GYNECOLOGIC LAPAROSCOPIC SURGERY IS NOT ASSOCIATED WITH AN INCREASE OF SEROTONIN METABOLITES EXCRETION

Gynecologic laparoscopic surgery is associated with a high incidence o f postoperative nausea and vomiting (PONV). The specific antagonists o f the 5-hydroxytryptamine-3 (5-HT3) receptor have been progressively i ntroduced in anesthesiology to prevent or treat PONV. Although a large increase of serotonin has been documented after cisplatin treatment, the link between serotonin and PONV in surgery/anesthesiology is unkno wn. In a prospective study, we compared the excretion of the serotonin metabolite 5-hydroxyindoacetic add (5-HIAA) in 40 women undergoing ei ther gynecologic laparoscopic surgery (laparoscopy group) or tradition al open laparotomy surgery (laparotomy group). Premedication, anesthet ic technique, and postoperative pain treatment were standardized. The excretion of 5-HIAA corrected to creatinine was measured in all patien ts immediately after the induction of anesthesia and was repeated regu larly until 9 h after induction. The excretion of 5-HIAA/creatinine wa s similar in the two groups; no increase was observed in either group. The incidence of nausea and vomiting was 40% and 35%, respectively in the laparoscopy group versus 60% and 15%, respectively, in the laparo tomy group (not significantly different). The excretion of 5-HIAA/crea tinine was comparable in patients of both groups among those who vomit ed and those who did not. We conclude that the creation of a pneumoper itoneum during gynecologic laparoscopic surgery is not associated with an increase of 5-HIAA excretion. PONV after gynecologic laparoscopic surgery is not explained by an increase of serotonin secretion. Implic ations: The mechanism leading to the high incidence of postoperative n ausea and vomiting after gynecologic laparoscopic surgery is unknown. The excretion of the serotonin metabolite 5-hydroxyindoacetic acid did not increase during the creation of the pneumoperitoneum and the firs t 9 h postoperatively. Increase of serotonin secretion from the gut ma y not explain postoperative nausea and vomiting associated with this s urgery.