title: Laparoscopic cholecystectomy does not prevent the postoperative protein catabolic response in muscle.
abstract: OBJECTIVE
  The authors determined the effect of laparoscopic cholecystectomy on protein synthesis in skeletal muscle. In addition to a decrease in muscle protein synthesis, after open cholecystectomy, the authors previously demonstrated a decrease in insulin sensitivity. This study on patients undergoing laparoscopic and open surgery, therefore, included simultaneous measurements of protein synthesis and insulin sensitivity.
  
  
  BACKGROUND
  Laparoscopy has become a routine technique for several operations because of postoperative benefits that allow rapid recovery. However, its effect on postoperative protein catabolism has not been characterized. Conventional laparotomy induces a drop in muscle protein synthesis, whereas degradation is unaffected.
  
  
  METHODS
  Patients were randomized to laparoscopic or open cholecystectomy, and the rate of protein synthesis in skeletal muscle was determined 24 hours postoperatively by the flooding technique using L-(2H5)phenylalanine, during a hyperinsulinemic normoglycemic clamp to assess insulin sensitivity.
  
  
  RESULTS
  The protein synthesis rate decreased by 28% (1.77 +/- 0.11%/day vs. 1.26 +/- 0.08%/day, p < 0.01) in the laparoscopic group and by 20% (1.97 +/- 0.15%/day vs. 1.57 +/- 0.15%/day, p < 0.01) in the open cholecystectomy group. In contrast, the fall in insulin sensitivity after surgery was lower with laparoscopic (22 +/- 2%) compared with open surgery (49 +/- 5%).
  
  
  CONCLUSIONS
  Laparoscopic cholecystectomy did not avoid a substantial decline in muscle protein synthesis, despite improved insulin sensitivity. The change in the two parameters occurred independently, indicating different mechanisms controlling insulin sensitivity and muscle protein synthesis.
authors.affiliation: Department of Anesthesiology, Huddinge University Hospital, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Essén
authors.forename: A
authors.initials: A
authors.lastname: Thorell
authors.forename: M A
authors.initials: MA
authors.lastname: McNurlan
authors.forename: S
authors.initials: S
authors.lastname: Anderson
authors.forename: O
authors.initials: O
authors.lastname: Ljungqvist
authors.forename: J
authors.initials: J
authors.lastname: Wernerman
authors.forename: P J
authors.initials: PJ
authors.lastname: Garlick
mesh_terms: D000328:Adult; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D009124:Muscle Proteins / Q000096:biosynthesis*; D018482:Muscle, Skeletal / Q000378:metabolism*
chemical_list: D009124:Muscle Proteins