Coagulation, inflammatory, and stress responses in a randomized comparison of open and laparoscopic repair of recurrent inguinal hernia.

Abstract

BACKGROUND:

In previous comparisons of inflammatory and stress responses to open (OR) and laparoscopic (LR) hernia repair, all operations were performed under general anesthesia. Since local anesthesia is widely used for OR, a comparison of this approach with LR seemed relevant.

METHODS:

Patients with recurrent inguinal hernia were randomized to OR under local anesthesia (n = 30) or LR under general anesthesia (n = 31). The magnitude of the surgical trauma was assessed by measuring markers of coagulation (prothrombin fragment 1 + 2), endothelial activation (von Willebrand factor), inflammation [leukocytes, interleukin-6, -8 and -10, granulocyte macrophage colony-stimulating factor, and C-reactive protein (CRP)], and endocrine stress (cortisol) in blood collected before operation, 4 h postincision, and on postoperative day 2.

RESULTS:

Leukocyte counts and interleukin-6 and CRP levels increased in both groups, with the CRP increase being significantly greater in the OR group. The other markers did not increase significantly.

CONCLUSION:

The acute phase response was more pronounced after OR, even when this was done under local anesthesia. Both techniques seemed rather atraumatic.

• Authors: H B Rahr, J Bendix, P Ahlburg, J Gjedsted, P Funch-Jensen, E Tønnesen
• Journal: Surgical endoscopy (Surg Endosc) Vol. 20 Issue 3 Pg. 468-72 (Mar 2006) ISSN: 1432-2218 [Electronic] Germany
• PMID: 16437269 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Blood Coagulation Factors
• Interleukin-6
• C-Reactive Protein

Topics

• Adult
• Aged
• Anesthesia, Local
• Blood Coagulation Factors (analysis)
• C-Reactive Protein (analysis)
• Female
• Hematocrit
• Hernia, Inguinal (blood, surgery)
• Humans
• Inflammation (blood)
• Interleukin-6 (blood)
• Laparoscopy
• Leukocyte Count
• Male
• Middle Aged
• Recurrence
• Smoking (blood)