Systemic inflammation and immune response after laparotomy vs laparoscopy in patients with acute cholecystitis, complicated by peritonitis

Figure 1 Randomization of diagnosis of bile peritonitis.

Figure 2 Severe leukocytosis was observed only after open cholecystectomy, but not after aparoscopic cholecystectomy, mostly due to an increment of neutrophils on day 1 and 3. Regarding Neutrophilis values, the difference between baseline values and post-operative values were significant in both groups (using the Friedman test, ^aP < 0.05). LC: Laparoscopic cholecystectomy; OC: Open cholecystectomy.

Figure 3 Change in human leukocyte antigen-DR expression in the open cholecystectomy group and laparoscopic cholecystectomy group. Regarding human leukocyte antigen-DR values, the difference between baseline values and post-operative values were significant in both groups (using the Friedman test, ^aP < 0.05). LC: Laparoscopic cholecystectomy; OC: Open cholecystectomy.

Figure 4 Change in plasma elastase concentration in the open cholecystectomy group and laparoscopic cholecystectomy group. Regarding polymorphonuclear (PMN)-elastase values, the difference between baseline values and post-operative values were significant in both groups (using the Friedman test, ^aP < 0.05). Concerning significance between baseline values and post-operative values, they were significant at day 1, 3 and 6 after surgery (P = 0.047) using the Mann-Whitney U test; P < 0.05. LC: Laparoscopic cholecystectomy; OC: Open cholecystectomy.

Figure 5 Chronological change in the serum level of interleukin-1β and interleukin-6β after surgery. A: The chronological change in the serum level of interleukin-1β (IL-1β) after surgery. Regarding IL-1β values, the difference between baseline values and post-operative values were significant in both groups (using the Friedman test, ^aP < 0.05); B: The chronological change in the serum level of interleukin-6β after surgery. Regarding IL-6β values, the difference between baseline values and post-operative values were significant in both groups (using the Friedman test, ^aP < 0.05). LC: Laparoscopic cholecystectomy; OC: Open cholecystectomy.

Figure 6 Change of values of the serum C-reactive protein on post-operative days. Regarding C-reactive protein values, the difference between baseline values and post-operative values were significant in both groups (using the Friedman test, ^aP < 0.05).

Figure 7 Systemic endotoxin concentration significantly increased during the course of surgery but returned to near baseline by day 2. Regarding endotoxin values, the difference between baseline values and postoperative values were significant in both groups (using the Friedman test, ^aP < 0.05). Besides, significance was obtained by comparing values between groups 60, 90 and 120 min after surgery, using the Mann-Whitney U test, P < 0.05.