[Operative stress response and energy metabolism after laparoscopic cholecystectomy and open cholecystectomy].
OBJECTIVE
To determine the level of neurohormonal operative stress response-reactive protein (CRP) and rest energy expenditure (REE) after laparoscopic cholecystectomy (LC) and open cholecystectomy (OC).


METHODS
Twenty-six consecutive patients with noncomplicated gallstones were randomized for LC (n = 14) and OC (n = 12). Plasma concentrations of somatotropin, insulin, cortisol and CRP were measured. The levels of REE were also measured.


RESULTS
On the third postoperative day, the insulin levels were lower than those before operation (P < 0.05). On the first postoperative day, the levels of somatotropin and cortisol were higher in OC than in LC. After operation, the parameters of somatotropin, CRP and cortisol increased compared to the preoperative period in all patients (P < 0.05). On the all-postoperative day, the CRP levels were higher in OC than in LC (P < 0.05). After operation, the REE level increased in OC and LC (P < 0.05). On the all-postoperative day, the REE levels were higher in OC than in LC (P < 0.05).


CONCLUSIONS
LC results in less prominent stress response and smaller metabolic interference compared to open surgery. These benefit the restoration of stress hormones, nitrogen balance, and energy metabolism. However, LC can also induce acidemia and pulmonary hypoperfusion because of pneumoperitoneum during surgery.
Luo
Kai
K
Department of General Surgery, Nanjing General Hospital of People's Liberation Army, Nanjing 210002, China.
Li
Jieshou
J
Li
Lingtang
L
Wang
Gefei
G
Sun
Jinmei
J
Wu
Sumei
S
D000136:Acid-Base Equilibrium; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism; D002763:Cholecystectomy / Q000009:adverse effects*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D004734:Energy Metabolism; D005260:Female; D042882:Gallstones / Q000601:surgery; D013006:Growth Hormone / Q000097:blood; D006801:Humans; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011184:Postoperative Period; D013312:Stress, Physiological / Q000209:etiology* / Q000503:physiopathology; D013997:Time Factors
D007328:Insulin; D000324:Adrenocorticotropic Hormone; D013006:Growth Hormone; D002097:C-Reactive Protein