Physiologic stress responses to laparoscopic cholecystectomy. A comparison of the gasless and pneumoperitoneal procedures.
BACKGROUND
Differences in the physiological stress response to pneumoperitoneal (PP) and gasless abdominal wall-lifting (AWL) procedures used for laparoscopic cholecystectomy have not been properly evaluated.


METHODS
We compared leukocyte count, interleukin-6 (IL-6) levels, arterial blood gases, creatinine clearance, plasma renin activity, cardiothoracic ratio, and clinical outcome in 27 patients without systemic complications who underwent laparoscopic cholecystectomy, including 11 by AWL and 16 by PP.


RESULTS
Transient leukocytosis and high IL-6 levels were observed at POD 1 (postoperative day) in both groups, but both values returned to baseline by POD 2. IL-6 levels correlated significantly with operation time (p < 0.01). Changes in blood gases, creatinine clearance, plasma renin activity, and cardiothoracic ratio were not different for the two groups. The clinical outcome was similar for both groups.


CONCLUSIONS
Our results indicate that both PP and AWL are appropriate for patients without serious complications.
Nanashima
A
A
The First Department of Surgery, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki, 8528501, Japan.
Yamaguchi
H
H
Tsuji
T
T
Yamaguchi
E
E
Sawai
T
T
Yasutake
T
T
Nakagoe
T
T
Ayabe
H
H
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001784:Blood Gas Analysis; D002303:Cardiac Output, Low; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000032:analysis*; D007677:Kidney Function Tests; D007964:Leukocytosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects* / Q000379:methods*; D011379:Prognosis; D013314:Stress, Mechanical; D016896:Treatment Outcome
D015850:Interleukin-6