title: The growth endocrine axis and inflammatory responses after laparoscopic cholecystectomy.
abstract: OBJECTIVE
  It is well known that conventional surgery leads to detrimental immune and catabolic responses, thus there is growing interest in the effect of minimally invasive techniques on postoperative endocrine and immune function. The aim of this prospective study was to evaluate the growth hormone (GH)/insulin-like growth factor-1 (IGF-1)/IGF binding protein-3 (IGFBP-3) axis and acute phase (interleukin-6, IL-6, and C-reactive protein, CRP) responses in patients who underwent laparoscopic cholecystectomy.
  
  
  METHODS
  Twenty-nine patients (16 women, 13 men; age: 58+8 years) with a history of uncomplicated symptomatic cholelithiasis participated in the study. Blood samples were collected prior to and at 24 hrs and 48 hrs after laparoscopic cholecystectomy. Serum concentrations of GH, IGF-1, IGFBP-3, and IL-6 were determined by standard sandwich enzyme-linked immunosorbent assay (ELISA), while CRP was measured by nephelometry. ANOVA with repeated measures and Tukey's post-hoc test were used to evaluate changes in serum measurements.
  
  
  RESULTS
  The laparoscopic cholecystectomy resulted in a significant postoperative increase in circulating levels of IL-6 (p=0.031), which is the main cytokine responsible for inducing the acute inflammatory response, and of the acute phase protein CRP (p=0.005). A significant increase in GH levels at 24 hrs (p=0.034) and decrease of IGF-1 on both postoperative days were also found (p=0.045, 0.044), while no changes were documented in IGFBP-3 levels. Significant correlations were revealed between postoperative levels of the acute phase proteins and growth axis hormones (p<0.05 - 0.001).
  
  
  CONCLUSIONS
  Our findings suggest that laparoscopic cholecystectomy induces acute phase endocrine and immune responses. These changes may represent a state of systemic inflammation and GH resistance, compatible with possible cytokine-induced anti-anabolic or catabolic effects even after this minimally invasive cholecystectomy.
authors.affiliation: 2nd Propaedeutic Department of Surgery, Laiko General Hospital, Athens, Greece.
authors.forename: Themistoklis
authors.initials: T
authors.lastname: Floros
authors.affiliation: Department of Experimental Physiology, Medical School, National and Kapodistrian University of Athens; Athens, Greece.
authors.forename: Anastassios
authors.initials: A
authors.lastname: Philippou
authors.affiliation: 2nd Propaedeutic Department of Surgery, Laiko General Hospital, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Bardakostas
authors.affiliation: 2nd Propaedeutic Department of Surgery, Laiko General Hospital, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Mantas
authors.affiliation: Department of Experimental Physiology, Medical School, National and Kapodistrian University of Athens; Athens, Greece.
authors.forename: Michael
authors.initials: M
authors.lastname: Koutsilieris
mesh_terms: D000209:Acute-Phase Proteins / Q000235:genetics / Q000378:metabolism*; D000368:Aged; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000601:surgery; D005260:Female; D005786:Gene Expression Regulation / Q000276:immunology; D013006:Growth Hormone / Q000378:metabolism*; D006801:Humans; D007249:Inflammation / Q000378:metabolism*; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000235:genetics / Q000378:metabolism*; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D008297:Male; D008875:Middle Aged
chemical_list: D000209:Acute-Phase Proteins; D018972:Insulin-Like Growth Factor Binding Protein 3; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone