Surgically induced hormonal, metabolic and inflammatory changes in laparoscopic hysterectomy: a comparison with abdominal hysterectomy

Abstract

ABSTRACTObjective To assess and compare surgically induced hormonal, metabolic and inflammatory changes during laparoscopic and abdominal hysterectomy.Setting Baby Friendly Hospital, Kladno, Postgraduate Medical Institute, Prague.Design 77 women, with no major medical disorder but requiring hysterectomy for benign diseases, were prospectively assigned to undergo laparoscopic (n = 59) or abdominal hysterectomy (n = 18). Surgical characteristics, hospital stay and complications were analysed. Blood samples for assay of markers of tissue trauma (C‐reactive protein (CRP), interleukin‐6 (IL‐6), creatine kinase, cortisol, white blood cell count (WBC) and cystatin C) were taken preoperatively and on the first and third postoperative day.Results There were no differences between the two groups with regard to demographic characterics, but the mean uterine weight was 220 g in the laparoscopic hysterectomy group vs. 540 g in the abdominal hysterectomy group, (P < 0.0001). The median (interquartile range) operating time was 80 min (70–90 min) in the laparoscopic group and 105 min (80–120 min) in the abdominal group (P < 0.05). For the laparoscopic hysterectomy and abdominal hysterectomy groups, respectively, the estimated blood loss was 100 ml (95–200 ml) and 300 ml (250–2000 ml) (P < 0.0001), the median length of hospital stay was 4 days (3–4 days) and 8 days (7–10 days) (P < 0.0001), and the decline in the haemoglobin level was 0.9 and 2.45 g dl−1 on the third postoperative day (P < 0.001). Preoperative levels of biochemical markers were low in both groups. The rates of major and moderate complications were found to be low in the groups under comparison. One woman with a ureteral injury was excluded from the laparoscopic group for purposes of statistical analysis. There were significant increases in the serum concentrations of cortisol, CRP, IL‐6, creatine kinase and WBC after surgery in both groups. The laparoscopic group demonstrated a less intense stress response in terms of IL‐6 (P < 0.0001), CRP (P < 0.0001), creatine kinase (P < 0.001), cortisol (P < 0.05) and WBC (P < 0.001). Plasma concentrations of cystatin‐C decreased insignificantly during the first postoperative day.Conclusion Compared with abdominal hysterectomy in women with pelvic disorders, laparoscopic hysterectomy was associated with a less intense hormonal, metabolic and inflammatory reponse and a more favourable clinical outcome.