The metabolic response to cholecystectomy: insulin resistance after open compared with laparoscopic operation.

Objective: To study the changes in insulin sensitivity and plasma concentrations of interleukin-6 (IL-6) after open compared with laparoscopic cholecystectomy.

Design: Prospective open study.

Setting: University hospital, Sweden.

Subjects: 12 otherwise healthy patients undergoing either open (n = 6) or laparoscopic (n = 6) cholecystectomy.

Main Outcome Measure: Relative insulin sensitivity (compared with preoperative) on the day after operation. Changes in IL-6 concentrations postoperatively.

Results: The mean (SEM) relative reduction in insulin sensitivity was significantly smaller after laparoscopic (18 (5)%) compared with the open operation, (58 (4)%) (p < 0.01). There was a significant increase in plasma concentrations of IL-6 postoperatively, but there was no difference between the groups.

Conclusion: Insulin sensitivity is less affected 24 hours after laparoscopic than after open cholecystectomy, which in this study was not accompanied by a simultaneous difference in the IL-6 response. The small postoperative reduction of insulin sensitivity may be a contributing factor to the clinical benefit of improved wellbeing observed after laparoscopic surgery.