IMMUNOLOGICAL STATUS OF PATIENTS BEFORE AND AFTER LAPAROSCOPIC CHOLECYSTECTOMY

A number of immune complexes are known to become significantly altered following surgical stress, The degree of immunosuppression has been r eported to be less following laparoscopic cholecystectomy (LC) as comp ared to open cholecystectomy (OC). These complex immunological changes were therefore studied in 31 patients (10 male and 21 female) with un complicated gall-stones, undergoing either OC (n=15) or LC (n=16). The duration of symptoms and sex distribution were similar in the two gro ups, The OC group patients were relatively older than the LC group, Th e types of anaesthetic agents used and duration of surgery were also t he same in the two groups, Ten healthy volunteers were studied to serv e as control for the lymphocyte transformation test (LTT). Blood sampl es were drawn preoperatively and at various time intervals after surge ry, Both the humoral (immunoglobulins and complements) as well as cell ular components (LTT) of the immune system were studied, All patients with cholelithiasis were found to have significantly depressed LTT res ponse to mitogen in the preoperative period as compared to the control group. Immunoglobulin IgG and complement C-3 values fell significantl y immediately after surgery, in the OC group, These, however, returned to normal on the third post-operative day. LTT response in the OC gro up did not show any significant change from the preoperative value, In the LC group a significant drop following surgery was seen only in Ig G level. The LTT response on the other hand showed significant increas e following LC, The duration of surgery in the LC group (less than or equal to 90 vs >90 min) did not have any effect on immune parameters. The present study has thus confirmed that patients with gall-stones ha ve depressed immune status to start with, Following LC, the immune sta tus has been shown to be better than preoperative status and even quic kly returned to normal level while significant depression had persiste d following OC.