INFLUENCE OF VAGINAL VERSUS ABDOMINAL HYSTERECTOMY ON PERIOPERATIVE GLUCOSE-METABOLISM

The aim of this study was to investigate the metabolic effects of abdo minal versus vaginal hysterectomy with specific regard to perioperativ e glucose metabolism. Fourteen patients received either abdominal (AH, n=7) or vaginal hysterectomy (VH, n=7). Hepatic glucose production wa s measured before and 2.5 h after the operation by stable isotope tech nique ([6,6-H-2(2)]-glucose). Metabolic substrates (glucose, lactate, nonesterified fatty acids [NEFA], beta-hydroxybutyrate) and hormones ( insulin, glucagon, cortisol, catecholamines) were determined pre-, int ra-, and postoperatively. VH induced a higher postoperative glucose co ncentration than the abdominal approach (VH, 148+/-25 mg/dL; AH, 111+/ -16 mg/dL; P <0.05). Since postoperative enhancement of hepatic glucos e production was comparable in both groups, glucose clearance was lowe r after the vaginal procedure (VH, 1.7+/-0.3 mL . kg(-1). min(-1); AH, 2.1+/- 0.3 mL . kg(-1). min(-1); P <0.05). NEFA, beta-hydroxybutyrate , and catecholamines similarily increased after surgery. Cortisol leve ls were more increased after VH (VH, 80+/-26 mu g/dL; AH, 37+/-14 mu g /dL; P <0.001). Lactate, glucagon, and insulin concentrations did not change perioperatively. The more pronounced hyperglycemic response to VH was due to lower peripheral glucose use caused by higher postoperat ive cortisol values. The mechanisms responsible for this marked cortis ol enhancement after the vaginal operation as well as the clinical sig nificance for patients with preexisting impaired carbohydrate toleranc e, however, remained unclear and warrant further investigation.