Metabolic and inflammatory responses after laparoscopic and abdominal hysterectomy

• Published in: American journal of obstetrics and gynecology Vol. 179; no. 1; pp. 1 - 5
• Main Authors: Yuen, Pong Mo, Mak, Tony W.L., Yim, So Fan, Ngan Kee, Warwick D., Lam, Christopher W.K., Rogers, Michael S., Chang, Allan M.Z.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01.07.1998; Elsevier
• Subjects: Abdomen - surgery; Adult; Area Under Curve; Biological and medical sciences; Biomarkers - blood; Biomarkers - urine; Female; Humans; Hysterectomy; Hysterectomy - adverse effects; Hysterectomy - methods; Inflammation - etiology; Inflammation - metabolism; inflammatory; laparoscopy; Laparoscopy - adverse effects; laparotomy; Medical sciences; metabolic; Middle Aged; Postoperative Complications; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the genital tract and mammary gland; laparoscopy; Hysterectomy; laparotomy; inflammatory; metabolic; Human; Postoperative; Urine; Endoscopic surgery; Inflammation; Laparoscopy; Metabolism; Stress; Female genital diseases; Blood plasma; Response; Surgery; Abdominal route; Female; Surgical approach; Endoscopy; Comparative study
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/S0002-9378(98)70243-1

OBJECTIVE: Our purpose was to quantify and compare the metabolic and inflammatory changes after laparoscopic and abdominal hysterectomy. STUDY DESIGN: Forty-four patients with no major medical disease requiring abdominal hysterectomy for benign disorders were randomly assigned to have laparoscopic hysterectomy ( n = 20) and abdominal hysterectomy ( n = 24). Venous blood and 24-hour urine samples were collected the day before and for each of the first 3 postoperative days. RESULTS: No differences were present in demographic characteristics, operating time, and uterine weight between the two groups. No major complications were encountered. The laparoscopic hysterectomy group had a significantly lower postoperative morphine consumption (median 5.5 vs 14 mg, P < .05), lower febrile morbidity rate (15% vs 45.8%, P < .05), and shorter hospital stay (median 4 vs 6 days, P < .001) and demonstrated a less intense stress response in terms of serum interleukin-6 (median 50.6 vs 73.9 pg/mL × hour × 10, P = .01), C-reactive protein (median 28.1 vs 44.7 mg/L × hour × 10 2, P = .005), cortisol (median 23.4 vs 27.2 mg/mL × hour × 10 3, P = .04), white blood cell count (median 59.5 vs 69.8 10 9 /L × hour × 10, P = .009), 24-hour urinary excretion of cortisol (median 34.8 vs 44.2 nmol/L × hour × 10 3, P = .02), and norepinephrine (median 80.8 vs 132.4 nmol/L × hour × 10 2, P = .001). No significant difference was detected in plasma glucose (median 41.5 vs 45.6 mmol/L × hour × 10, P = 6) and 24-hour urinary excretion of epinephrine (median 32.2 vs 34.1 nmol/L × hour × 10 2, P = .3). CONCLUSION: Laparoscopic hysterectomy is associated with a lower morbidity and a less intense stress response than abdominal hysterectomy for benign diseases. (Am J Obstet Gynecol 1998;179:1-5.)