Systemic inflammatory responses during laparoscopic and open inguinal hernia repair: a randomised prospective study.
OBJECTIVE
To see if the inflammatory responses during and after laparoscopic and open inguinal hernia repairs differed.


METHODS
Randomised prospective study.


METHODS
County hospital, Denmark.


METHODS
18 men aged 25-77 years with unilateral inguinal hernias.


METHODS
Ten patients had a laparoscopic repair and 8 an open tension-free repair.


METHODS
Serum concentrations of interleukin (IL)-2 receptors (R) of the alpha group (IL-2Ralpha), IL-6, anti-IL-6, IL-10, tumour necrosis factor (TNF)-alpha, sTNF-RI and sTNF-RII before and 2, 6, 12, and 24 hours after the repairs. Duration of operation and time for return to normal activities or work were also recorded.


RESULTS
Serum IL-6 concentrations increased significantly after operation in both groups (p < 0.0001), but the increase was significantly higher after open than after laparoscopic surgery at all sampling times (p = 0.00) at 6 hours postoperatively). Anti-IL-6 and IL-10 remained undetectable at all time points. There were no significant differences or increases in the concentrations of TNF-alpha or sTNF-RII. However, sTNF-RI concentrations increased significantly in both groups (p < 0.001) though there was no difference in between the two groups. IL-2Ralpha decreased significantly in both groups (p < 0.01) with no differences between the groups. The median operation time was 85 min (range 55-100 min) in the laparoscopic group and 52 min (range 45-79 min) in the "open" group (p < 0.01). Median time to return to normal activities/work were 2 and 13 days after laparoscopic and open operations, respectively (p < 0.01).


CONCLUSIONS
The surgical trauma of laparoscopic inguinal hernia repair is less than that of open tension-free hernia operations as assessed by circulating mediators of the postoperative inflammatory response. The clinical relevance of this finding must be evaluated in larger randomised studies.
Jess
P
P
Department of Surgery, Roskilde County Hospital, Køge, Denmark.
Schultz
K
K
Bendtzen
K
K
Nielsen
O H
OH
D000328:Adult; D000368:Aged; D016207:Cytokines / Q000097:blood; D006552:Hernia, Inguinal / Q000097:blood / Q000601:surgery*; D006801:Humans; D007378:Interleukins / Q000097:blood; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000209:etiology*; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D016207:Cytokines; D007378:Interleukins; D014409:Tumor Necrosis Factor-alpha