title: Changes in T-lymphocytes' viability after laparoscopic versus open cholecystectomy.
abstract: Laparoscopic surgery results in decreased immune and metabolic stress response compared to open surgery. Our aim was to evaluate the suspension of host immune defense in terms of apoptosis, necrosis, and survival of peripheral T-lymphocytes in patients undergoing laparoscopic versus open cholecystectomy. Apoptosis, necrosis and viability of peripheral T-lymphocytes were measured preoperatively and postoperatively by means of flow cytometry in 27 patients undergoing laparoscopic cholecystectomy and 25 undergoing open cholecystectomy. White cell count, CRP, and serum glucose levels were also measured. Viable peripheral T-lymphocytes were significantly decreased in open cholecystectomy (P = 0.02), while their late apoptotic as well as the overall necrotic rate were significantly increased (P = 0.01 and P < 0.01, respectively). Open cholecystectomy was also associated with lower levels of surviving circulating T-lymphocytes (P = 0.01) and higher percentage of necrotic T lymphocytes (P = 0.03) 24 hours postoperatively compared to laparoscopic cholecystectomy. Serum CRP was increased 24 hours after open cholecystectomy (P = 0.04). All differences failed to sustain more than 48 hours postoperatively. Increased viability and decreased necrosis of circulating T-lymphocytes were observed in laparoscopic cholecystectomy. Necrosis (and not apoptosis) seems to be the predominant pathway of T-lymphocyte death in open cholecystectomy, in a process reaching its peak at 24 hours and further attenuating 48 hours postoperatively.
authors: Laboratory of Surgical Research, 1st Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece.
authors: Ilias P
authors: IP
authors: Gomatos
authors: Leonidas
authors: L
authors: Alevizos
authors: Olga
authors: O
authors: Kalathaki
authors: Harilaos
authors: H
authors: Kantsos
authors: Agapi
authors: A
authors: Kataki
authors: Emmanuel
authors: E
authors: Leandros
authors: George
authors: G
authors: Zografos
authors: Manousos
authors: M
authors: Konstantoulakis
mesh_terms: D017209:Apoptosis; D001786:Blood Glucose / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis; D002763:Cholecystectomy / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D013601:T-Lymphocytes / Q000276:immunology* / Q000473:pathology*
chemical_list: D001786:Blood Glucose; D002097:C-Reactive Protein
keywords: Apoptosis; Flow cytometry; Immune response; Laparoscopic cholecystectomy; Necrosis; Open cholecystectomy; T-lymphocytes