Randomized study of coagulation and fibrinolysis during and after gasless and conventional laparoscopic cholecystectomy

Background: Carbon dioxide pneumoperitoneum may be an important pathophysio logical factor stimulating the coagulation system during conventional lapar oscopic cholecystectomy. The aim of this study was to test the hypothesis t hat gasless laparoscopy produces smaller changes in the coagulation and fib rinolytic system than carbon dioxide pneumoperitoneum in patients undergoin g laparoscopic cholecystectomy. Methods: Fifty patients were allocated randomly to conventional (n = 26) or gasless (n = 24) laparoscopic cholecystectomy. Blood samples were obtained on admission, after induction of anaesthesia, after insufflation or tracti on, 30 min after introduction of the laparoscope, 10 min after exsufflation of carbon dioxide or traction, 4 h after extubation and 24 h after operati on. Results: The two groups were comparable with respect to age, sex, body mass index and duration of operation. Plasma levels of prothrombin fragment 1 a nd 2 (F1 + 2), soluble fibrin and d-dimer did not differ between the two gr oups. F1 + 2 levels varied significantly in both groups during and after op eration (P < 0.001). Soluble fibrin and d-dimer levels did not change durin g operation in either group, but after operation the levels increased signi ficantly in both groups (P < 0.001). Conclusions: Carbon dioxide pneumoperitoneum does not enhance the activatio n of coagulation and fibrinolysis associated with laparoscopic cholecystect omy. The coagulation and fibrinolytic systems are activated during and afte r gasless as well as conventional laparoscopic cholecystectomy.