title: Systemic and cell-mediated immune response after laparoscopic and open cholecystectomy in patients with chronic liver disease. A randomized, prospective study.
abstract: BACKGROUND
  As impaired immune function observed in cirrhotic patients is known to increase the risk of postoperative complications, the immunological response to surgery was investigated.
  
  
  METHODS
  Twenty-eight patients with postnecrotic liver cirrhosis or chronic hepatitis C and symptomatic gallstone disease were randomly allocated to laparoscopic (LC) or open cholecystectomy (OC). Changes in concentrations of cytokines (TNF-alpha, IL-1beta, IL-6, IL-8 and IL-10) were followed and the effect of surgical trauma on the distribution of lymphocyte subpopulations (CD3, CD4, CD8, CD16 and CD19) and NK cell cytotoxicity were measured.
  
  
  RESULTS
  After OC a decrease in circulating CD3 (p < 0.05) and CD4 (p < 0.05) and an increase in CD19 (p < 0.05) cells were detected in contrast to LC after which only CD16 cells decreased (p = 0.05). The number of CD3 cells was higher after LC than after OC (p < 0.01), whereas the number of CD19 cells was higher after OC than after LC (p < 0.01). NK cell cytotoxicity was reduced after LC (p < 0.05). In cirrhotic patients circulating cytokines were unaffected by OC, whereas TNF-alpha (p < 0.05) and IL-1beta (p < 0.05) were reduced after LC. In chronic hepatitis IL-1beta decreased after OC (p = 0.05) and IL-10 was significantly higher after LC than following OC (p < 0.05).
  
  
  CONCLUSIONS
  The immune response is less pronounced after a laparoscopic procedure compared to a conventional approach in patients with chronic liver disease.
authors.affiliation: Department of Surgery, Aarhus University Hospital, Denmark. gastlau@dadlnet.dk
authors.forename: S B
authors.initials: SB
authors.lastname: Lausten
authors.forename: T M
authors.initials: TM
authors.lastname: Ibrahim
authors.forename: T
authors.initials: T
authors.lastname: El-Sefi
authors.forename: L S
authors.initials: LS
authors.lastname: Jensen
authors.forename: B
authors.initials: B
authors.lastname: Gesser
authors.forename: C G
authors.initials: CG
authors.lastname: Larsen
authors.forename: E
authors.initials: E
authors.lastname: Tønnesen
authors.forename: S L
authors.initials: SL
authors.lastname: Jensen
mesh_terms: D000328:Adult; D000917:Antibody Formation / Q000276:immunology*; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000276:immunology / Q000601:surgery*; D016207:Cytokines / Q000097:blood; D003602:Cytotoxicity, Immunologic / Q000276:immunology; D005260:Female; D019694:Hepatitis B, Chronic / Q000276:immunology*; D019698:Hepatitis C, Chronic / Q000276:immunology*; D006801:Humans; D007108:Immune Tolerance / Q000276:immunology; D007111:Immunity, Cellular / Q000276:immunology*; D007694:Killer Cells, Natural / Q000276:immunology; D008103:Liver Cirrhosis / Q000276:immunology*; D016131:Lymphocyte Subsets / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000276:immunology*
chemical_list: D016207:Cytokines