Abstract
Although recent experimental and clinical trials have documented that postoperative inflammation and changes in different immunologic parameters are less pronounced after laparoscopic approaches in comparison to open surgery, it still remains unclear what influence the pneumoperitoneum itself has on immunologic defense and function. This is mainly due to the endpoints of the different studies which investigate changes in the so-called immunologic parameters (cell subunits, C-reactive protein, cytokines, catecholamines or other stress hormones in plasma samples) rather than analyzing immunologic functions, such as cell activation, production of proteins, cell proliferation or in vivo immune defenses. So far, especially in clinical trials, no correlation has been demonstrated between the changes in immunologic parameters and relevant postoperative clinical endpoints, such as postoperative complications. Thus further clinical prospective randomized studies with relevant clinical endpoints and additional investigations of immunologic parameters are needed to prove the consequences of either minimally invasive surgery or open procedures on postoperative immune functions.
References
1.
Allendorf JDF, Bessler M, Whelan RL, Trokel M, Laird DA, Terry MB, Treat MR: Postoperative immune function varies inversely with the degree of surgical trauma in a murine model. Surg Endosc 1997;11:427–430.
2.
Allendorf JDF, Bessler M, Whelan RL, Trokel M, Laird DA, Terry MB, Treat MR: Better preservation of immune function after laparoscopic-assisted vs. open bowel resection in a murine model. Dis Colon Rectum 1996;39:67–72.
3.
Hensler T, Hecker H, Heeg K, Heidecke CD, Bartels H, Barthlen W, Wagner H, Siewert JR, Holzmann B: Distinct mechanism of immunosuppression as a consequence of major surgery. Infect Immun 1997;65:2283–2291.
4.
Jacobi CA, Ordemann J, Zieren HU, Volk HD, Bauhofer A, Halle E, Müller JM: Increased systemic inflammation after laparotomy vs. laparoscopy in an animal model of peritonitis. Arch Surg 1998;133:258–262.
5.
Daphan CE, Agalar F, Hascelik G, Onat D, Sayek I: Effects of laparotomy and carbon dioxide and air pneumoperitoneum on cellular immunity and peritoneal host defences in rats. Eur J Surg 1999;165:253–258.
6.
Chekan EG, Nataraj C, Clary EM, Hayward TZ, Brodny FJ, Stamat JC, Fina MC, Eubanks WS, Westcott CJ: Intraperitoneal immunity and pneumoperitoneum. Surg Endosc 1999;13:1135–1138.
7.
Puttick MI, Nduka CC, Yong L, Darzi A: Macrophage function is suppressed by a carbon dioxide pneumoperitoneum. 2nd Workshop of Experimental Laparoscopic Surgery, Rotterdam, 1998.
8.
Berggren U, Gordh T, Grama D, Haglund U, Rastad J, Arvidsson D: Laparoscopic versus open cholecystectomy: Hospitalisation, sick leave, analgesia and trauma responses. Br J Surg 1994;81:1362–1365.
9.
Bellón JM, Manzano L, Bernardos L, Honduvilla NG, Larrad A, Bujan J, Alvarez-Mon M: Cytokine levels after open and laparoscopic cholecystectomy. Eur Surg Res 1997;29:27–34.
10.
Bruce DM, Smith M, Walker CB, Heys SD, Binnie NR, Gough DB, Broom J, Eremin O: Minimal access surgery for cholelithiasis induces an attenuated acute phase. Am J Surg 1999;178:232–234.
11.
Brune I, Wilke W, Hensler T, Feussner H, Holzmann B, Siewert JR: Normal T lymphocyte and monocyte function after minimally invasive surgery. Surg Endosc 1998;12:1020–1024.
12.
Carlei F, Schietroma M, Cianca G, Risetti A, Mattucci S, Ngome Enang G, Simi M: Effects of laparoscopic and conventional (open) cholecystectomy on human leukocyte antigen-DR expression in peripheral blood monocytes: Correlations with immunological status. World J Surg 1999;23:18–22.
13.
Chaudhary D, Verma GR, Gupta R, Bose SM, Ganguly NK: Comparative evaluation of the inflammatory mediators in patients undergoing laparoscopic versus conventional cholecystectomy. Aust N Z J Surg 1999:69:369–372.
14.
