Skip to main content
SpringerLink
Log in

Coagulation, inflammatory, and stress responses in a randomized comparison of open and laparoscopic repair of recurrent inguinal hernia

  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background

In previous comparisons of inflammatory and stress responses to open (OR) and laparoscopic (LR) hernia repair, all operations were performed under general anesthesia. Since local anesthesia is widely used for OR, a comparison of this approach with LR seemed relevant.

Methods

Patients with recurrent inguinal hernia were randomized to OR under local anesthesia (n = 30) or LR under general anesthesia (n = 31). The magnitude of the surgical trauma was assessed by measuring markers of coagulation (prothrombin fragment 1 + 2), endothelial activation (von Willebrand factor), inflammation [leukocytes, interleukin-6, -8 and -10, granulocyte macrophage colony-stimulating factor, and C-reactive protein (CRP)], and endocrine stress (cortisol) in blood collected before operation, 4 h postincision, and on postoperative day 2.

Results

Leukocyte counts and interleukin-6 and CRP levels increased in both groups, with the CRP increase being significantly greater in the OR group. The other markers did not increase significantly.

Conclusion

The acute phase response was more pronounced after OR, even when this was done under local anesthesia. Both techniques seemed rather atraumatic.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Akhtar K, Kamalky-asl ID, Lamb WR, Laing I, Walton L, Pearson RC, Parrott NR (1998) Metabolic and inflammatory responses after laparoscopic and open inguinal hernia repair. Ann R Coll Surg Engl 80: 125–130

    CAS  PubMed  Google Scholar 

  2. Baroody M, Bansal V, Maish G (2004) The open preperitoneal approach to recurrent inguinal hernias in high-risk patients. Hernia 8: 373–375

    Article  PubMed  Google Scholar 

  3. Brewster N, Guthrie C, McBirnie J (1994) CRP levels as a measure of surgical trauma: a comparison of different general surgical procedures. J R Coll Surg Edinb 39: 86–88

    CAS  PubMed  Google Scholar 

  4. Chernow B, Alexander R, Smallridge RC, Thompson WR, Cook D, Beardsley D, Fink MP, Lake CR, Fletcher JR (1987) Hormonal responses to graded surgical stress. Arch Intern Med 147: 1273–1278

    Article  CAS  PubMed  Google Scholar 

  5. Chong AY, Blann AD, Lip GYH (2003) Assessment of endothelial damage and dysfunction: observations in relation to heart failure. Q J Med 96: 253–267

    Google Scholar 

  6. Cruickshank AM, Fraser WD, Burns HJG, van Damme J, Shenkin A (1990) Response of serum interleukin-6 in patients undergoing elective surgery of varying severity. Clin Sci 79: 161–165

    CAS  PubMed  Google Scholar 

  7. Delves PJ, Roitt IM (2000) The immune system. Second of two parts. N Engl J Med 343: 108–117

    CAS  PubMed  Google Scholar 

  8. Flordal PA (1995) The plasma dilution factor: predicting how concentrations in plasma and serum are affected by blood volume variations and blood loss. J Lab Clin Med 126: 353–357

    CAS  PubMed  Google Scholar 

  9. Gabay C, Kushner I (1999) Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 340: 448–454

    Article  CAS  PubMed  Google Scholar 

  10. Gan TJ, Meyer T, Apfel CC, et al (2003) Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg 97: 62–71

    PubMed  Google Scholar 

  11. Gianetta E, Cuneo S, Vitale B, Camerini G, Marini P, Stella M (2000) Anterior tension-free repair of recurrent inguinal hernia under local anesthesia. Ann Surg 231: 132–136

    Article  CAS  PubMed  Google Scholar 

  12. Gris JC, Schved JF, Brun S, Brunschwig C, Petris I, Lasonnery M, Martinez P, Sarlat C (1991) Venous occlusion and chronic cigarette smoking: dose-dependent decrease in the measurable release of tissue-type plasminogen activator and von Willebrand factor. Atherosclerosis 91: 247–255

