The laparoscopic approach reduces the endocrine response to elective cholecystectomy

The purpose of this study was to prospectively determine and compare the effect of laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC) on the neuroendocrine response to surgical trauma. Twenty-three evenly matched patients were assigned to either OC (11) or LC (12). Plasma concentrations of norepinephrine (NEPI), epinephrine (EPI), dopamine (DOPA), total catecholamine (TCAT), cortisol, and glucose were measured before and up to 9 hours after skin incision. Compared with preoperative values, significant (P < 0.05) increases in the plasma concentrations of catecholamines, cortisol, and glucose occurred shortly after skin incision following both LC and OC. Compared to post-incision values for OC patients, the increases in NEPI (3-9 hrs), EPI (2-9 hrs), DOPA (1-9 hrs), cortisol (4-9 hrs) and glucose (4-9 hrs) were significantly (P < 0.05) less following LC. Levels of these stress indicators returned to baseline by 4-5 hrs after LC but remained elevated for 9 hrs after OC. The laparoscopic approach results in a significantly reduced neuroendocrine response to surgical trauma following cholecystectomy. The laparoscopic technique may be the best surgical approach in critically ill patients requiring cholecystectomy or other intraabdominal procedures.