ACTIVATION OF COAGULATION AND FIBRINOLYSIS IN OPEN AND LAPAROSCOPIC CHOLECYSTECTOMY

Background: Activation of coagulation and fibrinolysis occurs as a str ess response to surgery and may predispose the patient to thromboembol ic complications. Other components of the surgical stress response (cy tokine release, neurohumoral response, etc.) have been shown to differ between laparoscopic and open cholecystectomy, and the aim of this st udy was to investigate the effects of laparoscopic and open surgery on the coagulation and fibrinolytic pathways. Methods: Fourteen patients undergoing laparoscopic cholecystectomy and 12 patients undergoing op en cholecystectomy had blood taken in the perioperative period for fib rinopeptide A (FPA) prothrombin fragment F1.2, antithrombin 3, tissue plasminogen activator (tPA) and its fast-acting inhibitor plasminogen activator inhibitor-1 (PAI-I antigen and activity), and the euglobulin clot lysis time (ECLT). Results: The only significant differences bet ween the two groups occurred 6 h after surgery when the ECLT was longe r (p < 0.005; Mann Whitney), and PAI-1 antigen and activity were highe r (p < 0.01 and p < 0.001, respectively; Mann Whitney) after open chol ecystectomy than laparoscopic cholecystectomy. Conclusions: Other chan ges in fibrinolysis and coagulation were similar for open and laparosc opic cholecystectomy. With respect to hemostasis, laparoscopic cholecy stectomy does not increase the risk of thromboembolic complications co mpared to the conventional procedure.