A PROSPECTIVE RANDOMIZED COMPARISON OF THE METABOLIC AND STRESS HORMONAL RESPONSES OF LAPAROSCOPIC AND OPEN CHOLECYSTECTOMY

BACKGROUND: In a relatively short period of time, therapeutic laparosc opy has become an everyday part of the general surgeon's Life. Althoug h laparoscopy provides distinct clinical advantages, it is not yet cle ar that it lessens the stress response typical of elective surgical pr ocedures, and as such, the morbidity of surgery. The hypothesis that l aparoscopic cholecystectomy produces less of a metabolic and stress ho rmonal response than open cholecystectomy was tested in a prospective randomized trial. STUDY DESIGN: Twenty otherwise healthy women between 18 and 45 years of age with a history of uncomplicated symptomatic ch olelithiasis undergoing either laparoscopic (n=10) or open cholecystec tomy (n=10) were studied. The hormonal response of the adrenocortical (serum adrenocorticotropic hormone, cortisol, and urinary free cortiso l), adrenomedullary (plasma and urinary epinephrine and norepinephrine ), thyroid (thyroid-stimulating hormone, thyroxine, and triiodothyroni ne), pituitary (antidiuretic hormone and growth hormone), and glucose (serum glucose, glucagon, and insulin) homeostatic axes were measured serially over a 24-hour period. RESULTS: No difference was seen betwee n the laparoscopic and open groups in operative time (mean plus or min us standard error of the mean, 70+/-6 minutes compared with 77+/-6.3 m inutes) or hospital stay 1.3+/-0.2 compared with 1.1+/-0.1 days). Asse ssment of postoperative pain using an analog pain score was less in th e laparoscopic group (4.9+/-1.3 compared with 12.3+/-2.5, p=0.01). The response of the adrenocortical, adrenomedullary, thyroid, and glucose axes were similar or identical in both groups. Antidiuretic hormone l evels were greater in the laparoscopic group at one hour intraoperativ ely (281+/-79 pg/mL compared with 54+/-18 pg/mL, p<0.01), and at extub ation (122+/-18 pg/mL compared with 36+/-7 pg/mL, p<0.01). Serum gluco se levels were greater immediately following laparoscopic cholecystect omy. Glucose and insulin levels were greater at four, 12, and 24 hours after open cholecystectomy. CONCLUSIONS: Elective laparoscopic and op en cholecystectomy for uncomplicated cholelithiasis result in similar degrees of perioperative hormonal stimulation. The different hormonal responses in the immediate and later postoperative periods after lapar oscopic and open cholecystectomy suggest differential stressful stimul i between the two procedures.