A Prospective Randomised Study on Endotoxaemia, Mediator Release and Morbidity in Conventional, Compared with Laparoscopic Cholecystectomy

Abstract

Surgical procedures usually result in elevation of body temperature and changes of blood cell count or electrolyte levels, commonly known as the postoperative acute phase reaction. The present prospective randomised study compares the intensity of the postoperative acute phase reaction and postoperative morbidity in groups of patients who underwent either laparoscopic or conventional cholecystectomy. Conventionally-operated patients had significantly higher endotoxin plasma levels and a lower endotoxin-neutralisation capacity in the plasma 20 min after skin incision. This difference persisted until 6 h postoperatively. The plasma levels of interleukin-6 (IL-6) increased postoperatively, but did not differ between the two groups. C-reactive protein (CRP) increased postoperatively, with a maximum at 48 h after surgery. When comparing both groups, laparoscopically-operated patients had lower CRP-levels. The postoperatively elevated body temperature decreased significantly earlier in laparoscopically-operated patients, whereas there was no statistically relevant difference in the leukocyte count of the two groups. Contrary to studies from other authors, we did not find a significant increase of tumour necrosis factor (TNF-α). Patients with conventional cholecystectorny experienced significantly more postoperative pain, more restriction of total vital capacity and a longer postoperative hospital stay. In conclusion, patients who underwent laparoscopic rather than conventional cholecystectomy had a lower intensity postoperative acute phase reaction, as indicated by lower plasma endotoxin, CRP and body temperature, and a higher endotoxin-neutralisation capacity.

Key Words:

• endotoxin
• limulus amebocyte test
• acute phase reaction
• mediator release
• laparoscopic
• conventional cholecystectomy