Unimpaired immune functions after laparoscopic cholecystectomy.

BACKGROUND

The advantages of laparoscopic cholecystectomy over the open procedure seem to be related to the lesser surgical trauma. Whether this is also reflected by reduced postoperative immune suppression is not known.

METHODS

The perioperative cellular immunocompetence of patients undergoing either laparoscopic (n = 8) or open (n = 8) cholecystectomy was evaluated before operation and at 24 hours and 6 days after operation for inflammatory reactivity by white blood cell counting and serum interleukin-6 assessment. Immunocompetence was evaluated by skin testing with phytohemagglutinin and by phenotyping blood mononuclear cells.

RESULTS

Although 24 hours after conventional cholecystectomy granulocyte and interleukin-6 levels were strongly increased, laparoscopic cholecystectomy did not affect these acute inflammation parameters. Patients who had undergone conventional cholecystectomy showed a strong reduction of phytohemagglutinin responsiveness, in contrast to laparoscopic patients (67% versus 0% reduction). Flow cytometric analysis of blood mononuclear cells revealed a distinct reduction of HLA-DR expression on monocytes in the open cholecystectomy group only. Both parameters returned to baseline levels within 6 days after operation.

CONCLUSIONS

In contrast to open cholecystectomy, laparoscopic cholecystectomy does not significantly affect parameters reflecting immunocompetence. This lack of interference with cellular immune functions provides another argument favoring laparoscopic rather than open cholecystectomy.