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Systemic immune response after open versus laparoscopic cholecystectomy in acute cholecystitis: a prospective
Summary
Laparoscopic cholecystectomy results in less surgical trauma and immunosuppression compared to open surgery for acute cholecystitis. This leads to shorter hospital stays and reduced postoperative complications.
Area of Science:
- Immunology
- Surgical Oncology
- Gastroenterology
Background:
- Surgical trauma can impact systemic inflammation and immune response.
- Laparoscopic surgery is hypothesized to mitigate these effects compared to open procedures.
Purpose of the Study:
- To evaluate the influence of surgical trauma on systemic inflammation and immune response in acute cholecystitis.
- To compare laparoscopic cholecystectomy (LC) with open cholecystectomy (OC) regarding immunologic outcomes.
Main Methods:
- Thirty-three patients with acute calculous cholecystitis underwent either LC (n=18) or OC (n=15).
- Blood samples were analyzed preoperatively and on postoperative days 1 and 3 for C-reactive protein (CRP), leukocyte subpopulations, and ex vivo tumor necrosis factor-alpha (TNF-alpha) secretion by peripheral blood mononuclear cells (PBMCs).
Main Results:
- Hospitalization was significantly shorter in the LC group (3.7 days) versus the OC group (6.3 days).
- The OC group showed significantly lower postoperative TNF-alpha secretion, PBMC counts, CRP levels, and monocyte counts compared to the LC group.
- No postoperative morbidity was observed in the LC group, while two patients in the OC group experienced complications.
Conclusions:
- Laparoscopic surgery appears to induce less surgical trauma and immunosuppression in patients with acute cholecystitis.
- The findings suggest a potential benefit of the laparoscopic approach in modulating the inflammatory and immune response post-surgery.
