[Surgical trauma in laparoscopic and classical cholecystectomy]. / Operativna trauma pri laparoskopskoj i klasicnoj holecistektomiji.

ABSTRACT

INTRODUCTION: Accidental or surgical trauma stimulates a response and its intensity is proportional to extent of trauma. The aim of this prospective study was to compare the intensity of the acute-phase reaction and metabolic changes in patients undergoing elective cholecystectomy for chronic cholecystitis. PATIENTS AND METHODS: Sixty patients with cholelithiasis were divided into two groups thirty patients underwent laparoscopic cholecystectomy (LC group) and thirty patients open cholecystectomy (OC group). Glucose concentration, mean cortisol concentration, C-reactive protein, albumin levels and lactate-dehydrogenase activity were measured preoperatively and postoperatively for up to 48 hours. RESULTS AND DISCUSSION: The examined groups of patients were comparable in regard to age and sex. The duration of operation was similar in both groups. Postoperative hospital stay after laparoscopic operation was significantly shorter than after open cholecystectomy (p < 0.05). The mean glucose concentration (s.e.m.) during the initial 24 hours after surgery was significantly higher (p < 0.05) following open cholecystectomy. The mean cortisol concentration was significantly higher (p < 0.05) following open in regard to laparoscopic operation. Increase in plasma C-reactive protein was significantly higher (p < 0.05) after open cholecystectomy, with maximal levels 48 h after operation. There was a statistically significant decrease (p < 0.05) in albumin concentration after open cholecystectomy. Serum concentration of intracellular enzyme lactate-dehydrogenase increased significantly (p < 0.05) following open in regard to laparoscopic cholecystectomy. CONCLUSION: According to these results, aspects of metabolic and acute-phase responses and tissue damage are reduced following laparoscopic cholecystectomy. The mean postoperative hospital stay was significantly shorter after laparoscopic cholecystectomy with rapid patient recovery.