Metabolic and inflammatory responses after laparoscopic and abdominal hysterectomy

doi:10.1016/S0002-9378(98)70243-1

American Journal of Obstetrics and Gynecology

Volume 179, Issue 1, July 1998, Pages 1-5

https://doi.org/10.1016/S0002-9378(98)70243-1 Get rights and content

Abstract

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 × 10², P = .005), cortisol (median 23.4 vs 27.2 mg/mL × hour × 10³, P = .04), white blood cell count (median 59.5 vs 69.8 10⁹/L × hour × 10, P = .009), 24-hour urinary excretion of cortisol (median 34.8 vs 44.2 nmol/L × hour × 10³, P = .02), and norepinephrine (median 80.8 vs 132.4 nmol/L × hour × 10², 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 × 10², 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.)

Section snippets

Material and methods

Patients with no major medical diseases requiring hysterectomy for benign disorders, between January and June 1996, were invited to participate in the study. Patients who were suitable for vaginal hysterectomy or who had a uterus larger than 16 weeks’ gravid size were excluded. After informed written consent was obtained, each patient was assigned to have either laparoscopic hysterectomy or abdominal hysterectomy by a computer-generated sequence of random numbers. The study was approved by the

Results

Fifty patients were recruited, 6 were subsequently excluded because 4 declined the operation and 2 refused to participate postoperatively. As a result, 20 patients were in the laparoscopic hysterectomy group and 24 were in the abdominal hysterectomy group. Demographic characteristics and uterine weight were similar between the two groups (Table I), and fibroids were the most common indication for the hysterectomy (74% in laparoscopic hysterectomy versus 64% in abdominal hysterectomy).

Comment

Changes in acute-phase proteins occur in response to injury. Interleukin-6 is produced by activated monocytes, macrophages, fibroblasts, and endothelial cells and is a major regulator of this response. It rises rapidly and peaks between 3 and 24 hours after injury.7, 11 Interleukin-6 induces specific hepatic proteins, the most important of which is C-reactive protein.7, 12, 13, 14 C-reactive protein therefore reached its peak level shortly after that of interleukin-6, as shown in our study.

Acknowledgements

We thank Ms Priscilla Ngan for her assistance in collecting the clinical data.

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^☆: From the Department of Obstetrics and Gynaecology,^a the Department of Chemical Pathology,^b and the Department of Anesthesia and Intensive Care,^c The Chinese University of Hong Kong, Prince of Wales Hospital.

^☆☆: Supported by a Direct Grant for Research from the Chinese University of Hong Kong.

^★: Reprint requests: Dr P.M. Yuen, Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Shatin, N.T., Hong Kong.

^★★: 0002-9378/98 $5.00 + 0 6/1/89114

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Metabolic and inflammatory responses after laparoscopic and abdominal hysterectomy☆,☆☆,★,★★

Abstract

Section snippets

Material and methods

Results

Comment

Acknowledgements

Clin Immunol Immunopathol

Obstet Gynecol

Laparoscopic hysterectomy

J Gynecol Surg

Laparoscopic alternatives to laparotomy: a new approach to gynaecological surgery

Br J Obstet Gynaecol

Interlukin-6 as a new indicator of inflammatory status: detection of serum levels of interleukin-6 and C-reactive protein after surgery

Surgery

Quantification of “acute phase proteins” postoperatively

Am J Clin Pathol

Determination of C-reactive protein and alpha-1-antitrypsin for quantitative assessment of surgical trauma

Eur Surg Res

Response of serum interleukin-6 in patients undergoing elective surgery of varying severity

Clin Sci

Serum interleukin-6 and C reactive protein responses in patients after laparoscopic or conventional cholecystectomy

Eur J Surg