Comparison of immune preservation between CO2 pneumoperitoneum and gasless abdominal lift laparoscopy.
OBJECTIVE
Carbon dioxide (CO2) pneumoperitoneum has been implicated as a possible factor in early immune preservation in laparoscopic surgery. Although the current analysis was not adequate to clarify this issue, the aim of this study was to compare CO2 insufflation laparoscopic cholecystectomy to gasless abdominal wall lift laparoscopic cholecystectomy with respect to preservation of the immune system.


METHODS
An analysis of the temporal immune responses was performed in 2 similar groups of patients (n = 50) who were divided randomly into the categories of gas or abdominal wall lift laparoscopic cholecystectomy. The patients were matched with respect to age, weight, and operation time. The immune parameters (serum white blood cell count, cortisol, erythrocyte sedimentation rate [ESR], tumor necrosis factor-alpha [TNF-alpha], interferon-y [INF-gamma], interleukin-6 [IL-6], interleukin-8 [IL-8]) were assessed at preoperative 24 hours and at postoperative 24 and 72 hours for the 2 groups. During the operation, the levels of cytokines that were cultured in the peritoneal macrophages were also checked.


RESULTS
The serum white blood cell count, cortisol, and ESR levels were not statistically different in either of the 2 groups. Further, the serum TNF-alpha, INF-gamma, IL-6, and IL-8 levels in both groups were not significantly different from each other at preoperative 24 hours, and postoperative 24 and 72 hours. However, an immediate decrease in the cytokine levels at 24 hours after the operation was significant in both groups. The cytokine levels were particularly higher in the cultured peritoneal macrophages than in the serum, but were not statistically different between the 2 groups.


CONCLUSIONS
Our results showed that the beneficial immune response obtained in the CO2 gas insufflation laparoscopic procedure could also be obtained in the gasless abdominal wall lift laparoscopic procedure. An immediate preservation of the immune functions in the postoperative period was detected similarly in the 2 groups.
Kim
Won Woo
WW
Department of Surgery, St. Mary's Hospital, The Catholic University of Korea, Seoul. lizk@chollian.net
Jeon
Hae Myung
HM
Park
Seung Chul
SC
Lee
Sang Kuon
SK
Chun
Sung Won
SW
Kim
Eung Kook
EK
D000328:Adult; D001799:Blood Sedimentation; D002245:Carbon Dioxide / Q000008:administration & dosage*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007109:Immunity; D010535:Laparoscopy / Q000379:methods*; D007958:Leukocyte Count; D017737:Macrophages, Peritoneal / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial
D016207:Cytokines; D002245:Carbon Dioxide; D006854:Hydrocortisone