Inflammation in laparoendoscopic single-site surgery versus laparoscopic cholecystectomy.
BACKGROUND
Laparoendoscopic single-site surgery (LESS) uses a multiple-entry portal in a single 3.0- to 4.0-cm incision in a natural scar, the umbilicus. The present study aimed to compare the inflammatory impact of classic video laparoscopic cholecystectomy (LC) versus LESS cholecystectomy.


METHODS
A prospective randomized controlled study was conducted from January to June 2011 at 2 university hospitals in Rio de Janeiro, Brazil. Fifty-seven patients (53 women, 4 men; mean age = 48.7 years) were randomly assigned to receive LC (n = 29) or LESS (n = 28) cholecystectomy. C-reactive protein (CRP) and interleukin 6 (IL-6) were measured from blood samples collected during induction of anesthesia and at 3 and 24 hours postoperatively.


RESULTS
Median IL-6 levels in the LESS and LC groups, respectively, were 2.96 and 4.5 pg/mL preoperatively, 11.6 and 28.05 pg/mL at 3 hours postoperatively (P = .029), and 13.18 and 15.1 pg/mL at 24 hours postoperatively (P = .52). Median CRP levels in the LESS and LC groups, respectively, were 0.33 and 0.44 mg/mL preoperatively, 0.40 and 0.45 mg/mL (P = .73) at 3 hours postoperatively, and 1.7 and 1.82 mg/mL (P = .84) at 24 hours postoperatively. We did not find a significant association between IL-6 (and CRP) and body mass index in the LESS group.


CONCLUSIONS
LESS cholecystectomy requires a larger size incision than LC. We found a tendency of less postoperative pain following LESS cholecystectomy than LC. There was also a tendency toward lower early inflammatory impact following LESS cholecystectomy versus LC.
Universidade Federal do Estado do Rio de Janeiro-UNIRIO, Rio de Janeiro, Brazil drfmadureira@hotmail.com.
Fernando Athayde Veloso
FA
Madureira
Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, Brazil.
José Eduardo Ferreira
JE
Manso
Pontifícia Universidade Católica-PUC, Rio de Janeiro, Brazil.
Delta
D
Madureira Filho
Universidade Federal do Estado do Rio de Janeiro-UNIRIO, Rio de Janeiro, Brazil.
Antonio Carlos Garrido
AC
Iglesias
D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D055815:Young Adult
LESS; acute-phase reaction; cholecystectomy; inflammation; interleukin-6; laparoscopy