    Article  CAS  PubMed  Google Scholar 

  13. Ido K, Suzuki T, Kimura K, Taniguchi Y, Kawamoto C, Isoda N, Nagamine N, Ioka T, Kumagai M, Hirayama Y (1995) Lower-extremity venous stasis during laparoscopic cholecystectomy as assessed using color Doppler ultrasound. Surg Endosc 9: 310–313

    Article  CAS  PubMed  Google Scholar 

  14. Ingerslev J (1987) A sensitive ELISA for von Willebrand factor (vWf:Ag). Scand J Clin Lab Invest 47: 143–149

    CAS  PubMed  Google Scholar 

  15. Jess P, Schultz K, Bendtzen K, Nielsen OH (2000) Systemic inflammatory responses during laparoscopic and open inguinal hernia repair: a randomised prospective study. Eur J Surg 166: 540–544

    CAS  PubMed  Google Scholar 

  16. Larsen JF (2004) Pathophysiological and clinical aspects of carbonic dioxide pneumoperitoneum [Thesis]. Aarhus University, Aarhus, Denmark

  17. McCormack K, Scott NW, Go PMNYH, Ross S, Grant AM (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev CD001785

  18. Memon MA, Cooper NJ, Memon MI, Abrams KR (2003) Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair. Br J Surg 90: 1479–1492

    Article  CAS  PubMed  Google Scholar 

  19. Nguyen NT, Owings JT, Gosselin R, Pevec WC, Lee SJ, Goldman C, Wolfe BM (2001) Systemic coagulation and fibrinolysis after laparoscopic and open gastric bypass. Arch Surg 136: 909–916

    CAS  PubMed  Google Scholar 

  20. Ohzato H, Yoshizaki K, Nishimoto N, Ogata A, Tagoh H, Monden M, Gotoh M, Kishimoto T, Mori T (1992) Interleukin-6 as a new indicator of inflammatory status: detection of serum levels of interleukin-6 and C-reactive protein after surgery. Surgery 111: 201–209

    CAS  PubMed  Google Scholar 

  21. Rahr HB (2001) Clinical application of newer assays for markers of coagulation and fibrinolysis in upper abdominal surgery [Thesis]. Aarhus University, Aarhus, Denmark

  22. Rahr HB, Fabrin K, Larsen JF, Thorlacius-Ussing O (1999) Coagulation and fibrinolysis during laparoscopic cholecystectomy. Thromb Res 93: 121–127

    Article  CAS  PubMed  Google Scholar 

  23. Uzunköy A, Coskun A, Akinci OF, Kocyigit A (2000) Systemic stress response after laparoscopic or open hernia repair. Eur J Surg 166: 467–471

    PubMed  Google Scholar 

  24. Yogendran S, Asokumar B, Cheng DCH, Chung F (1995) A prospective randomized double-blinded study of the effect of intravenous fluid therapy on adverse outcomes on outpatient surgery. Anesth Analg 80: 682–686

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We are grateful to Dr. Jørgen Ingerslev and his coagulation laboratory at Skejby Hospital for performing the F1 + 2 and vWF analyses. This study was supported by a grant from the Kong Christian X Foundation, Denmark, and Grant 22-02-0174 from the Danish Research Council.

Author information

Authors and Affiliations

  1. Department of Surgery, Aarhus University Hospital, Aarhus C, DK-8000, Denmark

    H. B. Rahr, J. Bendix & P. Funch-Jensen

  2. Center for Day-case Surgery, Aarhus University Hospital, Aarhus C, DK-8000, Denmark

    P. Ahlburg

  3. Department of Anesthesia, Aarhus University Hospital, Aarhus C, DK-8000, Denmark

    J. Gjedsted & E. Tønnesen

Authors
  1. H. B. Rahr
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Bendix
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Ahlburg
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Gjedsted
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Funch-Jensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E. Tønnesen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. B. Rahr.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rahr, H.B., Bendix, J., Ahlburg, P. et al. Coagulation, inflammatory, and stress responses in a randomized comparison of open and laparoscopic repair of recurrent inguinal hernia. Surg Endosc 20, 468–472 (2006). https://doi.org/10.1007/s00464-005-0305-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-005-0305-4

Keywords

Search

Navigation