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

Abstract

Background: Laparoscopic 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.

Methods: Twenty-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.

Results: The 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).

Conclusions: The 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.

Keywords: Cytokines; Hysterectomy; Interleukine-6; Laparoscopy; Surgical procedures.

Fig. 1

Changes in the plasma IL-6 concentration (mean ± SEM) during and after laparoscopic and abdominal hysterectomy. Measurement points: T0 = before anesthesia, T1 = after skin incision, T2 = at the end of peritoneal closure, T3 = 1 h after operation, T4 = 24 h after operation. ^*P < 0.05 versus the preoperative value. ^†P < 0.05 versus abdominal hysterectomy.

Fig. 2

Changes in the plasma CRP concentration (mean ± SEM) during and after laparoscopic and abdominal hysterectomy. Measurement points: T0 = before anesthesia, T1 = after skin incision, T2 = st the end of peritoneal closure, T3 = 1 h after operation, T4 = 24 h after operation. ^*P < 0.05 versus the preoperative value. ^†P < 0.05 versus abdominal hysterectomy.

Fig. 3

Changes in the plasma cortisol concentration (mean ± SEM) during and after laparoscopic and abdominal hysterectomy. Measurement points: T0 = before anesthesia, T1 = after skin incision, T2 = at the end of peritoneal closure, T3 = 1 h after operation, T4 = 24 h after operation. ^*P < 0.05 versus the preoperative value.