Minimal access surgery for cholelithiasis induces an attenuated acute phase response.
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.
Bruce
D M
DM
Department of Surgery, University of Aberdeen, Foresterhill, Scotland.
Smith
M
M
Walker
C B
CB
Heys
S D
SD
Binnie
N R
NR
Gough
D B
DB
Broom
J
J
Eremin
O
O
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
D000209:Acute-Phase Proteins; D016207:Cytokines