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Inflammatory mediators and surgical trauma regarding laparoscopic access: neutrophil function
1Department of Experimental Surgery, University Medical School of Pécs, Hungary.
Abstract:
Polymorphonuclear leukocytes (PMN) are well recognised as being the principal cells in the inflammatory response reaction. The current investigation was designed to evaluate the stimulated state of neutrophils in patients undergoing open (OC) and laparoscopic cholecystectomy (LC). The superoxide radical generation of isolated PMN and its lag time, and PMN elastase were measured in peripheral venous blood samples collected from 42 patients. The observation period started on the day of hospital admission and ended on the 5 th day. Our results showed that although there were no characteristic changes in the superoxide radical production of PMN in the LC group, we found a marked depletion already by the first day in OC group which persisted during the whole observation period. There was an elevation of PMN elastase on the first postoperative day in both groups, but in the laparoscopically operated patients it decreased considerably on the 3rd postoperative day while in the OC group it maintained a high level. The same discrepancy was present between the two groups on the 5th day. Decreased free radical production of isolated PMN may reflect depleted neutrophil functional state, while changes of PMN elastase indicates increased harmful potential. These data suggest the differences in neutrophil activation between the two groups can be partially responsible for the better outcome in patients operated by laparoscopic cholecystectomy.
Insights
Laparoscopic cholecystectomy patients showed normal neutrophil function, unlike open surgery patients who had depleted neutrophils. This suggests differing neutrophil activation contributes to better outcomes in laparoscopic surgery.
Area of Science:
- Immunology
- Surgical Inflammation
Background:
- Polymorphonuclear leukocytes (PMN), or neutrophils, are key inflammatory response cells.
- Surgical procedures like cholecystectomy can significantly impact neutrophil function.
Purpose of the Study:
- To compare neutrophil activation in patients undergoing open cholecystectomy (OC) versus laparoscopic cholecystectomy (LC).
- To evaluate superoxide radical generation and PMN elastase levels post-surgery.
Main Methods:
- Blood samples were collected from 42 patients from admission to day 5 post-surgery.
- Measured superoxide radical generation, lag time, and PMN elastase in isolated PMN.
Main Results:
- Open cholecystectomy (OC) patients exhibited marked depletion in superoxide radical production from day 1 onwards.
- Both groups showed elevated PMN elastase post-surgery, but levels decreased by day 3 in the laparoscopic cholecystectomy (LC) group, while remaining high in the OC group.
- PMN elastase remained elevated longer in OC patients compared to LC patients.
Conclusions:
- Depleted neutrophil functional state in OC patients indicated by reduced free radical production.
- Elevated PMN elastase in OC patients suggests increased harmful potential.
- Differences in neutrophil activation may partly explain the better clinical outcomes observed in LC patients.