Comparative Study of CRP and Serum Albumin as Stress Response Markers in Laparoscopic Versus Open Cholecystectomy

Abstract

BACKGROUND Body responds to any trauma and surgery with 'stress response' in the form of metabolic and hormonal changes. Change in 'Acute Phase Proteins' (APP) like C-Reactive Proteins and Albumin occurs after surgery. Less injury induces less 'acute stress response' and good surgical outcome. Laparoscopic surgery produces less operative stress as compared to open laparotomy. Changes in albumin levels starts appearing much earlier than changes in levels of CRP. This study was conducted with an aim to compare the response kinetics & levels of acute phase proteins (APP) like C-reactive Proteins and Albumin and asses the accurate predictability of these makers in surgical outcome to the extent of surgical trauma. Aims & Objectives-To understand the behavior of stress response markers CRP and Serum Albumin in minimally invasive procedure lap-cholecystectomy versus open cholecystectomy and their predictability in clinical outcome. MATERIALS AND METHODS Settings & Design-This prospective randomized study was conducted on patients admitted in the Department of Surgery, Rama Medical College, Kanpur during May 2016 to April 2018. 80 Patients with diagnosis of chronic cholelithiasis were included and randomly divided in two groups, open-cholecystectomy (Group A) and lap-cholecystectomy (Group B) each having 40 patients. The levels of C-reactive Proteins (CRP) and serum albumin (S. Alb) were measured 12 hrs. pre-operatively, then post-operatively at 6 Hrs., 12 Hrs., 24 hrs. 2 nd , 3 rd and 4 th day and data analyzed. Sample size was taken for convenience. Statistical Analysis-Data was analyzed by statistical software package SPSS version 21.0 (SPSS Inc. Chicago, IL, USA). The average (Mean) value of CRP and Albumin in the two groups have been compared using independent sample 't' test. The levels of both CRP and Albumin at different sampling time have been compared by using Repeated Measure ANOVA and individual comparison between individual groups were done using Post-Hoc test (Bonferroni Test. 'p' value < 0.05 is considered significant. 'p' value <0.05 is considered significant. RESULTS 80 patients were divided into two groups (Open and Laproscopic) randomly. Pre-operative CRP levels are almost equal in both the groups, while there is a sharp rise of CRP levels in both groups from 2 nd post-operative day to 3 rd post-operative day and then there is slow decline of levels from 4 th post-operative day. The rise of CRP level was more in open group as compared to Lap group indicative of extent of trauma in more in open group. The decline in Albumin levels is significant only up to first 24 hrs. and after 24 hrs., decline of Albumin is statistically not significant. This shows that measurement of Albumin level can be used as early predictor of stress response in early post-operative period as compared to CRP levels. CONCLUSION Laparoscopic cholecystectomy is less traumatizing as compared to open cholecystectomy. Post-operative albumin drops can be measured as early as 4-6 hours after surgery as compared to rise of CRP levels wh...

The impact of enhanced recovery after surgery on inflammatory indicators and prognosis related to complex appendicitis in children

“…After surgery, CRP concentration usually increases rapidly within 4-12 h and reaches its peak within 24-72 h, lasting up to 2 weeks. The increase of proinflammatory cytokine IL-6 after surgery is related to insulin resistance (14), and its sensitivity is higher than CRP. Jawa RS (2011) pointed out that the increase of IL-6 after surgery is related to the degree of tissue damage (15), including the surgical approach, laparoscopy and open surgery, the complexity of surgery, cholecystectomy, and colectomy.…”