title: Fibrinolytic and coagulation pathways after laparoscopic and open surgery: a prospective randomized trial.
abstract: BACKGROUND
  Tissue injury poses increased risk for postoperative thromboembolic complications. Laparoscopic surgery, by causing limited tissue injury, is associated with lower risk for thromboembolism than is open surgery. We conducted a prospective randomized study in order to detect potentially existing differences in activation of coagulation and fibrinolytic pathways between open and laparoscopic surgery.
  
  
  METHODS
  Forty patients with chronic cholelithiasis were randomly assigned to undergo open (group A) or laparoscopic cholecystectomy (group B). Blood samples were taken preoperatively, at the end of the procedure, and at 24 and 72 h postoperatively. Prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), platelets (PLT), soluble fibrin monomer complexes (F.S. test), fibrin degradation products (FDP), D-dimers (D-D), and fibrinogen (FIB) were measured and compared within each group and between groups: Thrombin-antithrombin complexes (TAT) and prothrombin fragments (F1 + 2) were measured at 24 and 72 h postoperatively.
  
  
  RESULTS
  Demographics were comparable between groups. Immediately postoperatively, TAT and F1 + 2 were significantly higher in group A (p < 0.05). They also increased significantly postoperatively as compared with preoperative levels within each group (p < 0.05). D-dimers were significantly higher in group A (p < 0.01) immediately postoperatively. D-dimers also increased significantly postoperatively in group B as compared with preoperative levels (p < 0.001). FIB decreased slightly in both groups at 24 h postoperatively but there was a significant increase in group A (p < 0.01). Soluble fibrin monomer complexes (SFMC) were detected twice in group A and only once in group B. FDP levels over 5 μg/ml were detected more often in group A (p < 0.05). There was not any case of thromboembolism or abnormal bleeding.
  
  
  CONCLUSIONS
  Open surgery leads to higher activation of the clotting system than do laparoscopic procedures. Although of a lower degree, hypercoagulability is still observed in patients undergoing laparoscopic surgery and therefore routine thromboembolic prophylaxis should be considered.
authors.affiliation: Department of Digestive Surgery, Centre Hospitalier Intercommunal de Poissy, Poissy, France. nikotsim@otenet.gr
authors.forename: Nikos
authors.initials: N
authors.lastname: Tsiminikakis
authors.forename: Elie
authors.initials: E
authors.lastname: Chouillard
authors.forename: Christos
authors.initials: C
authors.lastname: Tsigris
authors.forename: Theodoros
authors.initials: T
authors.lastname: Diamantis
authors.forename: Christine
authors.initials: C
authors.lastname: Bongiorni
authors.forename: Constantinos
authors.initials: C
authors.lastname: Ekonomou
authors.forename: C
authors.initials: C
authors.lastname: Antoniou
authors.forename: Ioannis
authors.initials: I
authors.lastname: Bramis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001777:Blood Coagulation / Q000502:physiology*; D001798:Blood Proteins / Q000378:metabolism*; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000097:blood* / Q000601:surgery; D002908:Chronic Disease; D005260:Female; D005342:Fibrinolysis / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011517:Prothrombin Time
chemical_list: D001798:Blood Proteins