This study was conducted on 100 patients with symptomatic cholelithiasis. These patients
were divided randomly into 2 groups, 50 patients in each group. Patients of the first group
underwent Open cholecystectomy and patients of the second group underwent laparoscopic
cholecystectomy. History taking, general examination, routine investigations, abdomen a!
ultrasonography and upper gastrointestinal endoscopy were done for each patient before surgery.
The neuroendocrine and metabolic stress responses after open and laparoscopic cholecystectomy
were compared. Plasma levels of cortisol, glucose, and C-reactive protein were measured before,
during, 4 hours and 24 hours after operation. Follow up of pain score, need for analgesia,
hospital stay and time off work were recorded for each patients after surgery. It was found that
postoperative pain and need for analgesia were significantly lower after laparoscopic than after
open cholaystectomy. Also hospital stay and return to normal activities were significantly
shorter after laparoscopic than open cholecystectomy. Preoperative values of endocrine and
metabolic variables studied were similar in both groups. Plasma cortisol level increased
vignificantly during and after both open and laparoscopic cholecystectomy as compared with
preoperative values. However, its level was significantly higher after open than laparoscopic
cholecystectomy. Plasma glucose level increased significant& compared with preoperative value
after the end of operation in both groups. However, postoperative glucose levels were consistently
lower after laparoscopic cholecystectomy and they returned to preoperative level earlier than
after open cholecystectomy. C-reactive protein level increased signcantly by 24 hours after
surgery in both groups. However, C-reactive protein levels were significantly higher after open
than after laparoscopic cholecystectomy. In conclusion, the neuroendocrine stress response
and inflammatory response following laparoscopic cholecystectomy were significantly reduced
compared with those after open cholecystectomy. The results of this study confirmed some
advantages of laparoscopic cholecystectomy which is a well established technique.
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