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. 1995 Apr;221(4):372–380. doi: 10.1097/00000658-199504000-00007

General stress response to conventional and laparoscopic cholecystectomy.

F Glaser 1, G A Sannwald 1, H J Buhr 1, C Kuntz 1, H Mayer 1, F Klee 1, C Herfarth 1
PMCID: PMC1234586  PMID: 7726672

Abstract

OBJECTIVE: In many retrospective and prospective observational studies, laparoscopic cholecystectomy (LC) compares favorably with conventional cholecystectomy (CC), with respect to length of hospital stay, postoperative pain, and pulmonary function, indicating a diminished operative trauma. Comparison of laboratory findings (stress hormones, blood glucose, interleukins) are a possibility to objectify stress and tissue trauma of laparoscopic and conventional cholecystectomy. SUMMARY BACKGROUND DATA: Major body injury, surgical or accidental, evokes reproducible hormonal and immunologic responses. The magnitude of many of these changes essentially is proportional to the extent of the injury. METHODS: In a prospective study, biochemical stress parameters were measured in the blood of patients undergoing elective cholecystectomy because of symptomatic cholecystolithiasis. Patients with acute cholecystitis, pancreatitis, choledocholithiasis, or malignant disease were excluded. Values from 40 patients after LC and from 18 patients after CC were compared. Both groups had similar patient characteristics, baseline values, and perioperative care, except for deeper anesthesia during CC. RESULTS: On postoperative day 1, epinephrine (p = 0,05), norepinephrine (p = 0.02), and glucose (p = 0.02) responses were higher after CC. Two days postoperatively, norepinephrine remained higher after CC (p < 0.01). Interleukin-1 beta responses were higher during (p < 0.01) and 6 hours after CC (p = 0.03). Interleukin-6 responses were higher 6 hours (p = 0.03), 1 day (p = 0.02), and 2 days (p < 0.01) after CC. CONCLUSIONS: The results show significant lower values of intraoperatively and postoperatively measured epinephrine, norepinephrine, interleukin-1 beta, and interleukin-6 in patients with laparoscopic cholecystectomy, indicating a minor stress response and tissue trauma in this group of patients. The results correspond to the favorable results of most other trials evaluating clinical aspects of laparoscopic cholecystectomy.

