A prospective investigation of the inflammatory and neuroendocrine responses in laparoscopic and open cholecystectomy
Soykan Arıkan1, Macit Koldaş2, Abdullah Başlı2, Ahmet Kocakuşak3, Yıldıray Dadük3, Yasemin Döventaş2
1İstanbul Eğitim ve Araştırma Hastanesi 4. Cerrahi Kliniği, İSTANBUL
2Haseki Eğitim ve Araştırma Hastanesi Biyokimya Laboratuvarı, İSTANBUL
3Haseki Eğitim Araştırma Hastanesi 1. Cerrahi Kliniği, İSTANBUL
Purpose: To determine the advantage of laparoscopic intervention, it is necessary to understand the responses of the organism under stressful conditions. We designed a study to compare the different neuroendocrine and inflammatory responses, which occur during laparoscopic and open cholecystectomy.
Materials and Methods: Twenty patients who underwent cholecystectomy divided in two groups (Group I: open cholecystectomy, Group II: laparoscopic cholecystectomy) were studied prospectively. Adrenocorticotrophic hormone (ACTH), cortisole, insulin, C-reactive protein (CRP), and interleukin-6 (IL- 6) levels were measured in the preoperative period, postoperative 4th and 24th hours.
Results: According to the comparisons within the groups, in regard to the first group, there were statistically significant differences in the ACTH, cortisole, IL-6 levels between the values measured preoperatively and the values measured both in the 4th and 24th postoperative hours. There were statistically significant differences only in the postoperative 24th hour for insulin and CRP levels.
In regard to the second group, there were statistically significant differences only in the postoperative 4th hour for cortisole levels and only in the postoperative 24th hour for insulin and CRP levels, whereas there were statistically significant differences both in the 4th and 24th postoperative hours for IL-6 levels.
When the groups were compared with each other, there were no statistically significant differences in the cortisole and insulin levels according to the values measured preoperatively, as well as in the 4th and 24th postoperative hours. The IL-6 levels were found to have statistically insignificant differences according to the values measured preoperatively, however the comparisons were statistically significant both in the 4th and 24th postoperative hours. There were statistically significant differences for ACTH levels in the 4th postoperative hour, but not in the preoperative and in the 24th postoperative hour values. In regard to CRP levels, statistically significant differences were detected according to the values in the 24th postoperative hours, but there were no differences both in the preoperative and in the 4th postoperative hour measurements.
Conclusion: Laparoscopic cholecystectomy lessens the acute phase response but does not cause a great difference in regard to neuroendocrine changes when compared to conventional open cholecystectomy.
Keywords: Laparoscopy, cholecystectomy, neuroendocrine response, inflammation