulating cytokines were unaffected by OC, whereas TNF-alph a (p < 0.05) and IL-1 beta (p < 0.05) were reduced after LC. In chronic hep atitis IL-1 beta decreased after OC (p = 0.05) and IL-10 was significantly higher after LC than following OC (p < 0.05). Conclusion: The immune respon se is less pronounced after a laparoscopic procedure compared to a conventi onal approach in patients with chronic liver disease. Copyright (C) 1999 S. Karger AG, Basel.