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The metabolic response to cholecystectomy: insulin resistance after open compared with laparoscopic operation
1Department of Surgery, Karolinska Hospital & Institute, Stockholm, Sweden.
Objective:
To study the changes in insulin sensitivity and plasma concentrations of interleukin-6 (IL-6) after open compared with laparoscopic cholecystectomy.
Design:
Prospective open study.
Setting:
University hospital, Sweden.
Subjects:
12 otherwise healthy patients undergoing either open (n = 6) or laparoscopic (n = 6) cholecystectomy.
Main Outcome Measure:
Relative insulin sensitivity (compared with preoperative) on the day after operation. Changes in IL-6 concentrations postoperatively.
Results:
The mean (SEM) relative reduction in insulin sensitivity was significantly smaller after laparoscopic (18 (5)%) compared with the open operation, (58 (4)%) (p < 0.01). There was a significant increase in plasma concentrations of IL-6 postoperatively, but there was no difference between the groups.
Conclusion:
Insulin sensitivity is less affected 24 hours after laparoscopic than after open cholecystectomy, which in this study was not accompanied by a simultaneous difference in the IL-6 response. The small postoperative reduction of insulin sensitivity may be a contributing factor to the clinical benefit of improved wellbeing observed after laparoscopic surgery.