From the early days of surgery, it has been well known that surgical treatment impaired the host immune system.1 However, the mechanisms of this phenomenon are still unclear. We read with interest the report by Redmond et al2 in which they compared the immune function response to open and laparoscopic cholecystectomy. A significant increase in the regulation of monocytes and leukocytes was shown in the open cholecystectomy group.
We have studied the cytokine and endocrinological response after major and minor surgery in humans to examine the immunosuppressive mechanisms. The serum from patients following transthoracic esophagectomy (major surgery) and from patients following laparoscopic cholecystectomy (minor surgery) was sampled over a 48-hour period. The serum levels of interleukin-1 (IL-1), IL-6, tumor necrosis factor, corticotropin, cortisol, and antidiuretic hormone were measured. The concentrations of IL-1 and IL-6 increased immediately after major surgery (the measured IL-6 levels [mean±SD] were 5.0±1.1, 348.2±61.3, and