title: Inflammatory response to surgical trauma in patients with minilaparotomy cholecystectomy versus laparoscopic cholecystectomy: a randomised multicentre study.
abstract: OBJECTIVE
  The aim of the study was to evaluate the inflammatory response to surgical trauma in minilaparotomy cholecystectomy (MC) compared to laparoscopic cholecystectomy (LC). Assessment of inflammatory response to surgical trauma in MC has not been addressed properly. Therefore, we investigated five interleukins (IL) and C-reactive protein (CRP) in MC versus LC group in a prospective randomised trial.
  
  
  METHODS
  Initially, 106 patients with non-complicated symptomatic gallstone disease were randomised into MC (n = 56) or LC (n = 50) groups. Plasma levels of five interleukins (IL-1β, IL-1ra, IL-6, IL-8, IL-10) and hs-CRP were measured at three time points; before operation (PRE), immediately after operation (POP1) and six hours after operation (POP2). The primary end-point of the study was to compare the plasma levels of five interleukins and CRP in LC versus MC group.
  
  
  RESULTS
  The demographic variables and the surgical data were similar in the study groups. The patients in the MC group had higher elevation of the CRP mean values post-operatively (p = 0.01). However, the patients in the MC group had higher elevation of the IL-1ra mean values post-operatively, the mean pre-/post-operative IL-1ra values being 299/614 pg/ml in the MC group versus 379/439 pg/ml in the LC group (p = 0.003). There was no statistical significance in IL-6 mean values between the MC and LC groups pre- and post-operatively (POP1). However, the patients in the MC group had higher IL-6 mean values six hours post-operatively (POP2), the mean IL-6 values being 27.6 pg/ml in the MC group versus 14.8 pg/ml in the LC group (p = 0.037). In addition, the patients in the MC group had higher elevation of the IL-6 mean values post-operatively, the mean pre-/post-operative IL-6 values being 4.1/27.6 pg/ml in the MC group versus 3.8/14.8 pg/ml in the LC group (p = 0.04). There was no statistical significance in IL-8, IL-10, and IL-1β mean values between the MC and LC groups pre- and post-operatively.
  
  
  CONCLUSIONS
  Our results suggest that the inflammatory response in MC versus LC groups was similar based on the IL-8, IL-10, and IL-1β values. A new finding with possible clinical relevance in the present work is higher relative elevation of the IL-1ra and IL-6 mean values post-operatively in the MC group.
authors.affiliation: a Department of Surgery , Kuopio University Hospital and School of Medicine, University of Eastern Finland , Kuopio , Finland ;
authors.forename: Samuli
authors.initials: S
authors.lastname: Aspinen
authors.affiliation: a Department of Surgery , Kuopio University Hospital and School of Medicine, University of Eastern Finland , Kuopio , Finland ;
authors.forename: Mari
authors.initials: M
authors.lastname: Kinnunen
authors.affiliation: b Department of Surgery , Helsinki University Central Hospital , Helsinki , Finland ;
authors.forename: Jukka
authors.initials: J
authors.lastname: Harju
authors.affiliation: a Department of Surgery , Kuopio University Hospital and School of Medicine, University of Eastern Finland , Kuopio , Finland ;
authors.forename: Petri
authors.initials: P
authors.lastname: Juvonen
authors.affiliation: c Science Service Centre, Kuopio University Hospital , Kuopio , Finland ;
authors.forename: Tuomas
authors.initials: T
authors.lastname: Selander
authors.affiliation: d Department of Clinical Chemistry , Institute of Clinical Medicine, University of Eastern Finland and Eastern Finland Laboratory Centre , Kuopio , Finland ;
authors.forename: Anu
authors.initials: A
authors.lastname: Holopainen
authors.affiliation: e Department of Anaesthesia and Operative Services , Kuopio University Hospital and School of Medicine, University of Eastern Finland , Kuopio , Finland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Kokki
authors.affiliation: d Department of Clinical Chemistry , Institute of Clinical Medicine, University of Eastern Finland and Eastern Finland Laboratory Centre , Kuopio , Finland ;
authors.forename: Kari
authors.initials: K
authors.lastname: Pulkki
authors.affiliation: a Department of Surgery , Kuopio University Hospital and School of Medicine, University of Eastern Finland , Kuopio , Finland ;
authors.forename: Matti
authors.initials: M
authors.lastname: Eskelinen
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002763:Cholecystectomy / Q000379:methods; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D007378:Interleukins / Q000097:blood; D007813:Laparotomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D007378:Interleukins; D002097:C-Reactive Protein
keywords: Cholecystectomy; inflammatory response; laparoscopy; minilaparotomy