title: Ultrasonic versus standard electric dissection in laparoscopic cholecystectomy in patients with acute calculous cholecystitis, complicated by peritonitis: influence on the postoperative systemic inflammation and immune response. A prospective randomized study.
abstract: BACKGROUND
  Ultrasonic surgery can dissect structures and divide vessels by the effect produced by vibrations in the tissues. It is believed to be less traumatic than the more commonly used monopolar electrosurgery (ELC). Laparoscopic techniques are being used increasingly in surgical conditions complicated by peritonitis. This randomized study compares the acute inflammatory and systemic immune response after laparoscopic cholecystectomy in patients with acute calculous cholecystitis, complicated by peritonitis, performed using either ultrasonic energy or ELC.
  
  
  METHODS
  Forty-three patients, scheduled for laparoscopic cholecystectomy, were randomly assigned to treatment using either an ultrasonic device (UC) (n=22 patients) or ELC (n=21 patients). Bacteremia, endotoxemia, white blood cells, the peripheral lymphocyte subpopulation, human leukocyte antigen-DR (HLA-DR), neutrophil-elastase, interleukin-6 and -1, and C-reactive protein (CRP) were investigated.
  
  
  RESULTS
  Significantly higher concentration of systemic endotoxin, neutrophil, neutrophil-elastase, interleukin-6 and -1, and CRP were detected intraoperatively and/or postoperatively in the ELC group of patients in comparison with the UC group (P<.05). A statistically significant change in HLA-DR expression was recorded on postoperative Day 1 as a reduction of this antigen expressed on the monocyte surface in patients from the ELC group; no changes were noted in UC patients (P<.05). We recorded 4 patients (22.2%) who developed an intraabdominal abscess in the ELC group and 1 (4%) in the UC group (P<.05).
  
  
  CONCLUSIONS
  Laparoscopic cholecystectomy after biliary peritonitis, conducted by ELC, increased the incidence of bacteremia and systemic inflammation compared with the UC group. Early enhanced postoperative systemic inflammation may cause lower transient immunologic defense in the ELC group, leading to enhanced sepsis.
authors.affiliation: Department of Surgery, University of L'Aquila , L'Aquila, Italy .
authors.forename: Federico
authors.initials: F
authors.lastname: Sista
authors.forename: Mario
authors.initials: M
authors.lastname: Schietroma
authors.forename: Valentina
authors.initials: V
authors.lastname: Abruzzese
authors.forename: Zuleyca
authors.initials: Z
authors.lastname: Bianchi
authors.forename: Francesco
authors.initials: F
authors.lastname: Carlei
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Santis
authors.forename: Emanuela Marina
authors.initials: EM
authors.lastname: Cecilia
authors.forename: Beatrice
authors.initials: B
authors.lastname: Pessia
authors.forename: Federica
authors.initials: F
authors.lastname: Piccione
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Amicucci
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D041881:Cholecystitis, Acute / Q000150:complications* / Q000601:surgery*; D004210:Dissection / Q000379:methods*; D004598:Electrosurgery / Q000379:methods*; D005260:Female; D042882:Gallstones / Q000150:complications*; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology; D011446:Prospective Studies; D014464:Ultrasonic Therapy / Q000379:methods*