Résumé
To investigate stress response and postoperative outcome in laparoscopic and open cholecystectomy. In addition, to compare between two anesthetic techniques for laparoscopic cholecystectomy as regards serum cytokines changes and postoperative outcome. Thirty patients scheduled for elective cholecystectomy for gall stone disease were classified into 3 equal groups. Group I: underwent open cholecystectomy under halothane anesthesia; Group II : underwent laparoscopic cholecystectomy under halothane anesthesia; Group III : underwent laparoscopic cholecystectomy under isoflurane anesthesia. All patients were subjected to the following : [1] Measurements of IL-6, IL-1 before anesthesia, I hour and 24 hours postoperatively; [2] Recordings the time to eye opening and orientation to persons and place; [3] Evaluation of postoperative pain at 1, 6, 12, 24 h and 48 h postoperatively; [4] Frequency of nausea and vomiting; [5] Length of the hospital stay, IL-6 and IL-I increased significantly in the-three groups at 1 hour postoperatively, then decreased significantly at 24 hours postoperatively. The differences between group I and group II or III was significant, but there was no significant difference between group II and group III. Laparoscopic groups [II and III] were associated with less postoperative pain and narcotic requirements compared with open group [I] while no significant difference between laparoscopic group [II and III]. Nausea and vomiting were encountered more frequent in laparoscopic groups than in open group, but the difference was not significant. Hospital stay was significantly short in laparoscopic group than in open group. Time to eye opening and time to orientation to place and person were significantly short in isoflurane laparoscopic cholecystectomy group than halothane laparoscopic cholecystectomy group. [1] Laparoscopic cholecystectomy is associated with less tissue injury and less stress response as indicated by lower serum levels of IL-6 and IL-1 compared to open cholecystectomy; [2] Laparoscopic cholecystectomy is associated with better postoperative outcome as indicated by less postoperative narcotic requirements and short hospital stay; [3] Apart from early eye opening and early orientation associated with isoflurane anesthesia, it exerts minor influence on postoperative outcome compared to fluthane anesthesia for laparoscopic cholecystectomy