Operative stress response and energy metabolism after laparoscopic cholecystectomy compared to open surgery.
OBJECTIVE
To determine the least invasive surgical procedure by comparing the levels of operative stress hormones, response-reactive protein (CRP) and rest energy expenditure (REE) after laparoscopic (LC) and open cholecystectomy (OC).


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


RESULTS
In the third postoperative day, the insulin levels were lower compared to that before operation (P<0.05). In the first postoperative day, the levels of somatotropin and cortisol were higher in OC than those in LC. After operation the parameters of somatotropin, CRP and cortisol increased, compared to those in the preoperative period in the all patients (P<0.05). In the all-postoperative days, the CRP level was higher in OC than that in LC (7.46+/-0.02; 7.38+/-0.01, P<0.05). After operation the REE level all increased in OC and LC (P<0.05). In the all-postoperative days, the REE level was higher in OC than that in LC (1438.5+/-418.5; 1222.3+/-180.8, P<0.05).


CONCLUSIONS
LC results in less prominent stress response and smaller metabolic interference compared to open surgery. These advantages are beneficial to the restoration of stress hormones, the nitrogen balance, and the energy metabolism. However, LC can also induce acidemia and pulmonary hypoperfusion because of the penumoperitonium it uses during surgery.
Luo
Kai
K
Research Institute of General Surgery, Nanjing General Hospital, Nanjing Command of People's Liberation Army, and Clinical School of Medical College, Nanjing University, Nanjing 210002, Jiangsu Province, China. lokai@jlonline.com
Li
Jie-Shou
JS
Li
Ling-Tang
LT
Wang
Kei-Hui
KH
Shun
Jing-Mei
JM
D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002245:Carbon Dioxide / Q000097:blood; D002763:Cholecystectomy / Q000009:adverse effects* / Q000379:methods; D004734:Energy Metabolism; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007328:Insulin / Q000097:blood; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D011183:Postoperative Complications; D011184:Postoperative Period; D013312:Stress, Physiological / Q000209:etiology* / Q000503:physiopathology; D013458:Sulfur Dioxide / Q000097:blood
D015415:Biomarkers; D007328:Insulin; D013458:Sulfur Dioxide; D002245:Carbon Dioxide; D002097:C-Reactive Protein; D010100:Oxygen; D006854:Hydrocortisone