Videolaparoscopic cholecystectomy induces a hemostasis activation of lowergrade than does open surgery

Background: Tissue injury after trauma and surgery may induce alterations i n blood coagulation and fibrinolysis, and the hypercoagulable state observe d after surgery can be associated with the risk of postoperative thromboemb olic complications. Recently, videolaparoscopic (VLPS) cholecystectomy has been introduced, and its advantages over the open procedure seem related to the reduced surgical trauma. The aim of this study was to investigate hemo static system alterations in patients who undergo open and VLPS cholecystec tomy. Methods: Fibrinogen, prothrombin fragment F1+2, D-dimer, and plasminogen ac tivator inhibitor type-1 (PAI-1) activity was determined in 10 patients who underwent open (group A) and 10 patients who underwent VLPS cholecystectom y (group B), respectively. Blood samples were obtained the day of surgery i n the morning (B1), after anesthesia (A1), 1 hour after the start of surger y (S1), then 30 min (E.05) and 24 h (E.24) after the surgery. Results: No significant differences were observed in baseline values betwee n,groups A and B for the parameters investigated. At 24 h after surgery, fi brinogen increased significantly (p < 0.05) in group A and also was signifi cantly higher than in group B (p < 0.05). In group A, a marked increase in F1+2 levels (p < 0.01) was observed in all the samples, with the maximum va lues on the first day after surgery (3.7 mol/l; 1.2-6.0 nmol/l), whereas in group B, a slight but significant increase in F1+2 levels (2.1 nmol/l; 1.1 -3.9 nmol/l; p < 0.01) was observed only 30 min after the end of surgery. I n both groups A and B, D-dimer markedly increased after surgery, without st atistical significant differences between the two groups at any time. The P AI-1 activity plasma levels remained in the normal range during and after s urgery in both groups. Conclusions: These results indicate that VLPS surgery induces an activation of the clotting system that, although of low degree and short duration, ca n lead to a transient prothrombotic state.