Cho JM, LaPorta AJ, Clark JR, Schofield MJ, Hammond SL, Mallory PL: Response of serum cytokines in patients undergoing laparoscopic cholecystectomy. Surg Endosc 1994;8:1380–1384.
15.
Ellstrom M, Bengtsson A, Tylman M, Haeger M, Olsson JH, Hahlin M: Evaluation of tissue trauma after laparoscopic and abdominal hysterectomy measurements of neutrophil activation and release of interleukin-6, cortisol, C-reactive protein. J Am Coll Surg 1996;182:423–430.
16.
Fukushima R, Kawamura YJ, Saito H, Saito Y, Hashiguchi Y, Sawada T, Muto T: Interleukin-6 and stress hormone responses after uncomplicated gasless laparoscopic assisted and open sigmoid colectomy. Dis Colon Rectum 1996;39(suppl):S29–S34.
17.
Harmon GD, Senagore AJ, Kilbride MJ, Warzynski MJ: Interleukin-6 response to laparoscopic and open colectomy. Dis Colon Rectum 1994;37:754–759.
18.
Hendolin HI, Pääkönen ME, Alhava EM, Tarvainen R, Kemppinen T, Lahtinen P: Laparoscopic or open cholecystectomy: A prospective randomised trial to compare postoperative pain, pulmonary function, and stress response. Eur J Surg 2000;166:394–399.
19.
Hewitt PM, Ip SM, Kwok SP, Somers SS, Li K, Leung KL, Lau WY, Li AK: Laparoscopic-assisted vs. open surgery for colorectal cancer: comparative immune effects. Dis Colon Rectum 1998;41:901–909.
20.
Jakeways MSR, Mitchell V, Hashim LA, Chadwick SJD, Shenkin A, Green CJ, Carli F: Metabolic and inflammatory responses after open or laparoscopic cholecystectomy. Br J Surg 1994;81:127–131.
21.
Joris J, Cigarini I, Legrand M, Jaquet N, De Groote D, Franchimont P, Lamy M: Metabolic and respiratory changes after cholecystectomy performed via laparotomy or laparoscopy. Br J Anaesth 1992;69:341–345.
22.
Karaviannakis AJ, Makri GG, Mantzioka A, Karousos D, Karatzas G: Systemic stress response after laparoscopic or open cholecystectomy: a randomized trial. Br J Surg 1997;84:467–471.
23.
Kristiansson M, Saraste L, Soop M, Sundquist KG, Thorne A: Diminished interleukin-6 and C-reactive protein responses to laparoscopic versus open cholecystectomy. Acta Anaesthesiol Scand 1999;43:146–152.
24.
Lau JY, Lo SY, Ng EK, Lee DW, Lam YH, Chung SC: A randomized comparison of acute phase response and endotoxemia in perforated peptic ulcers receiving laparoscopic or open patch repair. Am J Surg 1998;175:325–327.
25.
Lausten SB, Ibrahim TM, El-Sefi T, Jensen LS, Gesser B, Larsen CG, Tonnesen E, Jensen SL: Systemic and cell-mediated immune response after laparoscopic and open cholecystectomy in patients with chronic liver disease. A randomised prospective study. Dig Surg 1999;16:471–477.
26.
Leung KL, Lai PB, Ho RL, Meng WC, Yiu RY, Lee JF, Lau WY: Systemic cytokine response after laparoscopic-assisted resection of rectosigmoid carcinoma: A prospective randomised trial. Ann Surg 2000;231:506–511.
27.
Maruszynski M, Pojda Z: Interleukin 6 (IL-6) levels in the monitoring of surgical trauma. Surg Endosc 1995;9:882–885.
28.
Mc Mahon AJ, O’Dwyer PJ, Cruikshank AM, McMillan DC, O’Reilly DS, Lowe GD, Rumley A, Logan RW, Baxter JN: Comparison of metabolic responses to laparoscopic and minilaparotomy cholecystectomy. Br J Surg 1993;80:1255–1258.
29.
Mealy K, Gallagher H, Barry M, Lennon F, Traynor O, Hyland J: Physiological and metabolic responses to open and laparoscopic cholecystectomy. Br J Surg 1992;79:1061–1064.
30.
Milheiro A, Sousa FC, Manso EC, Leitao F: Metabolic responses to cholecystectomy: Open vs. laparoscopic approach. J Laparoendosc Surg 1994;4:311–317.
31.
