Inflammatory responses after laparoscopic uterine myomectomy compared to open surgery in current clinical practice.
OBJECTIVE
To determine the differences in inflammatory response and clinical outcome of current clinical practice in women undergoing laparoscopic myomectomy (LM) and abdominal myomectomy (AM) for symptomatic fibroid.


METHODS
A total of 36 women entered the study between October 2004 to June 2005 at the Department of Gynecology and Obstetrics and the Endoscopy Training Center at the Baby Friendly Hospital in Kladno, Czech Republic, based upon an ultrasonographic assessment size of dominant fibroid (DM) before surgery. All women were allocated to one of 2 groups: group 1 (n=17), DM <6 cm and treated with LM, and group 2 (n=19) DM > or =6 cm, treated with open myomectomy. Surgical characteristics, hospital stay and complications were analyzed. Blood samples for assay of the acute phase reactants and markers of tissue trauma [C-reactive protein (CRP), interleukin-6 (IL-6), serum amyloid A (SAA), white blood cell count (WBC) and creatine kinase (CK)] were taken preoperatively and on the first and third postoperative day.


RESULTS
The difference between the groups in the mean size of DM was statistically significant (4.8 cm in group 1 versus 6.9 cm in group 2, p<0.05). Statistically, significant differences were found between the compared groups in intra-operative blood loss (p<0.05) and length of hospital stay (p<0.001). No complication was reported after LM. There were significantly higher levels of CRP, IL-6, SAA, WBC and CK in both groups after surgery. Increased levels of IL-6, WBC and CK were greatest on the first postoperative day in both groups, and increased levels of CRP and SAA on the third postoperative day in the open group. The serum CRP, IL-6, SAA, WBC, CK and the fall in hemoglobin were statistically different between the 2 groups.


CONCLUSIONS
Compared with open myomectomy, LM was associated with a less intensive inflammatory response and a more favorable clinical outcome.
Holub
Zdenek
Z
Department of Obstetrics and Gynecology, Baby Friendly Hospital, Vancurova Street 1548, 27258 Kladno, Czech Republic. holubz@seznam.cz
Jabor
Antonin
A
Kliment
Lev
L
Sprongl
Ludek
L
D000328:Adult; D002097:C-Reactive Protein / Q000032:analysis; D003402:Creatine Kinase / Q000097:blood; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D007249:Inflammation / Q000175:diagnosis / Q000209:etiology*; D015850:Interleukin-6 / Q000097:blood; D010535:Laparoscopy; D007813:Laparotomy; D007889:Leiomyoma / Q000000981:diagnostic imaging / Q000601:surgery*; D011446:Prospective Studies; D000685:Serum Amyloid A Protein / Q000032:analysis; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*
D015850:Interleukin-6; D000685:Serum Amyloid A Protein; D002097:C-Reactive Protein; D003402:Creatine Kinase