[Operative stress response and energy metabolism after laparoscopic cholecystectomy and open cholecystectomy].

OBJECTIVE

To determine the level of neurohormonal operative stress response-reactive protein (CRP) and rest energy expenditure (REE) after laparoscopic cholecystectomy (LC) and open cholecystectomy (OC).

METHODS

Twenty-six consecutive patients with noncomplicated gallstones were randomized for LC (n = 14) and OC (n = 12). Plasma concentrations of somatotropin, insulin, cortisol and CRP were measured. The levels of REE were also measured.

RESULTS

On the third postoperative day, the insulin levels were lower than those before operation (P < 0.05). On the first postoperative day, the levels of somatotropin and cortisol were higher in OC than in LC. After operation, the parameters of somatotropin, CRP and cortisol increased compared to the preoperative period in all patients (P < 0.05). On the all-postoperative day, the CRP levels were higher in OC than in LC (P < 0.05). After operation, the REE level increased in OC and LC (P < 0.05). On the all-postoperative day, the REE levels were higher in OC than in LC (P < 0.05).

CONCLUSIONS

LC results in less prominent stress response and smaller metabolic interference compared to open surgery. These benefit the restoration of stress hormones, nitrogen balance, and energy metabolism. However, LC can also induce acidemia and pulmonary hypoperfusion because of pneumoperitoneum during surgery.