Comparisons of Oxidative Stress during Laparoscopic Cholecystectomy and Open Cholecystectomy

Choi, Jin Yong; Cho, Jae Seung; Song, Tae Jin; Han, Hyung Joon; Lim, Chae Seung; Choi, Sang Yong; Suh, Sung Ock

Abstract

PURPOSE
During oxidative stress, the levels of oxygen free radical increase dramatically, which plays a role in apoptosis, aging and is chemic injury, but also leads to positive effects such as induction of host defense genes and mobilization of ion transport systems. It has been suggested that the advantages of laparoscopic surgery are closely related to the reduced oxidative stress that occurs during laparoscopic cholecystectomy (LC) when compared to open cholecystectomy (OC). This study was conducted to compare oxidative stress markers including total antioxidant status (TAS), superoxide dismutase (SOD) and gluthathione reductase (GR) between the LC group and OC group to determine if these surgical procedures result in different patterns of oxidative stress.
METHODS
Our prospective study included fifty patients with symptomatic cholelithiasis and cholecystitis, of whom 25 underwent LC and 25 underwent OC. The plasma levels of oxidative stress markers (TAS, SOD, and GR) were measured preoperatively and on the 1st, 2nd and 3rd postoperative days.
RESULTS
The postoperative hospitalization days differed significantly between the two groups (p<0.01). The value of TAS decreased in the OC group in the immediate postoperative period (p=0.037), but this difference was not significant when analyzed by ANCOVA (analysis of covariance; p>0.05). An acceptable postoperative decrease in SOD was observed in the OC group, especially after the 2nd postoperative day (p<0.01), and this decrease was also significant when analyzed by ANCOVA (p=0.020). GR was decreased in the OC group on the 2nd postoperative day (p=0.022), and ANCOVA revealed a significant difference between groups (p=0.039). The length of postoperative hospital stay was significantly different between the two groups (p<0.01). The TAS value decreased in the OC group in the immediate postoperative period (p=0.037), but the serial change in the plasma level of TAS did not differ significantly among groups (p>0.05) upon analysis of covariance. A significant postoperative decrease in the level of SOD was observed in the OC group, especially after the 2nd postoperative day (p<0.01), and there was also a significant difference in the serial change in SOD between groups (p=0.020). The level of GR in the OC group decreased significantly on the 2nd postoperative day (p=0.022). Moreover, ANCOVA revealed a significant difference in the serial changes in thelevel of GR between the two groups (p=0.039).
CONCLUSION
Our study compared oxidative stress between LC and OC groups based on the levels of TAS, SOD, and GR. We found that minimally invasive surgery, such as laparoscopic cholecystectomy, produced less oxidative stress than open surgery.