title: Systemic inflammatory responses during laparoscopic and open inguinal hernia repair: a randomised prospective study.
abstract: 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.
authors.affiliation: Department of Surgery, Roskilde County Hospital, Køge, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: Jess
authors.forename: K
authors.initials: K
authors.lastname: Schultz
authors.forename: K
authors.initials: K
authors.lastname: Bendtzen
authors.forename: O H
authors.initials: OH
authors.lastname: Nielsen
mesh_terms: 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
chemical_list: D016207:Cytokines; D007378:Interleukins; D014409:Tumor Necrosis Factor-alpha