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Selected References

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  1. Anand K. J., Hickey P. R. Halothane-morphine compared with high-dose sufentanil for anesthesia and postoperative analgesia in neonatal cardiac surgery. N Engl J Med. 1992 Jan 2;326(1):1–9. doi: 10.1056/NEJM199201023260101. [DOI] [PubMed] [Google Scholar]
  2. Baigrie R. J., Lamont P. M., Kwiatkowski D., Dallman M. J., Morris P. J. Systemic cytokine response after major surgery. Br J Surg. 1992 Aug;79(8):757–760. doi: 10.1002/bjs.1800790813. [DOI] [PubMed] [Google Scholar]
  3. Bickel U., Wiegand-Löhnert C., Fleischmann J. W., Heinemeyer G., Kewitz H., Dennhardt R., Voigt K. Different modulation of the perioperative stress hormone response under neurolept-anaesthesia or enflurane for cholecystectomy. Horm Metab Res. 1991 Apr;23(4):178–184. doi: 10.1055/s-2007-1003646. [DOI] [PubMed] [Google Scholar]
  4. Bunker J. P., Hinkley D., McDermott W. V. Surgical innovation and its evaluation. Science. 1978 May 26;200(4344):937–941. doi: 10.1126/science.347581. [DOI] [PubMed] [Google Scholar]
  5. Chernow B., Alexander H. R., Smallridge R. C., Thompson W. R., Cook D., Beardsley D., Fink M. P., Lake C. R., Fletcher J. R. Hormonal responses to graded surgical stress. Arch Intern Med. 1987 Jul;147(7):1273–1278. [PubMed] [Google Scholar]
  6. Clarke R. S., Johnston H., Sheridan B. The influence of anaesthesia and surgery on plasma cortisol, insulin and free fatty acids. Br J Anaesth. 1970 Apr;42(4):295–299. doi: 10.1093/bja/42.4.295. [DOI] [PubMed] [Google Scholar]
  7. Cruickshank A. M., Fraser W. D., Burns H. J., Van Damme J., Shenkin A. Response of serum interleukin-6 in patients undergoing elective surgery of varying severity. Clin Sci (Lond) 1990 Aug;79(2):161–165. doi: 10.1042/cs0790161. [DOI] [PubMed] [Google Scholar]
  8. Derbyshire D. R., Smith G. Sympathoadrenal responses to anaesthesia and surgery. Br J Anaesth. 1984 Jul;56(7):725–739. doi: 10.1093/bja/56.7.725. [DOI] [PubMed] [Google Scholar]
  9. Dubois F., Berthelot G., Levard H. Cholécystectomie par coelioscopie. Presse Med. 1989 May 13;18(19):980–982. [PubMed] [Google Scholar]
  10. Frazee R. C., Roberts J. W., Okeson G. C., Symmonds R. E., Snyder S. K., Hendricks J. C., Smith R. W. Open versus laparoscopic cholecystectomy. A comparison of postoperative pulmonary function. Ann Surg. 1991 Jun;213(6):651–654. doi: 10.1097/00000658-199106000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Glaser F., Kuntz C., Buhr H. J. Schmerzmittelverbrauch--laparoskopische versus konventionelle Cholecystektomie. Chirurg. 1992 Mar;63(3):216–218. [PubMed] [Google Scholar]
  12. Grace P. A., Quereshi A., Coleman J., Keane R., McEntee G., Broe P., Osborne H., Bouchier-Hayes D. Reduced postoperative hospitalization after laparoscopic cholecystectomy. Br J Surg. 1991 Feb;78(2):160–162. doi: 10.1002/bjs.1800780209. [DOI] [PubMed] [Google Scholar]
  13. Kunz R., Orth K., Vogel J., Steinacker J. M., Meitinger A., Brückner U., Beger H. G. Laparoskopische Cholecystektomie versus Mini-Lap-Cholecystektomie. Ergebnisse einer prospektiven, randomisierten Studie. Chirurg. 1992 Apr;63(4):291–295. [PubMed] [Google Scholar]
  14. Lacoumenta S., Yeo T. H., Burrin J. M., Bloom S. R., Paterson J. L., Hall G. M. Fentanyl and the beta-endorphin, ACTH and glucoregulatory hormonal response to surgery. Br J Anaesth. 1987 Jun;59(6):713–720. doi: 10.1093/bja/59.6.713. [DOI] [PubMed] [Google Scholar]
  15. Larsen C. G., Anderson A. O., Appella E., Oppenheim J. J., Matsushima K. The neutrophil-activating protein (NAP-1) is also chemotactic for T lymphocytes. Science. 1989 Mar 17;243(4897):1464–1466. doi: 10.1126/science.2648569. [DOI] [PubMed] [Google Scholar]
