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The influence of laparoscopic surgery on postoperative polymorphonuclear leukocyte function
C Sietses1, M J Wiezer, Q A Eijsbouts
1Department of Surgery, Academic Hospital Vrije Universiteit, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Background:
Laparoscopic surgery is thought to result in a better preservation of patients' immunological defenses. Polymorphonuclear leukocytes (PMN) are the most important effector cells in the elimination of pathogenic microorganisms. Because little is known about their function after laparoscopic surgery, we studied PMN phagocytosis, antigen expression, and oxygen radical production.
Methods:
In this study, 17 patients scheduled for Nissen fundoplication were randomly assigned to undergo either a laparoscopic or conventional procedure. To study phagocytic capacity, PMN were incubated with fluorescein isothiocyanate (FITC)-labeled Staphylococcus aureus. Plasma opsonic capacity was measured by comparing PMN phagocytosis in the presence of patients' own plasma with phagocytosis in the presence of control plasma. Cellular activation was measured by the expression of various cell surface markers and by assessment of PMA-stimulated oxidative burst.
Results:
Phagocytosis by PMN in the presence of patients' plasma was significantly lower 2 h after the conventional operation. No decrease in phagocytosis was observed when control plasma was used, indicating a decreased opsonic capacity of plasma after conventional surgery. No changes were observed after laparoscopic surgery. Furthermore, CD11b expression was significantly lower after the laparoscopic approach, indicating a blunted cellular activation. A significantly lower PMA-stimulated oxidative burst further confirmed the tempered stimulation after laparoscopic surgery.
Conclusions:
Laparoscopic surgery results in a preservation of the plasma opsonic capacity, and thereby the ability of PMN to phagocytose bacteria. Moreover, the postoperative cellular activation is reduced. The preserved phagocytosis and the blunted activation may prevent the development of postoperative infectious complications.
Insights
Laparoscopic surgery preserves immune function by maintaining polymorphonuclear leukocyte (PMN) phagocytosis and reducing cellular activation. This contrasts with conventional surgery, potentially lowering infection risk.
Area of Science:
- Immunology
- Surgical Research
- Cellular Biology
Background:
- Laparoscopic surgery is hypothesized to better preserve patient immune defenses compared to conventional methods.
- Polymorphonuclear leukocytes (PMN) are critical for combating microbial infections.
- Limited data exists on PMN function following laparoscopic procedures.
Purpose of the Study:
- To investigate the impact of laparoscopic versus conventional surgery on PMN function.
- To assess changes in PMN phagocytosis, antigen expression, and oxidative burst post-surgery.
Main Methods:
- 17 patients undergoing Nissen fundoplication were randomized to laparoscopic or conventional surgery.
- PMN phagocytosis of Staphylococcus aureus was measured.
- Plasma opsonic capacity, cellular activation (CD11b expression), and oxidative burst were assessed.
Main Results:
- Conventional surgery significantly reduced PMN phagocytosis and plasma opsonic capacity.
- Laparoscopic surgery showed no significant decrease in PMN phagocytosis or opsonic capacity.
- Laparoscopic surgery resulted in blunted cellular activation, evidenced by lower CD11b expression and oxidative burst.
Conclusions:
- Laparoscopic surgery preserves plasma opsonic capacity, enhancing PMN bacterial phagocytosis.
- Postoperative cellular activation is reduced following laparoscopic procedures.
- These preserved immune functions may mitigate postoperative infectious complications.