Influence of laparoscopic and conventional cholecystectomy upon cell-mediated immunity.
Surgery, trauma and anaesthesia induce a state of transient immunosuppression. Laparoscopic cholecystectomy has several well documented clinical advantages over traditional cholecystectomy and provokes a lower acute phase response, thought to be a result of the smaller wound size. The influence of laparoscopic cholecystectomy (21 patients) and conventional open cholecystectomy (13 patients) upon components of the cell-mediated immune system was investigated. Cell-mediated immunity was studied by in vitro assays of T lymphocyte proliferation to different mitogens, and by natural killer cell cytotoxicity using a standard 51Cr release assay. Blood samples were taken before and 24 h after the start of the operation. In the sample taken after operation there was significant depression of T lymphocyte proliferation to phytohaemagglutinin (stimulation index 149.4 versus 33.3, P < 0.002), staphylococcal enterotoxin B (85.2 versus 52.6, P = 0.01) and toxic shock syndrome toxin (48.4 versus 14.8, P = 0.08) in the group of patients who underwent open surgery, but not in the group treated by laparoscopic surgery. There was a small but statistically insignificant decrease of natural killer cell cytotoxicity in both groups of patients. These findings suggest that laparoscopic cholecystectomy causes less depression of cell-mediated immunity than open cholecystectomy.
Griffith
J P
JP
Leeds Institute for Minimally Invasive Therapy, General Infirmary, UK.
Everitt
N J
NJ
Lancaster
F
F
Boylston
A
A
Richards
S J
SJ
Scott
C S
CS
Benson
E A
EA
Sue-Ling
H M
HM
McMahon
M J
MJ
D000328:Adult; D000368:Aged; D002455:Cell Division; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006801:Humans; D007108:Immune Tolerance; D007111:Immunity, Cellular; D007694:Killer Cells, Natural / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011300:Preoperative Care; D013601:T-Lymphocytes / Q000276:immunology* / Q000473:pathology