Effect on Polymorphonuclear Leukocytes

Surgical stress affects polymorphonuclear function in the postoperative period. The phagocytic and chemotactic activity of neutrophils is reduced after surgery (36). Several studies have demonstrated a significant increase in overall peripheral leukocyte numbers following open, but not laparoscopic, procedures (19,37). Sietses et al. did not observe any difference in polymorphonuclear count between patients undergoing laparoscopic and open Nissen fundoplication. However, they found a significant reduction in the phagocytic activity of polymorphonuclears after open surgery, which was not noted following laparoscopic fundoplication (38). They also found significantly greater surface expression of CD11b, a receptor important in polymorphonuclear migration, in patients undergoing open surgery compared with those having laparoscopy (38).

Differences in stimulated free oxygen radical production have also been noted between open and laparoscopic techniques (38), suggesting a higher state of polymorphonuclear activation after open procedures. Likewise, the concentration of elastase, an indicator of polymorphonuclear activation, increases after both open and laparoscopic surgery, but returns to preoperative levels within three days after laparoscopic but not open surgery. The postoperative production of hypochloric acid, a potent neutrophil antimicrobial antioxidant, has been shown to fall significantly after open but not laparo-scopic surgery (39).

Nies et al. (40) randomized patients with acute cholecystitis to undergo either laparoscopic or open cholecystectomy and found significantly greater intraoperative and postoperative histamine levels in patients after the former procedure. Histamine levels reached their highest levels during establishment of pneumoperitoneum and Significantly less activation and pre- laparoscopic access.

served polymorphonuclear function cor- Significantly less activation and preserved polymorphonuclear function correlate relate with the clinical observation of with the clinical observation of fewer postoperative septic complications following fewer postoperative septic complica- laparoscopic surgery. This suggests that a laparoscopic approach might be beneficial in tions following laparoscopic surgery. the surgical management of intra-abdominal sepsis or peritonitis, although this remains a matter of debate as higher intra-abdominal pressure during laparoscopy may worsen clinical sepsis (1).

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