Postoperative Immosuppression in Patients Undergoing Laparoscopic Assisted Vaginal Hysterectomy versus Total Abdominal Hysterectomy: Preliminary Results

Abstract

Postoperative immunosuppression has been documented in healthy individuals following elective surgery, trauma, and bums. Both cellular immunity and humoral immunity are depressed transiently, the severity of which is correlated with the length of hospital stay, infectious morbidity, and mortality. The present study was designed to compare the degree of immunosuppression in patients undergoing laparoscopic assisted vaginal hysterectomy (LAVH) versus total abdominal hysterectomy (TAH). Total T cell count, B cell count, and delayed hypersensitivity response to intradermal injection of PPD antigen were documented preoperatively and on postoperative days 3 and 7. There was a significant fall in T cell count on day 3, which tended to normalize by day 7 in the TAH group, but no change was seen in the postoperative T cell count in the LAVH group. No significant change was observed in the B cell count in either group. In the TAH group, two of three patients who showed positive skin response to PPD preoperatively had a negative response after surgery, while in the LAVH group, the patients who had a positive response before continued to do so after surgery. These preliminary results suggest that there is a lesser degree of derangement of the immune system in patients undergoing LAVH than in those undergoing open hysterectomy, which may be a significant factor contributing to a shorter convalescence after laparoscopic surgery. This trend, however, needs further confirmation in a larger patient population. (J GYNECOL SURG 15:67, 1999)