METABOLIC AND INFLAMMATORY RESPONSES AFTER LAPAROSCOPIC AND ABDOMINALHYSTERECTOMY

OBJECTIVE: Our purpose was to quantify and compare the metabolic and i nflammatory changes after laparoscopic and abdominal hysterectomy. STU DY DESIGN: Forty-four patients with no major medical disease requiring abdominal hysterectomy for benign disorders were randomly assigned to have laparoscopic hysterectomy (n = 20) and abdominal hysterectomy (n = 24). Venous blood and 24-hour urine samples were collected the day before and for each of the first 3 postoperative days. RESULTS: No dif ferences were present in demographic characteristics, operating time, and uterine weight between the two groups. No major complications were encountered. The laparoscopic hysterectomy group had a significantly lower postoperative morphine consumption (median 5.5 vs 14 mg, P < .05 ), lower febrile morbidity rate (15% vs 45.8%, P < .05), and shorter h ospital stay (median 4 vs 6 days, P < .001) and demonstrated a less in tense stress response in terms of serum interleukin-8 (median 50.6 vs 73.9 pg/mL x hour x 10, P = .01), C-reactive protein (median 28.1 vs 4 4.7 mg/L x hour x 10(2), P = .005), cortisol (median 23.4 vs 27.2 mg/m L x hour x 10(3), P = .04), white blood cell count (median 59.5 vs 69. 8 10(9)/L x hour x 10, P = .009), 24-hour urinary excretion of cortiso l (median 34.8 vs 44.2 nmol/L x hour x 10(3), P = .02), and norepineph rine (median 80.8 vs 132.4 nmol/L x hour x 10(2), P = .001). No signif icant difference was detected in plasma glucose (median 41.5 vs 45.6 m mol/L x hour x 10, P = 6) and 24-hour urinary excretion of epinephrine (median 32.2 vs 34.1 nmol/L x hour x 102, P = .3). CONCLUSION: Laparo scopic hysterectomy is associated with a lower morbidity and a less in tense stress response than abdominal hysterectomy for benign diseases.