Activation of coagulation and fibrinolysis in open and laparoscopic cholecystectomy.
BACKGROUND
Activation of coagulation and fibrinolysis occurs as a stress response to surgery and may predispose the patient to thromboembolic complications. Other components of the surgical stress response (cytokine release, neurohumoral response, etc.) have been shown to differ between laparoscopic and open cholecystectomy, and the aim of this study was to investigate the effects of laparoscopic and open surgery on the coagulation and fibrinolytic pathways.


METHODS
Fourteen patients undergoing laparoscopic cholecystectomy and 12 patients undergoing open cholecystectomy had blood taken in the perioperative period for fibrinopeptide A (FPA) prothrombin fragment F1.2, antithrombin 3, tissue plasminogen activator (tPA) and its fast-acting inhibitor plasminogen activator inhibitor-1 (PAI-1 antigen and activity), and the euglobulin clot lysis time (ECLT).


RESULTS
The only significant differences between the two groups occurred 6 h after surgery when the ECLT was longer (p < 0.005; Mann Whitney), and PAI-1 antigen and activity were higher (p < 0.01 and p < 0.001, respectively; Mann Whitney) after open cholecystectomy than laparoscopic cholecystectomy.


CONCLUSIONS
Other changes in fibrinolysis and coagulation were similar for open and laparoscopic cholecystectomy. With respect to hemostasis, laparoscopic cholecystectomy does not increase the risk of thromboembolic complications compared to the conventional procedure.
Dexter
S P
SP
University Department of Surgery, Leeds Institute for Minimally Invasive Therapy, 6th Floor, Wellcome Wing, The General Infirmary, Leeds LS1 3EX, United Kingdom.
Griffith
J P
JP
Grant
P J
PJ
McMahon
M J
MJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001777:Blood Coagulation; D002763:Cholecystectomy / Q000009:adverse effects; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D005260:Female; D005342:Fibrinolysis; D005344:Fibrinopeptide A / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000032:analysis; D017395:Plasminogen Activator Inhibitor 1 / Q000032:analysis; D011516:Prothrombin / Q000032:analysis; D013312:Stress, Physiological / Q000097:blood / Q000209:etiology; D010959:Tissue Plasminogen Activator / Q000032:analysis
D010446:Peptide Fragments; D017395:Plasminogen Activator Inhibitor 1; C045879:prothrombin fragment 1.2; D005344:Fibrinopeptide A; D011516:Prothrombin; D010959:Tissue Plasminogen Activator