The Stress Response to Laparoscopic Cholecystectomy: Investigation of Endocrine Parameters

Abstract

Laparoscopic cholecystectomy, as a typical example of minimal invasive surgery, is associated with low complication rates and minimal patient discomfort, and provides the same safety as conventional cholecystectomy. In the present prospective observational study, endocrine parameters as indicators for stress response were measured. We investigated 53 patient with laparoscopy cholecystectomy and 12 patients with conventional cholecystectomy. Blood samples were taken pre-, peri-, and postoperatively for measurement of ACTH, cortisol, prolactin, and growth hormone. General anesthesia followed a standardized protocol. The increase in all stress hormones did not differ between patients in the two groups, and was comparable with that reported in the literature and the findings of our own previous studies in patients undergoing conventional cholecystectomy and elective colon resection. We conclude that laparoscopic cholecystectomy is associated with a pronounced endocrine stress response that does not account for the observed differences in the peri- and postoperative complication rate or patient comfort.

Evaluation of the response of cortisol, corticotropin and blood platelets kinetics after laparoscopic and open cholecystectomy

“…A significant difference in cortisol levels was observed between the laparoscopic and open surgery groups 2, 24 and 48 hours after surgery 16 , with the increase being higher in the laparoscopic group at 2 hours, probably because of the presence of pneumoperitoneum 17 . Similar to other reports 17,18 , an earlier increase in cortisol levels and a faster return to preoperative values were observed for the laparoscopic procedure. In open cholecystectomy, however, cortisol levels continued to be elevated 24 and 48 hours after surgery compared to baseline, indicating a longer lasting response to surgical stress as previously described 19,20 .…”

Prospective randomized study of stress and immune response after laparoscopic vs conventional colonic resection

“…These early changes correspond to those documented by other authors for patients undergoing surgical stress [19]. Only Deuss [6] could not find significant differences in endocrine parameters in laparoscopic vs open cholecystectomy, and he explains this fact by the unrandomized design of his study.…”

“…The advantages of most laparoscopic techniques are associated with decreased postoperative pain, less postoperative disability, shorter hospital stay, and an earlier return of the patients to work in comparison with conventional surgery. In the case of laparoscopic cholecystectomy these facts were confirmed by unrandomized trials demonstrating significant differences in stress and immune parameters [3,6,9,10,11,14].…”

Short- and long-term results after laparoscopic vs conventional colon resection in a tumor-bearing small animal model

“…These early changes correspond to those documented by other authors for patients undergoing surgical stress [27]. Only Deuss et al [9] could not find significant differences in endocrine parameters in laparoscopic vs open cholecystectomy; they explained these facts by pointing to the unrandomized design of the study.…”