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Published on: April 3, 2017
Effects of laparoscopic and conventional (open) cholecystectomy on human leukocyte antigen-DR expression in
F Carlei1, M Schietroma, G Cianca
1Department of Experimental Medicine, University of L'Aquila, Via Vetoio, Coppito 2, Coppito, L'Aquila, Italy.
Insights
Laparoscopic cholecystectomy (LC) preserves immune function better than open surgery, reducing postoperative pain and infection risk. This minimally invasive approach avoids immunosuppression by conserving human leukocyte antigen-DR (HLA-DR) activity.
Area of Science:
- Immunology
- Surgical Research
- Minimally Invasive Surgery
Background:
- Surgery is known to suppress the immune system.
- Open cholecystectomy is a traditional surgical approach.
- Laparoscopic cholecystectomy (LC) is a minimally invasive alternative.
Purpose of the Study:
- To compare the impact of LC versus open cholecystectomy on immune responses.
- To evaluate changes in specific immune markers post-surgery.
- To assess postoperative morbidity and recovery associated with each surgical method.
Main Methods:
- Immune activity (neutrophils, lymphocytes, HLA-DR) was measured in 53 patients before and after surgery.
- 26 patients underwent open cholecystectomy, and 27 underwent LC.
- Immune parameters were assessed on postoperative days 1, 3, and 6.
Main Results:
- Open surgery patients showed increased neutrophils and reduced monocyte HLA-DR post-surgery.
- LC patients exhibited minimal changes in neutrophils and maintained HLA-DR levels.
- Two cases of respiratory tract infection occurred in the open surgery group.
Conclusions:
- LC significantly reduces postoperative pain, hospitalization, and infection rates compared to open surgery.
- LC preserves immune function, particularly HLA-DR activity, mitigating postoperative immunosuppression.
- Minimally invasive laparoscopic cholecystectomy promotes faster recovery and reduces overall morbidity.
Abstract:
It is well known that surgery significantly decreases immune responses. Laparoscopic cholecystectomy (LC) is a "miniinvasive" surgical procedure; and on the basis of this consideration we have investigated if and how the immune response is modified in patients after laparoscopic cholecystectomy compared to patients who underwent open cholecystectomy. Immune activity [neutrophils, total lymphocytes count, lymphocytes subpopulations, human leukocyte antigen-DR (HLA-DR)] was evaluated in 53 patients 1 day before surgery and respectively, 1, 3, and 6 days after surgery; 26 patients underwent "open" cholecystectomy and 27 LC. A day after surgery, patients with open cholecystectomy showed a significant increase (p < 0.05) in plasma neutrophils, while they were almost unchanged in LC patients. Monocyte antigen HLA-DR was reduced in patients with "open" cholecystectomy. We recorded two cases (7.6%) of respiratory tract infection in the "open" group. In conclusion, LC strongly reduces postoperative (p.o.) pain and hospitalization, and it promotes earlier recovery and return to normal activity, avoiding p.o. immunosuppression, mostly due to conservation of HLA-DR activity, with less p.o. morbidity compared to that seen with open surgery.
