World Journal of Surgery

, Volume 34, Issue 9, pp 2045–2050 | Cite as

Changes of Inflammatory Mediators in Obese Patients After Laparoscopic Cholecystectomy

  • Gaetano Di Vita
  • Rosalia Patti
  • Fausto Famà
  • Carmela Rita Balistreri
  • Giuseppina Candore
  • Calogero Caruso
Article

Abstract

Background

Obesity is associated with the impairment of immunological functions. The aim of this study was to analyze some inflammatory mediators in obese subjects who underwent laparoscopic cholecystectomy.

Methods

Seventeen consecutive female patients with a BMI ranging from 35 to 45 kg/m2 (obese) and 17 consecutive female patients with BMI ranging from 20 to 25 kg/m2 (nonobese) were included in the study. All patients were affected by symptomatic gallbladder stone disease and underwent laparoscopic cholecystectomy. Changes in levels of leukocytes, neutrophils, IL-6, IL-10, leptin, and adiponectin were evaluated.

Results

We observed a significant increase in leukocyte and neutrophil levels in the obese subjects compared to the nonobese subjects. The serum levels of leptin and IL-6 were higher in the postoperative period (compared to the baseline values in both groups), and always higher in the obese. Both adiponectin and IL-10 increased in the postoperative period in nonobese subjects and was always higher than in the obese.

Conclusions

Obese patients have a stronger acute inflammatory response than do nonobese subjects in reaction to surgical stress.

