Effect on Monocyte Macrophage Function

The monocyte-macrophages are responsible for phagocytosis and the principal source of tumor necrosis factor and IL-1 following T-cell stimulation. Gutt et al. investigated the phagocytic activity of rat macrophages by means of an intravascular carbon clearance test during conventional and laparoscopic fundoplication using pneumoperi-toneum and gasless laparoscopy. Although the fastest carbon elimination half-life was found in rats undergoing gasless laparoscopy, carbon clearance after conventional laparoscopy was significantly greater than that associated with open surgery (52).

The monocyte-macrophage system also plays an important role as antigen presenting cells in association with human leucocyte antigen expression. A significant reduction in human leucocyte antigen-DR expression has been reported after open operation, but not after laparoscopic surgery. However, Brune et al. (53) found that this decrease in monocyte human leucocyte antigen-DR expression might not alter the antigen-presenting capacity of monocytes in either surgical group. Klava et al. assessed the potential role of IFN-7 by determining the capacity of monocytes to respond to this cytokine following open and laparoscopic surgical procedures. They observed that laparoscopic surgery is associated with a similar level of suppression of monocyte human leucocyte antigen-DR expression as seen after open surgery (54). This expression is refractory to further stimulation by IFN-7. This is consistent with other reports (53) that have demonstrated similar suppression but with earlier return to normal levels after laparoscopic than open surgery.

Monocyte-mediated cytotoxicity correlates closely with Kupffer cell-mediated cytotoxicity and both of these cells play a key role in limiting tumor growth in the liver. Vittimberga et al. (55) observed no difference in cytokine response following laparoscopy and open surgery, but intracellular Kupffer cell signalling was slightly different between laparoscopy and laparotomy. On the other hand, Sietses et al. (56) investigated three different laparoscopic procedures and demonstrated that laparoscopic surgery preserves monocyte-mediated cytotoxicity in contrast to the conventional approach.

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