Metabolic and inflammatory responses after open or laparoscopic cholecystectomy

Abstract

Metabolic and inflammatory responses and changes in fatigue were studied in groups of patients undergoing either laparoscopic (n = 14) or open (n = 10) elective cholecystectomy. The mean(s.e.m.) cortisol concentration was significantly (P<0·001) increased from 342(80) and 424(91) nmol l−1 before operation to 895(46) and 966(53) nmol l−1 after surgery in patients undergoing laparoscopic and open cholecystectomy respectively. There was no difference in cortisol response between the groups. Glucose concentration was increased (P < 0·02) at the end of surgery from mean(s.e.m.) preoperative levels of 5·54(0·15) and 6·16(0·15) mmol l−1 to postoperative values of 7·46(0·29) and 8·46(0·86) mmol−1 for the laparoscopic and open procedures respectively. The mean glucose concentration during the initial 12 h after surgery was significantly greater (P < 0·02) following open than laparoscopic cholecystectomy. The mean(s.e.m.) albumin concentration fell significantly (P < 0·01) during surgery by an equivalent extent from 38·9(0·77) and 38·5(1·10) g l−1 to 35·2(0·79) and 34·6(0·97) g l−1. The mean (95 per cent confidence interval) interleukin (IL) 6 concentration peaked 4 h after surgery at 57·2 (44·6–73·4) pg ml−1 following laparoscopic and 99·3 (72·8–135·4) pg ml−1 after open cholecystectomy. Mean (95 per cent confidence interval) C-reactive protein (CRP) levels at 24 h were 17·0 (12·7–21·2) and 49·0 (25·3–93·6) mg l−1 and at 48 h 28·0 (21·4–35·4) and 70·0 (36·4–133·6) mg l−1 following laparoscopic and open operations. The differences in IL-6 and CRP level between the groups were significant (P < 0·01). Mean(s.e.m.) fatigue scores were significantly (P < 0·05) increased from preoperative values of 2·4(0·24) and 2·6(0·44) to 5·5(0·56) and 6·8(0·51) at 24 h after laparoscopic and open operations. At 48 h the mean(s.e.m.) fatigue score (5·6(0·57)) remained significantly (P < 0·05) raised only after open cholecystectomy. Hand grip strength was significantly (P < 0·05) reduced only after the open procedure, to a mean(s.e.m.) of 88(6) per cent of the preoperative value. These results demonstrate that aspects of the metabolic and acute-phase responses are attenuated following laparoscopic cholecystectomy, consistent with a reduction in tissue trauma.