Avaliação comparativa do perfil imunológico, da função pulmonar e da força muscular respiratória em mulheres submetidas a colecistectomia laparoscópica convencional e por portal único

Abstract

Introduction: Laparoscopic cholecystectomy has become the standard surgical procedure for patients with benign gallstone diseases and the single-port approach through one umbilical incision is a technical option. Surgical procedures can induce the expression of pro- and anti-inflammatory cytokines and can alter lung function and respiratory muscle strength, thus compromising recovery of the patient. Objectives: To evaluate the expression of cytokines (TNF-α, IFN-γ, IL-1β, IL-17, IL-4), lung function (FVC, FEV1 and FEV1/FVC %) and respiratory muscle strength (PImax and PEmax) before and after conventional and single-port laparoscopic cholecystectomy. Patients and Methods: Forty women with symptomatic cholelithiasis, ranging in age from 18 to 70 years, participated in the study. The patients were divided into two groups: 21 patients submitted to conventional laparoscopic cholecystectomy and 19 patients submitted to single-port laparoscopic cholecystectomy. Blood samples were collected from all patients before and 24 h after the surgical procedures after a 12-h overnight fast. The sample was centrifuged immediately at 5,000 rpm and the supernatant was aspirated and stored in 1.5-ml sterile plastic tubes at -70°C. Plasma levels of TNF-α, IFN-γ, IL-1β, IL-17 and IL-4 were quantified by ELISA. Spirometry was performed for the evaluation of lung function at two time points: before and 24 h after the surgical procedures. The following parameters were evaluated: forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and FEV1/FVC % ratio. Respiratory muscle strength was evaluated by the measurement of maximum respiratory pressures: maximum inspiratory pressure (PImax) and maximum expiratory pressure (PEmax). These pressures were measured wit a manovacuometer (-300 to +300 cmH2O) at three time points: before and 24 and 48 h after the surgical procedures. Results: Evaluation of the immune response showed no significant difference in IFN-γ or IL-1β levels between groups and time points. Significantly higher expression of IL-17 was observed after surgery in the group undergoing single-port laparoscopic cholecystectomy. Serum TNF-α and IL-4 levels were below the detection level (10 pg/ml) in the two groups and at the time points analyzed. With respect to lung function, the results showed a greater reduction in FVC and FEV1 in patients undergoing conventional laparoscopic cholecystectomy. There was no significant difference in FEV1/FVC(%) between the groups or time points studied. Analysis of respiratory muscle strength showed a greater reduction in PImax and PEmax after 24 h in the group undergoing conventional laparoscopic cholecystectomy. Conclusions: Increased postoperative expression of IL-17A in patients submitted to single-port laparoscopic cholecystectomy suggests an important role of this cytokine in tissue repair and in the induction of inflammation. The recovery of lung volumes and respiratory muscle strength occurred earlier in the group submitted to single-port laparoscopic cholecystectomy.