Evaluation of immune response in patients after open or laparoscopic cholecystectomy.
OBJECTIVE
Laparoscopic cholecystectomy is a so called mini-invasive surgical procedure, and on this basis, we investigated whether and how the immune response is modified in patients after laparoscopic cholecystectomy compared to patients who underwent open cholecystectomy.


METHODS
In a prospective, nonrandomized trial, 35 patients underwent laparoscopic cholecystectomy and 31 open cholecystectomy. Immune activity (neutrophils, total lymphocytes, lymphocyte subpopulations, human leukocyte antigen (HLA-DR), interleukin 6, skin Multitest) was evaluated before surgery and respectively, 1, 3, and 6 days postoperatively.


RESULTS
One day after surgery, an increase in interleukin 6 (P < 0.01) was noted in patients who had undergone open cholecystectomy, while this parameter was almost unchanged in patients with laparoscopic cholecystectomy. Moreover, skin tests showed a hypo or anergic response in the majority (81.8%) of open cholecystectomy patients compared to laparoscopic cholecystectomy patients (10.5%), (P < 0.01). Finally, monocyte antigen HLA-DR was also reduced in open cholecystectomy patients (P < 0.05). In this group, we noted 2 cases (6.45%) of respiratory tract infection.


CONCLUSIONS
Even though laparoscopic cholecystectomy requires a longer surgery, it reduces postoperative pain, and hospitalization. It also facilitates rapid recovery, a return to normal activity, avoids postoperative immunosuppression and shows a better postoperative morbidity compared to open surgery.
Schietroma
M
M
Department of Experimental Medicine, Universita degli Studi di L'Aquila, Via Vetoio, Blocco 11, Coppito, 67100 L'Aquila (AQ), Italy.
Carlei
F
F
Lezoche
E
E
Agnifili
A
A
Enang
G N
GN
Mattucci
S
S
Minervini
S
S
Lygidakis
N J
NJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006684:HLA-DR Antigens / Q000097:blood; D006801:Humans; D007108:Immune Tolerance / Q000276:immunology; D015850:Interleukin-6 / Q000097:blood*; D007428:Intradermal Tests; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology; D017562:Postcholecystectomy Syndrome / Q000276:immunology*; D012867:Skin / Q000276:immunology
D006684:HLA-DR Antigens; D015850:Interleukin-6