Metabolic and inflammatory responses after open or laparoscopic cholecystectomy

M. S R Jakeways, V. Mitchell, I. A. Hashim, S. J D Chadwick, A. Shenkin, C. J. Green, F. Carli

Research output: Contribution to journalArticle

184 Citations (Scopus)

Abstract

Metabolic and inflammatory responses and changes in fatigue were studied in groups of patients undergoing either laparoscopic (n = 14) or open (n = 10) elective cholecystectomy. The mean(s.e.m.) cortisol concentration was significantly (P < 0.001) increased from 342(80) and 424(91) nmol l-1 before operation to 895(46) and 966(53 ) nmol l-1 after surgery in patients undergoing laparoscopic and open cholecystectomy respectively. There was no difference in cortisol response between the groups. Glucose concentration was increased (P < 0.02) at the end of surgery from mean(s.e.m.) preoperative levels of 5.54(0.15) and 6.16(0.15) mmol l-1 to postoperative values of 7·46(0·29) and 8.46(0.86) mmol l-1 for the laparoscopic and open procedures respectively. The mean glucose concentration during the initial 12 h after surgery was significantly greater (P < 0.02) following open than laparoscopic cholecystectomy. The mean(s.e.m.) albumin concentration fell significantly (P < 0.01) during surgery by an equivalent extent from 38.9(0.77) and 38.5(1.10) g l-1 to 35.2(0.79) and 34.6(0.97) g l-1. The mean (95 per cent confidence interval) interleukin (IL) 6 concentration peaked 4 h after surgery at 57.2(44.6-73.4) pg ml-1 following laparoscopic and 99.3(72.8-135.4) pg ml-1 after open cholecystectomy. Mean (95 per cent confidence interval) C-reactive protein (CRP) levels at 24 h were 17.0(12.7-21.2) and 492.0(25.3-93.6) mg l-1 and at 48 h 28.0(21.4-35.4) and 70.0(36.4-133.6) mg l-1 following laparoscopic and open operations. The differences in IL-6 and CRP level between the groups were significant (P < 0.01). Mean(s.e.m.) fatigue scores were significantly (P < 0.05) increased from preoperative values of 2.4(0.24) and 2.6(0.44) to 5.5(0.56) and 6.8(0.51) at 24 h after laparoscopic and open operations. At 48 h the mean(s.e.m.) fatigue score (5.6(0.57)) remained significantly (P < 0.05) raised only after open cholecystectomy. Hand grip strength was significantly (P < 0.05) reduced only after the open procedure, to a mean(s.e.m.) of 88(6) per cent of the preoperative value. These results demonstrate that aspects of the metabolic and acute-phase responses are attenuated following laparoscopic cholecystectomy, consistent with a reduction in tissue trauma.

Original languageEnglish (US)
Pages (from-to)127-131
Number of pages5
JournalBritish Journal of Surgery
Volume81
Issue number1
StatePublished - 1994

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Laparoscopic Cholecystectomy
Cholecystectomy
Fatigue
Hand Strength
C-Reactive Protein
Hydrocortisone
Interleukin-6
Confidence Intervals
Glucose
Acute-Phase Reaction
Albumins

ASJC Scopus subject areas

  • Surgery

Cite this

Jakeways, M. S. R., Mitchell, V., Hashim, I. A., Chadwick, S. J. D., Shenkin, A., Green, C. J., & Carli, F. (1994). Metabolic and inflammatory responses after open or laparoscopic cholecystectomy. British Journal of Surgery, 81(1), 127-131.

Metabolic and inflammatory responses after open or laparoscopic cholecystectomy. / Jakeways, M. S R; Mitchell, V.; Hashim, I. A.; Chadwick, S. J D; Shenkin, A.; Green, C. J.; Carli, F.

In: British Journal of Surgery, Vol. 81, No. 1, 1994, p. 127-131.

Research output: Contribution to journalArticle

Jakeways, MSR, Mitchell, V, Hashim, IA, Chadwick, SJD, Shenkin, A, Green, CJ & Carli, F 1994, 'Metabolic and inflammatory responses after open or laparoscopic cholecystectomy', British Journal of Surgery, vol. 81, no. 1, pp. 127-131.
Jakeways MSR, Mitchell V, Hashim IA, Chadwick SJD, Shenkin A, Green CJ et al. Metabolic and inflammatory responses after open or laparoscopic cholecystectomy. British Journal of Surgery. 1994;81(1):127-131.
Jakeways, M. S R ; Mitchell, V. ; Hashim, I. A. ; Chadwick, S. J D ; Shenkin, A. ; Green, C. J. ; Carli, F. / Metabolic and inflammatory responses after open or laparoscopic cholecystectomy. In: British Journal of Surgery. 1994 ; Vol. 81, No. 1. pp. 127-131.
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N2 - Metabolic and inflammatory responses and changes in fatigue were studied in groups of patients undergoing either laparoscopic (n = 14) or open (n = 10) elective cholecystectomy. The mean(s.e.m.) cortisol concentration was significantly (P < 0.001) increased from 342(80) and 424(91) nmol l-1 before operation to 895(46) and 966(53 ) nmol l-1 after surgery in patients undergoing laparoscopic and open cholecystectomy respectively. There was no difference in cortisol response between the groups. Glucose concentration was increased (P < 0.02) at the end of surgery from mean(s.e.m.) preoperative levels of 5.54(0.15) and 6.16(0.15) mmol l-1 to postoperative values of 7·46(0·29) and 8.46(0.86) mmol l-1 for the laparoscopic and open procedures respectively. The mean glucose concentration during the initial 12 h after surgery was significantly greater (P < 0.02) following open than laparoscopic cholecystectomy. The mean(s.e.m.) albumin concentration fell significantly (P < 0.01) during surgery by an equivalent extent from 38.9(0.77) and 38.5(1.10) g l-1 to 35.2(0.79) and 34.6(0.97) g l-1. The mean (95 per cent confidence interval) interleukin (IL) 6 concentration peaked 4 h after surgery at 57.2(44.6-73.4) pg ml-1 following laparoscopic and 99.3(72.8-135.4) pg ml-1 after open cholecystectomy. Mean (95 per cent confidence interval) C-reactive protein (CRP) levels at 24 h were 17.0(12.7-21.2) and 492.0(25.3-93.6) mg l-1 and at 48 h 28.0(21.4-35.4) and 70.0(36.4-133.6) mg l-1 following laparoscopic and open operations. The differences in IL-6 and CRP level between the groups were significant (P < 0.01). Mean(s.e.m.) fatigue scores were significantly (P < 0.05) increased from preoperative values of 2.4(0.24) and 2.6(0.44) to 5.5(0.56) and 6.8(0.51) at 24 h after laparoscopic and open operations. At 48 h the mean(s.e.m.) fatigue score (5.6(0.57)) remained significantly (P < 0.05) raised only after open cholecystectomy. Hand grip strength was significantly (P < 0.05) reduced only after the open procedure, to a mean(s.e.m.) of 88(6) per cent of the preoperative value. These results demonstrate that aspects of the metabolic and acute-phase responses are attenuated following laparoscopic cholecystectomy, consistent with a reduction in tissue trauma.

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