Controlled evaluation of fibrinolytic response to intraoperative pneumaticintermittent sequential compression of the lower extremities during laparoscopic cholecystectomy

Objective: During a pneumoperitoneum intraoperative intermittent sequential pneumatic compression (ISC) neutralizes venous stasis in the lower extremi ties and may also have an influence on systemic fibrinolytic activity. Design: Controlled study to evaluate whether ISC stimulates intravascular f ibrinolytic activity. Setting. University-Hospital. Materials: 26 patients underwent laparoscopic cholecystectomy with (+ISC, n = 10) or without (-ISC, n = 16) ISC. Intervention: Intraoperative intermittent sequential compression of the low er extremities. Main outcome measures: Major endpoint - postoperative plasma activity of ti ssue-plasminogen-activator (t-PA). Minor endpoints - postoperative plasmino gen-activator-inhibitor-1 (PAI-1) activity, plasmin-antiplasmin-complex (PA P) concentration, concentration of total fibrin degradation products (TDP), and D-Dimer concentration. Results: There was no difference in age, sex, b ody mass index (BMI), and properative fibrinolytic activity between the gro ups. Postoperative t-PA-activity (P=0.3), PAI-1-activity (P=0.9), PAP- (P=0 .5), TDP-(P=0.2), and D-Dimerconcentrations (P=0.1) were also not different between both groups. Conclusion: During laparoscopic cholecystectomy intraoperative ISC does not activate systemic intravascular fibrinolysis. Because of the positive hemo dynamic effect of ISC during pneumoperitoneum, studies of the antithromboti c efficacy of this tool are needed in the setting of laparoscopic surgery. (C) 2000 Harcourt Publishers Ltd.