Postoperative hepatic catabolic stress response in patients with cirrhosisand chronic hepatitis

Open (OC) or laparoscopic (LC) cholecystectomy is considered a relative con traindication in patients with liver cirrhosis. The effect of LC and OC on the hepatic catabolic stress response was studied in patients with postnecr otic liver cirrhosis and chronic hepatitis to define the most suitable proc edure from a metabolic point of view. Altogether 14 patients with cirrhosis and 14 with chronic hepatitis were randomized to LC or OC (n = 7 in each g roup). The increase in the functional hepatic nitrogen clearance (FHNC) was quantified. Changes in glucose, insulin, glucagon, cortisol, epinephrine, norepinephrine, and prostaglandin E-2 (PGE(2)) were observed, There was no difference in FHNC between LC and OC in any of the patients. Among cirrhoti c patients OC caused a 132% increase in FHNC (p < 0.05) and among the hepat itis patients a 69% increase (p < 0.05), In contrast, there was no signific ant increase following LC in any of the patients. OC increased fasting gluc ose and insulin in the hepatitis patients (p < 0.01 and p < 0.001, respecti vely) and in the cirrhosis group (p < 0.01 and p < 0.05, respectively). Ala nine stimulation increased glucose in hepatitis patients after OC (p < 0.05 ) and after LC (p < 0.01). Stimulated glucagon increased after OC in the he patitis group (p < 0.05). During stimulation cortisol was higher following LC in hepatitis patients (p < 0.01) and cirrhotic patients (p < 0.05). Fast ing PGE(2) was downregulated after LC in hepatitis patients (p < 0.05) and cirrhotic patients (p < 0.01) and after OC in the hepatitis group (p < 0.00 1). FHNC is similar after LC and OC. Thus from a metabolic point of view, L C has no advantage over OC.