Systemic stress response after laparoscopic or open cholecystectomy: a randomized trial.
BACKGROUND
Surgical injury induces a systemic endocrine-metabolic response which is proportional to the severity of surgical stress. Laparoscopic cholecystectomy is associated with a favourable clinical outcome compared with open cholecystectomy suggesting that surgical injury is reduced.


METHODS
In a randomized clinical trial of 41 patients undergoing laparoscopic cholecystectomy and 42 patients undergoing open cholecystectomy, the neuroendocrine and metabolic stress responses were compared. Plasma levels of cortisol, adrenaline, noradrenaline, glucose, interleukin (IL) 6 and C-reactive protein (CRP) were measured before, during and at 4, 8 and 24 h after operation.


RESULTS
Plasma levels of cortisol and catecholamines increased during and after both laparoscopic and open cholecystectomy; however, their postoperative responses during and after both laparoscopic and open cholecystectomy; however, their postoperative responses were significantly higher (P < 0.05) after open cholecystectomy. Glucose, IL-6 and CRP levels also increased after operation and were significantly higher (P < 0.05) in the open cholecystectomy group.


CONCLUSIONS
The neuroendocrine stress response and inflammatory response following laparoscopic cholecystectomy were significantly reduced compared with those after open cholecystectomy.
Karayiannakis
A J
AJ
Second Propaedeutic Department of Surgery, University of Athens Medical School, Greece.
Makri
G G
GG
Mantzioka
A
A
Karousos
D
D
Karatzas
G
G
D001786:Blood Glucose / Q000378:metabolism; D016063:Blood Loss, Surgical; D002097:C-Reactive Protein / Q000378:metabolism; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic; D004837:Epinephrine / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D013312:Stress, Physiological / Q000097:blood / Q000503:physiopathology
D001786:Blood Glucose; D015850:Interleukin-6; D002097:C-Reactive Protein; D006854:Hydrocortisone; D004837:Epinephrine