Cytokine activation in patients undergoing open or laparoscopic cholecystectomy

Laparoscopic surgery is estimated to produce a minor surgical injury in comparison with open and laparoscopic cholecystectomies. Studies in the past compare almost data of the first hours until day two. However, the surgical injury and the wound healing metabolism has to be detected.

A prospective study was designed to investigate cytokine responses after surgical injury. Twenty-three patients with symptomatic cholelithiasis were admitted to the study. Eleven patients underwent conventional (open) and twelve patients laparoscopic cholecystectomy. Circulating concentrations of cytokines-including Interleukin-6 (IL-6), Tumor necrosis factor-alpha (TNF-alpha) and neopterin, were compared between both groups. In addition, association of the cytokines with clinical parameters including leucocytes, urea, fever and C-reactive protein (CRP) were assessed. We are using ELISA-test of Medgenix GmbH, Ratingen, Germany and BRAHMS Diagnostica, Berlin, Germany.

Enhanced cytokine responses were observed in the conventional group compared to the laparoscopic group. On day 3 after operation, the second increase in cytokine levels (but smaller than the first increase) were observed in both groups. In the conventional group, a slightly high correlation ratio between the urea and cytokine levels was found. However, only neopterin and urea association on postoperative day 3 (r = 0.65) was significant (p < 0.05). There was no significant association between CRP and cytokine levels in both groups.

Cytokine response after cholecystectomy demonstrates the lesser degree of surgical injury in the laparoscopic group, however, TNF-alpha demonstrates on day 4 a similar increase in both groups. This is a new result of studies working in this field. In conclusion, the benefit of laparoscopic surgery results only in the minimal access to the abdominal cavity, the wound healing metabolism is at last the same in both groups.