Comparison of the neuroendocrine and inflammatory responses after laparoscopic and abdominal hysterectomy

Abstract

BackgroundLaparoscopic surgery is associated with a more favorable clinical outcome than that of conventional open surgery. This might be related to the magnitude of the tissue trauma. The aim of the present study was to examine the differences of the neuroendocrine and inflammatory responses between the two surgical techniques.MethodsTwenty-four patients with no major medical disease were randomly assigned to undergo laparoscopic (n = 13) or abdominal hysterectomy (n = 11). Venous blood samples were collected and we measured the levels of interleukin-6 (IL-6), CRP and cortisol at the time before and after skin incision, at the end of peritoneum closure and at 1 h and 24 h after operation.ResultsThe laparoscopic hysterectomy group demonstrated less of an inflammatory response in terms of the serum IL-6 and CRP responses than did the abdominal hysterectomy group, and the laparoscopic hysterectomy group had a shorter hospital stay (P < 0.05). The peak serum IL-6 (P < 0.05) and CRP concentrations were significantly less increased in the laparoscopic group as compared with that of the abdominal hysterectomy group (P < 0.05), while the serum cortisol concentration showed a similar time course and changes and there were no significant difference between the groups. The response of interleukin-6 showed a significant correlation with the response of CRP (r = 0.796; P < 0.05).ConclusionsThe laparoscopic surgical procedure leaves the endocrine metabolic response largely unaltered as compared with that of open abdominal hysterectomy, but it reduces the inflammatory response as measured by the IL-6 and CRP levels.

Physiologic considerations of Enhanced Recovery After Surgery (ERAS) programs: implications of the stress response

“…4 This has also been seen with laparoscopic hysterectomy where a recent study showed a decrease in circulating interleukin (IL)-6 and Creactive protein (CRP) compared with open hysterectomy. 5 The severity of the inflammatory response to a standardized surgical insult has been shown to be widely variable, with human studies using a cardiopulmonary bypass model attributing such variability to genetic polymorphism. 6 Patients with higher pro-inflammatory responses were shown to be prone to a greater incidence of postoperative complications.…”

“…The fact that the overall inflammatory response during laparoscopy is significantly attenuated may indicate an overall lesser degree of tissue damage. 4,5 This would explain, at least in part, the improved postoperative functional state following laparoscopy compared with conventional laparotomy. Thus, minimally invasive surgery remains an essential component of any ERAS program.…”

Perioperative humoral stress response to laparoscopic versus open aortobifemoral bypass surgery

“…Some studies have shown that laparoscopic surgery may lead to a decreased hormonal stress response in patients, which may result in decreased complication rates, morbidity and mortality [7,8]. The evidence has, however, not been conclusive and many studies in other fields of surgery show no statistically significant difference [5,9,10]. It has been suggested that the effect might be different in major surgery and this has been pointed out as an area for further research [5].…”

A prospective randomized study of the inflammatory responses to multiport and singleport laparoscopic hysterectomies

“…They suggest that both vaginal or laparoscopic approach have superior results than abdominal hysterectomy [6][7][8][9] . One possible evolution of laparoscopy, i.e., singleport access, aims to further reduce the surgical morbidity and is associated with better cosmetic results 10,11 .…”