title: Metabolic and inflammatory responses after laparoscopic and open inguinal hernia repair.
abstract: A prospective comparison of metabolic and inflammatory responses after laparoscopic and open inguinal hernia operations was undertaken. There were 10 patients in each group. Plasma levels of cortisol, growth hormone, prolactin, C-reactive protein (CRP) and interleukin-6 (IL-6) were measured preoperatively and at fixed intervals up to 120 h postoperatively. In vitro, endotoxin stimulated whole blood tumour necrosis factor alpha (TNF alpha) was measured in preoperative and 24 h postoperative blood samples. Changes in the plasma levels of cortisol, growth hormone and prolactin showed no statistically significant difference between the groups. No significant change in IL-6 levels were recorded in any group. Changes in CRP levels were significantly higher (P < 0.006) in open hernia patients. Endotoxin stimulated TNF alpha production was suppressed in both groups. The degree of suppression in open hernia patients was significantly higher (P < 0.005). This study has shown that both these operations produce similar stress responses. However, open hernia operation results in a higher acute phase response and induces a greater endotoxin tolerance.
authors.affiliation: University Department of Surgery, Manchester Royal Infirmary.
authors.forename: K
authors.initials: K
authors.lastname: Akhtar
authors.forename: I D
authors.initials: ID
authors.lastname: Kamalky-asl
authors.forename: W R
authors.initials: WR
authors.lastname: Lamb
authors.forename: I
authors.initials: I
authors.lastname: Laing
authors.forename: L
authors.initials: L
authors.lastname: Walton
authors.forename: R C
authors.initials: RC
authors.lastname: Pearson
authors.forename: N R
authors.initials: NR
authors.lastname: Parrott
mesh_terms: D000210:Acute-Phase Reaction / Q000209:etiology*; D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D004731:Endotoxins / Q000494:pharmacology; D005260:Female; D013006:Growth Hormone / Q000097:blood; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood; D011388:Prolactin / Q000097:blood; D011446:Prospective Studies; D013312:Stress, Physiological / Q000097:blood / Q000209:etiology*; D014409:Tumor Necrosis Factor-alpha / Q000096:biosynthesis
chemical_list: D004731:Endotoxins; D014409:Tumor Necrosis Factor-alpha; D011388:Prolactin; D013006:Growth Hormone; D002097:C-Reactive Protein; D006854:Hydrocortisone