Laparoscopic-assisted vaginal hysterectomy and the hyperglycemic response to surgery: an observational study

Purpose: To test the hypothesis that laparoscopic-assisted vaginal hysterec tomy (LAVH) attenuates the hyperglycemic response to surgery when compared to vaginal hysterectomy (VH). Methods: Fourteen patients received either LAVH (n=7) or VH (n=7). Whole bo dy glucose production was measured before and three hours after surgery usi ng [6.6(-2) H,] glucose. Before, during and after the operation, plasma con centrations of glucose, insulin, glucagon, cortisol, epinephrine and norepi nephrine were determined. Results: Plasma glucose concentration increased in both groups during and a fter surgery showing a significantly higher value after VH than after LAVH (VH: 8.3 +/- 1.4 mmol(.)L(-1); LAVH: 6.6 +/- 0.9 mmol(.)L(-1), P < 0.05). T he postoperative increase in glucose production was comparable in both grou ps. While plasma concentrations of insulin and glucagon remained unchanged, intra- and postoperative plasma cortisol concentrations were significantly higher in the VH group than in the LAVH group. Plasma catecholamine concen trations significantly increased after both types of surgery to the same ex tent. Conclusion: In this observational study, LAVH appears to blunt the hypergly cemic and cortisol response to surgery when compared to VH.