Ordemann J, Jacobi C, Schwenk W, Stösslein R, Müller JM: Cellular and humoral inflammatory response after laparoscopic and conventional colorectal resections – Results of a prospective randomized trial. Surg Endosc 2001;15:600–608.
32.
Ortega AE, Peters JH, Incarbone R, Estrada L, Ehsan A, Kwan Y, Spencer CJ, Moore-Jeffries E, Kuchta K, Nicoloff JT: A prospective randomized comparison of the metabolic and stress hormonal responses of laparoscopic and open cholecystectomy. J Am Coll Surg 1996;183:249–256.
33.
Perttila J, Salo M, Ovaska J, Gronroos J, Lavonius M, Katila A, Lahteenmaki M, Pulkki K: Immune response after laparoscopic and conventional Nissen fundoplication. Eur J Surg 1999;165:21–28.
34.
Redmond HP, Watson WG, Houghton T, Condron C, Watson RGK, Bouchier-Hayes D: Immune function in patients undergoing open vs. laparoscopic cholecystectomy. Arch Surg 1994;129:1240–1246.
35.
Roumen RM, van Meurs PA, Kuypers HHC, Kraak AG, Sauerwein RW: Serum interleukin-1 and C-reactive protein responses in patients after laparoscopic or conventional cholecystectomy. Eur J Surg 1992;158:541–544.
36.
Schrenk P, Bettelheim P, Woisetschlager R, Rieger R, Wayand WU: Metabolic responses after laparoscopic or open hernia repair. Surg Endosc 1996;10:628–632.
37.
Schwenk W, Jacobi C, Mansmann U, Böhm B, Müller JM: Inflammatory response after laparoscopic and conventional colorectal resections – Results of a prospective randomized trial. Langenbecks Arch Surg 2000;385:2–9.
38.
Sietses C, Wiezer MJ, Eijsbouts QAJ, Beelen RHJ, van Leeuwen PA, von Blomberg BM, Meijer S, Cuesta MA: A prospective randomised study of the systemic immune response after laparoscopic and conventional Nissen fundoplication. Surgery 1999;126:5–9.
39.
Squirrell DM, Majeed AW, Troy G, Peacock JE, Nicholl JP, Johnson AG: A randomized, prospective, blinded comparison of postoperative pain, metabolic response, and perceived health after laparoscopic and small incision cholecystectomy. Surgery 1998;123:485–495.
40.
Stage JG, Schulze S, Moller P, Overgaard H, Andersen M, Rebsdorf-Pedersen VB, Nielsen HJ: Prospective randomized study of laparoscopic versus open colonic resectible adenocarcinoma. Br J Surg 1997;84:391–396.
41.
Tang CL, Eu KW, Tai BC, Soh JG, MacHin D, Seow-Choen F: Randomized clinical trial of the effect of open versus laparoscopically assisted colectomy on systemic immunity in patients with colorectal cancer. Br J Surg 2001;88:801–807.
42.
Targarona EM, Pons MJ, Balaqué C, Espert JJ, Moral A, Martinez J, Gaya J, Filella X, Rivera F, Ballesta A, Trias M: Acute phase is the only significantly reduced component in the injury response after laparoscopic cholecystectomy. World J Surg 1996;20:528–533.
43.
Thorell A, Nygren J, Essen P, Gutniak M, Loftenius A, Andersson B, Ljungqvist O: The metabolic response to cholecystectomy: insulin resistance after open compared with laparoscopic operation. Eur J Surg 1996;162:187–191.
44.
Walker CBJ, Bruce DM, Heyes SD, Gough DB, Binnie NR, Eremin O: Minimal modulation of lymphocyte and natural killer cell subsets following minimal access surgery. Am J Surg 1999;177:48–54.
45.
Yoshida S, Ohta J, Yamasaki K, Kamei H, Harada Y, Yahara T, Kaibara A, Ozaki K, Tajiri T, Shirouzu K: Effect of surgical stress on endogenous morphine and cytokine levels in the plasma after laparoscopic or open cholecystectomy. Surg Endosc 2000;14:137–140.
46.
Zieren J, Jacobi CA, Wenger FA, Volk HD, Müller JM: Fundoplication a model for immunologic aspects of laparoscopic and conventional surgery. J Laparoendosc Adv Surg Tech A 2000;10:35–40.
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2002
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