title: Minimal access surgery for cholelithiasis induces an attenuated acute phase response.
abstract: BACKGROUND
  Some benefits of laparoscopic (LC) and minilaparotomy (MC) cholecystectomy may reflect attenuation of the acute phase response. The authors examined components of this response.
  
  
  METHODS
  Patients were randomized to LC (n = 11) or MC (n = 11). C-reactive protein (CRP), alpha-1-antitrypsin (AAT), retinol-binding protein (RBP), transferrin, and albumin were measured preoperatively and on postoperative days 1, 2, 4, and 7. Interleukin-1 receptor antagonist (IL-1ra), IL-6, and tumor necrosis factor (TNF-alpha) were measured more frequently perioperatively. Peak expiratory flow rate, forced expiratory volume in 1 second, and forced vital capacity were measured daily.
  
  
  RESULTS
  The IL-6 increase was more persistent and marked in the MC patients from hour 8 to day 7 postoperatively (P < 0.05). Alterations in CRP, AAT, and albumin were similar. Postoperative deficits of respiratory function correlated with the magnitude of acute phase protein alteration.
  
  
  CONCLUSIONS
  Minimal access surgery induces an acute phase response that is less prominent after a laparoscopic technique.
authors.affiliation: Department of Surgery, University of Aberdeen, Foresterhill, Scotland.
authors.forename: D M
authors.initials: DM
authors.lastname: Bruce
authors.forename: M
authors.initials: M
authors.lastname: Smith
authors.forename: C B
authors.initials: CB
authors.lastname: Walker
authors.forename: S D
authors.initials: SD
authors.lastname: Heys
authors.forename: N R
authors.initials: NR
authors.lastname: Binnie
authors.forename: D B
authors.initials: DB
authors.lastname: Gough
authors.forename: J
authors.initials: J
authors.lastname: Broom
authors.forename: O
authors.initials: O
authors.lastname: Eremin
mesh_terms: D000209:Acute-Phase Proteins / Q000032:analysis; D000210:Acute-Phase Reaction / Q000175:diagnosis / Q000517:prevention & control*; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000601:surgery; D002769:Cholelithiasis / Q000601:surgery; D016207:Cytokines / Q000097:blood; D006801:Humans; D007813:Laparotomy; D019060:Minimally Invasive Surgical Procedures; D012129:Respiratory Function Tests
chemical_list: D000209:Acute-Phase Proteins; D016207:Cytokines