Stress response to laparoscopic surgery: a review.
BACKGROUND
Laparoscopic surgery is associated with reduced surgical trauma, and therefore with a less acute phase response, as compared with open surgery. Impairment of the immune system may enhance surgical infections, port-site metastases, and sepsis. The objectives of this review was to assess immunologic consequences of benign laparoscopic surgery and to highlight controversial aspects.


METHODS
A literature search on stress response to nonmalignant laparoscopic and open surgery was conducted using the MEDLINE and Cochrane databases. Cross-references from the reference list of major articles on the subject were used, as well as manuscripts published between 1993 and 2002.


RESULTS
Local (i.e., peritoneal) immune function is affected by carbon dioxide pneumoperitoneum. The production of tumor necrosis factor and the phagocytotic capacity of peritoneal macrophages are less lowered. The systemic stress response, as determined by delayed-type hypersensitivity response and leukocyte antigen expression on lymphocytes, shows a preservation of immune function after laparoscopic surgery, as compared with conventional surgery.


CONCLUSIONS
Intraperitoneal carbon dioxide insufflation attenuates peritoneal immunity, but laparoscopic surgery is associated with a lower systemic stress response than open surgery.
Buunen
M
M
Department of Surgery, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
Gholghesaei
M
M
Veldkamp
R
R
Meijer
D W
DW
Bonjer
H J
HJ
Bouvy
N D
ND
D000210:Acute-Phase Reaction / Q000209:etiology / Q000276:immunology; D016516:CD4-CD8 Ratio; D002245:Carbon Dioxide / Q000008:administration & dosage / Q000009:adverse effects; D006684:HLA-DR Antigens / Q000096:biosynthesis; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000209:etiology / Q000276:immunology; D007111:Immunity, Cellular; D007378:Interleukins / Q000096:biosynthesis; D010535:Laparoscopy / Q000009:adverse effects*; D008262:Macrophage Activation; D017737:Macrophages, Peritoneal / Q000502:physiology; D018448:Models, Immunological; D010587:Phagocytosis; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D013312:Stress, Physiological / Q000209:etiology* / Q000276:immunology; D014409:Tumor Necrosis Factor-alpha / Q000096:biosynthesis
D006684:HLA-DR Antigens; D007378:Interleukins; D014409:Tumor Necrosis Factor-alpha; D002245:Carbon Dioxide