Immunogenic alteration in laparoscopic common bile duct exploration

• Published in: The Journal of surgical research 2014-03, Vol.187 (1), p.302-309
• Main Authors: Wang, Caoye, MD, Wang, Qi, MD, Sun, Donglin, MD, Chen, Xueming, MD, Sun, Yueming, PhD
• Format: Article
• Language: English
• Subjects: Adult; Aged; C-Reactive Protein - metabolism; Choledocholithiasis - surgery; Common Bile Duct - surgery; Comparative study; Drainage - methods; Female; Follow-Up Studies; Humans; Immune Tolerance - immunology; Immunologic change; Inflammation - immunology; Inflammation - prevention & control; Interleukin-6 - blood; Laparoscopic common bile duct exploration; Laparoscopy; Male; Middle Aged; Postoperative Complications - immunology; Postoperative Complications - prevention & control; Prospective Studies; Surgery; Suture Techniques; Tumor Necrosis Factor-alpha - blood
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2013.10.022

Abstract Background The immunologic benefits of laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis are poorly understood. The aim of the present study was to investigate immunologic changes during LCBDE using primary suture or T-tube drainage. Methods Patients with choledocholithiasis undergoing laparoscopic primary suture of the common bile duct after LCBDE (primary suture group) or laparoscopic LCBDE with choledochotomy plus T-tube drainage (T-tube group) at a single center between June 2008 and June 2011 were included in the present study. Blood samples were collected 24 h preoperatively, and 24 and 72 h postoperatively to assess interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) as inflammation markers. Immunosuppression was evaluated using C-reactive protein and leukocyte subpopulations. Results Patients were 60 ± 17 y old in the primary suture group (56 men and 76 women) and 54 ± 20 y old in the T-tube group (50 men and 58 women). In the primary suture group, three patients (2.3%) required open surgery and six (4.5%) developed postoperative bile leakage. In the T-tube group, two patients (1.9%) required open surgery and four (3.7%) had bile leakage. Operation time and hospital stay were shorter in the primary suture group ( P