Systemic inflammatory response after laparoscopic and open application of adjustable banding for morbidly obese patients.
BACKGROUND
Surgical injury induces a systemic inflammatory metabolic-endocrine response that is proportional to the severity of the surgical stress. Compared with the conventional open method, laparoscopic surgery is mini-invasive and has decreased postoperative pain and length of hospitalization. The aim of this study was to investigate the systemic inflammatory response, after laparoscopic and open stoma-adjustable silicone band application, which is thought to be mediated by cytokines.


METHODS
30 morbidly obese patients underwent Swedish adjustable gastric banding (SAGB). 15 patients underwent laparoscopic (group 1) and 15 open SAGB (group 2). Mean operative time for the laparoscopic group was 70-110 min and for the laparotomy group 80-120 min. Gallbladders were not removed, and there were no systemic diseases in the patients. The intensity of surgical trauma was evaluated by measurement of metabolic and hormonal responses to the surgery. Plasma levels of C-reactive (CRP), haptoglobin, ceruloplasmin, albumin, transferrin, IL-6, malonic dialdehyde (MDA) and creatinine were measured before and after the operation.


RESULTS
CRP and IL-6 levels increased during and after laparoscopic and open SAGB. However, postoperative responses were significantly greater after open SAGB (group 2) (p < 0.05). MDA level, an indicator of an oxidative trauma, was elevated in group 1 at the 6th postoperative hour but was significantly higher in group 2 at the 6th and 12th postoperative hours. The results were more significant in group 2 (p < 0.05). There was no statistical difference between groups 1 and 2 in terms of albumin, creatinine, and transferrin levels before and after surgery.


CONCLUSIONS
The systemic inflammatory responses after laparoscopic SAGB were significantly reduced compared with those after open SAGB.
Zengin
Kagan
K
Department of General Surgery, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey. ak_zengin@yahoo.com
Taskin
Mustafa
M
Sakoglu
Nevin
N
Salihoglu
Ziya
Z
Demiroluk
Sener
S
Uzun
Hafize
H
D000209:Acute-Phase Proteins / Q000032:analysis; D000328:Adult; D001458:Bandages / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology*; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood / Q000601:surgery*; D011183:Postoperative Complications; D013270:Stomach / Q000601:surgery*; D054047:Surgical Stomas / Q000009:adverse effects*; D013997:Time Factors; D015599:Trauma Severity Indices
D000209:Acute-Phase Proteins