References

  1. 1.
    World Health Organization (1998) Obesity: preventing and managing the global epidemic. WHO, GenevaGoogle Scholar
  2. 2.
    Mokdad AH, Marks JS, Stroup DF et al (2004) Actual causes of death in the United States, 2000. JAMA 291:1238–1245CrossRefPubMedGoogle Scholar
  3. 3.
    Khan LK, Bowman BA (1999) Obesity: a major global public health problem. Annu Rev Nutr 19:13–17CrossRefGoogle Scholar
  4. 4.
    Martí A, Marcos A, Martínez JA (2001) Obesity and immune function relationships. Obes Rev 2:131–140CrossRefPubMedGoogle Scholar
  5. 5.
    Livingstone EH, Ko CY (2002) Use of the health and activities limitation index as a measure of quality of life in obesity. Obes Res 10:824–832CrossRefGoogle Scholar
  6. 6.
    Bamgbade OA, Rutter TW, Nafiu OO et al (2007) Postoperative complications in obese and nonobese patients. World J Surg 31:556–560CrossRefPubMedGoogle Scholar
  7. 7.
    Dindo D, Muller MK, Weber M et al (2003) Obesity in general elective surgery. Lancet 361:2032–2035CrossRefPubMedGoogle Scholar
  8. 8.
    Tanaka S, Inoue S, Isoda F et al (1993) Impaired immunity in obesity: suppressed but reversible lymphocyte responsiveness. Int J Obes Relat Metab Disord 17:631–636PubMedGoogle Scholar
  9. 9.
    Gendall KA, Raniga S, Kennedy R et al (2007) The impact of obesity on outcome after major colorectal surgery. Dis Colon Rectum 50:2223–2237CrossRefPubMedGoogle Scholar
  10. 10.
    de Oliveira AC, Ciosak SI, Ferraz EM et al (2006) Surgical site infection in patients submitted to digestive surgery: risk prediction and the NNIS risk index. Am J Infect Control 34:201–207CrossRefPubMedGoogle Scholar
  11. 11.
    Ondrula DP, Nelson RL, Prasad ML et al (1992) Multifactorial index of preoperative risk factors in colon resections. Dis Colon Rectum 35:117–122CrossRefPubMedGoogle Scholar
  12. 12.
    Brandt M, Harder K, Walluscheck KP et al (2001) Severe obesity does not adversely affect perioperative mortality and morbidity in coronary artery bypass surgery. Eur J Cardiothorac Surg 19:662–666CrossRefPubMedGoogle Scholar
  13. 13.
    Mullen JT, Moorman DW, Davenport DL (2009) The obesity paradox: body mass index and outcomes in patients undergoing nonbariatric general surgery. Ann Surg 250:166–172CrossRefPubMedGoogle Scholar
  14. 14.
    Schwarzenberg SJ, Sinaiko AR (2006) Obesity and inflammation in children. Paediatr Respir Rev 7:239–246CrossRefPubMedGoogle Scholar
  15. 15.
    Gregoire FM, Smas CM, Sul HS (1998) Understanding adipocyte differentiation. Physiol Rev 78:783–809PubMedGoogle Scholar
  16. 16.
    Cancello R, Clement K (2006) Is obesity an inflammatory illness? Role of low-grade inflammation and macrophage infiltration in human white adipose tissue. BJOG 113:1141–1147CrossRefPubMedGoogle Scholar
  17. 17.
    O’Rourke RW, Kay T, Scholz MH et al (2005) Alterations in T-cell subset frequency in peripheral blood in obesity. Obes Surg 15:1463–1468CrossRefPubMedGoogle Scholar
  18. 18.
    Di Vita G, Sciumè C, Milano S et al (2001) Inflammatory response in open and laparoscopic cholecystectomy. Ann Ital Chir 72:669–673PubMedGoogle Scholar
  19. 19.
    Schietroma M, Carlei F, Cappelli S et al (2007) Effects of cholecystectomy (laparoscopic versus open) on PMN-elastase. Hepatogastroenterology 54:342–345PubMedGoogle Scholar
  20. 20.
    Huskisson EC (1982) Measurement of pain. J Rheumatol 9:768–769PubMedGoogle Scholar
  21. 21.
    Fantuzzi G (2005) Adipose tissue, adipokines, and inflammation. J Allergy Clin Immunol 115:911–919CrossRefPubMedGoogle Scholar
  22. 22.
    Chandra RK, Au B (1980) Spleen hemolytic plaque-forming cell response and generation of cytotoxic cells in genetically obese (C57Bl/6J ob/ob) mice. Int Arch Allergy Appl Immunol 62:94–98CrossRefPubMedGoogle Scholar
  23. 23.
    Weber DJ, Rutala WA, Samsa GP et al (1986) Impaired immunogenicity of hepatitis B vaccine in obese persons. N Engl J Med 314:1393PubMedGoogle Scholar
  24. 24.
    Lago F, Dieguez C, Gómez-Reino J et al (2007) Adipokines as emerging mediators of immune response and inflammation. Nat Clin Pract Rheumatol 3:716–724CrossRefPubMedGoogle Scholar
  25. 25.
    Maffei M, Fei H, Lee GH et al (1995) Increased expression in adipocytes of ob RNA in mice with lesions of the hypothalamus and with mutations at the db locus. Proc Natl Acad Sci USA 92:6957–6960CrossRefPubMedGoogle Scholar
  26. 26.
    Wolf AM, Wolf D, Rumpold H et al (2004) Wolf adiponectin induces the anti-inflammatory cytokines IL-10 and IL-1RA in human leukocytes. Biochem Biophys Res Commun 323:630–635CrossRefPubMedGoogle Scholar
  27. 27.
    Angele MK, Faist E (2002) Clinical review: immunodepression in the surgical patient and increased susceptibility to infection. Crit Care 6:298–305CrossRefPubMedGoogle Scholar
  28. 28.
    Di Vita G, Patti R, Buscemi S et al (2006) Acute phase response in oldest-old individuals after surgical stress. J Am Geriatr Soc 54:561–563CrossRefPubMedGoogle Scholar
  29. 29.
    Sietses C, Beelen RH, Meijer S et al (1999) Immunological consequences of laparoscopic surgery, speculations on the cause and clinical implications. Langenbecks Arch Surg 384:250–258CrossRefPubMedGoogle Scholar
  30. 30.
    Bone RC (1996) Towards a theory regarding the pathogenesis of the systemic inflammatory response syndrome: what we do and do not know about cytokine regulation. Crit Care Med 24:163–172CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Gaetano Di Vita
    • 1
  • Rosalia Patti
    • 1
  • Fausto Famà
    • 1
  • Carmela Rita Balistreri
    • 2
  • Giuseppina Candore
    • 2
  • Calogero Caruso
    • 2
  1. 1.General Surgery Unit, Department of Surgical and Oncological ScienceUniversity of PalermoPalermoItaly
  2. 2.Immunosenescence Unit, Department of Pathobiology and Biomedical MethodologiesUniversity of PalermoPalermoItaly

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