  16. Neugebauer E., Troidl H., Spangenberger W., Dietrich A., Lefering R. Conventional versus laparoscopic cholecystectomy and the randomized controlled trial. Cholecystectomy Study Group. Br J Surg. 1991 Feb;78(2):150–154. doi: 10.1002/bjs.1800780207. [DOI] [PubMed] [Google Scholar]
  17. Newsome H. H., Rose J. C. The response of human adrenocorticotrophic hormone and growth hormone to surgical stress. J Clin Endocrinol Metab. 1971 Sep;33(3):481–487. doi: 10.1210/jcem-33-3-481. [DOI] [PubMed] [Google Scholar]
  18. Penninckx F., Aerts R., Kerremans R., Koninckx P. R. Laparoscopic cholecystectomy: some advantages or just an artifice of new technology? HPB Surg. 1991 Apr;3(4):291–295. doi: 10.1155/1991/67569. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Pier A., Thevissen P., Ablassmaier B. Die Technik der laparoskopischen Cholecystektomie. Erfahrungen und Ergebnisse bei 200 Eingriffen. Chirurg. 1991 Apr;62(4):323–331. [PubMed] [Google Scholar]
  20. Raff H., Findling J. W. A new immunoradiometric assay for corticotropin evaluated in normal subjects and patients with Cushing's syndrome. Clin Chem. 1989 Apr;35(4):596–600. [PubMed] [Google Scholar]
  21. Ratge D., Wiedemann A., Kohse K. P., Klar H., Hellberg K., Wisser H. Magnitude and kinetics of alterations in plasma catecholamines and leukocyte beta-adrenergic receptors in response to anaesthesia and surgery. J Clin Chem Clin Biochem. 1990 Jun;28(6):391–398. doi: 10.1515/cclm.1990.28.6.391. [DOI] [PubMed] [Google Scholar]
  22. Salas M. A., Evans S. W., Levell M. J., Whicher J. T. Interleukin-6 and ACTH act synergistically to stimulate the release of corticosterone from adrenal gland cells. Clin Exp Immunol. 1990 Mar;79(3):470–473. doi: 10.1111/j.1365-2249.1990.tb08114.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Shenkin A., Fraser W. D., Series J., Winstanley F. P., McCartney A. C., Burns H. J., Van Damme J. The serum interleukin 6 response to elective surgery. Lymphokine Res. 1989 Summer;8(2):123–127. [PubMed] [Google Scholar]
  24. Strieter R. M., Kunkel S. L., Showell H. J., Remick D. G., Phan S. H., Ward P. A., Marks R. M. Endothelial cell gene expression of a neutrophil chemotactic factor by TNF-alpha, LPS, and IL-1 beta. Science. 1989 Mar 17;243(4897):1467–1469. doi: 10.1126/science.2648570. [DOI] [PubMed] [Google Scholar]
  25. Testas P., Chollet J. M., De Watteville J. C. Essai d'évaluation de la cholécystectomie par abord coelioscopique. A propos de 2,266 malades. Chirurgie. 1990;116(10):844–847. [PubMed] [Google Scholar]
  26. Tosato G., Jones K. D. Interleukin-1 induces interleukin-6 production in peripheral blood monocytes. Blood. 1990 Mar 15;75(6):1305–1310. [PubMed] [Google Scholar]
  27. Troidl H., Spangenberger W., Dietrich A., Neugebauer E. Laparoskopische Cholecystektomie. Erste Erfahrungen und Ergebnisse bei 300 Operationen: eine prospektive Beobachtungsstudie. Chirurg. 1991 Apr;62(4):257–265. [PubMed] [Google Scholar]
  28. Weicker H., Feraudi M., Hägele H., Pluto R. Electrochemical detection of catecholamines in urine and plasma after separation with HPLC. Clin Chim Acta. 1984 Aug 15;141(1):17–25. doi: 10.1016/0009-8981(84)90162-1. [DOI] [PubMed] [Google Scholar]
  29. Wittgen C. M., Andrus C. H., Fitzgerald S. D., Baudendistel L. J., Dahms T. E., Kaminski D. L. Analysis of the hemodynamic and ventilatory effects of laparoscopic cholecystectomy. Arch Surg. 1991 Aug;126(8):997–1001. doi: 10.1001/archsurg.1991.01410320083011. [DOI] [PubMed] [Google Scholar]
  30. Wittgen C. M., Naunheim K. S., Andrus C. H., Kaminski D. L. Preoperative pulmonary function evaluation for laparoscopic cholecystectomy. Arch Surg. 1993 Aug;128(8):880–886. doi: 10.1001/archsurg.1993.01420200054010. [DOI] [PubMed] [Google Scholar]
  31. van der Linden W. Pitfalls in randomized surgical trials. Surgery. 1980 Mar;87(3):258–262. [PubMed] [Google Scholar]

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