Stress hyperglycemia in minimally invasive surgery

This study examined the selected hormonal responses to, and hormone-mediate d glucose metabolism during minimally invasive surgery in, patients undergo ing laparoscopic cholecystectomy for symptomatic gallstone disease. Thirty- two patients with symptomatic gallstone disease were included in this study and scheduled for open or laparoscopic procedure in a randomized trial. Re sults are expressed as mean and standard error of the mean. Statistical eva luations were performed with Mann-Whitney U and Wilcoxon signed-rank tests. Blood cortisol, glucagon, insulin, and glucose concentrations were measure d immediately in the preoperative period and 6 h after surgery. Blood corti sol, glucagon, and glucose concentrations increased significantly after ope n and minimally invasive surgery, while insulin levels and the insulin:gluc agon ratio remained unchanged. The rise of glucagon and cortisol values was found to be significantly higher in the postoperative period of the open p rocedure, than in the laparoscopic approach. However, in the patients who u nderwent open surgery, the increase in glucose concentrations was not signi ficantly higher in the postoperative period. Surgery-induced hormonal effects on the islets increase glucagon and suppre ss insulin secretion. The glucagon-mediated increase in hepatic glucose pro duction is excluded by the posttraumatic insulin levels from the insulin-se nsitive tissues. A bihormonal setting favors a greater rate of hepatic gluc ose production in both open and laparoscopic surgery. Hormonal changes do r eflect the degree of surgical stress, but their metabolic consequences are not parallel to the grade of surgical trauma in minimally invasive surgery.