LYMPHOCYTIC SUBPOPULATION CHANGES AFTER OPEN AND LAPAROSCOPIC CHOLECYSTECTOMY - A PROSPECTIVE AND COMPARATIVE-STUDY ON 38 PATIENTS

Up to now it has been unclear whether laparoscopic surgery has fewer i mmunosuppressive effects than traditional laparotomic procedures. In a series of 38 patients affected by symptomatic gallstone disease and o perated on either by laparoscopy (group 1) or by traditional open surg ery (group 2), we determined the postoperative changes in lymphocyte s ubpopulations up to postoperative day (POD) 30. We collected 15 mi of venous brood from all patients in both groups on the day before surger y and on POD 1, 7, 15, and 30. A control group (group 3) comprised 56 healthy volunteers; the control group was used only to ensure that bas eline values were totally comparable with a normal population; only on e blood sample was obtained from the subjects in group 3. Patients und ergoing open cholecystectomy had a significant decrease in total lymph ocyte count on POD 1. Basal levels of lymphocyte subpopulations did no t differ significantly in the study and control groups. No differences were found in the preoperative lymphocyte cell counts in the two grou ps who underwent cholecystectomy. Pan-T cells (CD3) showed a statistic ally significant marked reduction throughout the observation period. T he counts of helper (CD4), suppressor (CD8), and natural killer Mt (CD 16) T cells were reduced on POD 1; the NK cell (CD16) count remained l ow until POD 30. B lymphocytes showed no postoperative reduction. In p atients who underwent laparoscopic cholecystectomy, a significant post operative decrease in total lymphocyte count, and in CD3, CD4, and CD8 subpopulations was observed on day 1 only. There was no reduction in CD16 and CD19 subpopulations. A comparative statistical analysis of ly mphocyte subpopulations in the two groups was carried out: In the open cholecystectomy group, compared with the laparoscopy group, CD3, CD4, CD8, and CD16 lymphocyte subpopulations showed marked reductions at d ifferent time points. In particular, statistically significant differe nces were found in CD3 levels from POD 1 through POD 30, in CD4 from d ay 1 through day 7, and in CD8 and CD16 only on day 1.