Neutrophil elastase is a neutral
proteinase present mainly in the azurophilic granules of segmented granulocytes, the main cells involved in the inflammatory response reaction. In our study we attempted to determine whether an
enzyme such as
neutrophil elastase produced by polymorpho-nuclear leukocytes could be an
indicator capable of determining the degree of surgical
trauma, comparing two surgical approaches, namely,
laparoscopic cholecystectomy and open
cholecystectomy. Plasma
neutrophil elastase was determined photometrically, using an immune-activation immunoassay, in 66 patients (32 patients underwent open
cholecystectomy and 34
laparoscopic cholecystectomy) 1 day before surgery and 1, 3, 6 and 12 days after surgery. We established a reference range for
elastase by measuring the serum
elastase concentration in 48 healthy control patients. A significant increase (p < 0.05) in plasma
neutrophil elastase levels was observed on days 1, 3 and 6 after surgery in patients undergoing open
cholecystectomy, whereas the levels of the
enzyme were almost stable in patients undergoing
laparoscopic cholecystectomy. We recorded two cases (6.2%) of
respiratory tract infections in the "open" group.
Neutrophil elastase is a good
indicator for discriminating the severity of the surgical
trauma, which is certainly more severe in
laparotomy than in laparascopic
cholecystectomy. Peripheral leukocyte function seems to be better preserved after laparoscopic surgery than after
laparotomy.