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Influence of laparoscopic and conventional cholecystectomy upon cell-mediated immunity
J P Griffith1, N J Everitt, F Lancaster
1Leeds Institute for Minimally Invasive Therapy, General Infirmary, UK.
Insights
Laparoscopic cholecystectomy causes less immune suppression than open surgery. This study found T-lymphocyte proliferation was preserved after laparoscopic procedures, unlike open surgery, indicating better cell-mediated immunity.
Area of Science:
- Immunology
- Surgical Oncology
- Cellular Biology
Background:
- Surgery, trauma, and anesthesia can cause temporary immunosuppression.
- Laparoscopic cholecystectomy offers clinical benefits over traditional open surgery, potentially due to a smaller wound size and reduced acute phase response.
Purpose of the Study:
- To investigate the impact of laparoscopic versus open cholecystectomy on cell-mediated immunity.
- To compare T-lymphocyte proliferation and natural killer cell cytotoxicity between the two surgical methods.
Main Methods:
- Assessed T-lymphocyte proliferation using in vitro assays with mitogens (phytohaemagglutinin, staphylococcal enterotoxin B, toxic shock syndrome toxin).
- Measured natural killer (NK) cell cytotoxicity via a standard 51Cr release assay.
- Collected blood samples pre-operatively and 24 hours post-operatively from patients undergoing either laparoscopic (n=21) or open (n=13) cholecystectomy.
Main Results:
- Open cholecystectomy significantly depressed T-lymphocyte proliferation post-operatively (P < 0.002 to P = 0.01).
- Laparoscopic cholecystectomy did not significantly depress T-lymphocyte proliferation.
- A minor, statistically insignificant decrease in NK cell cytotoxicity was observed in both groups.
Conclusions:
- Laparoscopic cholecystectomy appears to cause less depression of cell-mediated immunity compared to open cholecystectomy.
- The findings suggest a potential immunological advantage for the laparoscopic approach in cholecystectomy patients.
Abstract:
Surgery, trauma and anaesthesia induce a state of transient immunosuppression. Laparoscopic cholecystectomy has several well documented clinical advantages over traditional cholecystectomy and provokes a lower acute phase response, thought to be a result of the smaller wound size. The influence of laparoscopic cholecystectomy (21 patients) and conventional open cholecystectomy (13 patients) upon components of the cell-mediated immune system was investigated. Cell-mediated immunity was studied by in vitro assays of T lymphocyte proliferation to different mitogens, and by natural killer cell cytotoxicity using a standard 51Cr release assay. Blood samples were taken before and 24 h after the start of the operation. In the sample taken after operation there was significant depression of T lymphocyte proliferation to phytohaemagglutinin (stimulation index 149.4 versus 33.3, P < 0.002), staphylococcal enterotoxin B (85.2 versus 52.6, P = 0.01) and toxic shock syndrome toxin (48.4 versus 14.8, P = 0.08) in the group of patients who underwent open surgery, but not in the group treated by laparoscopic surgery. There was a small but statistically insignificant decrease of natural killer cell cytotoxicity in both groups of patients. These findings suggest that laparoscopic cholecystectomy causes less depression of cell-mediated immunity than open cholecystectomy.
