Tissue trauma and inflammatory response following laparoscopic versus abdominal hysterectomy: a prospective randomized clinical trial

Authors

  • Ahmed M. Abbas Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
  • Khaled H. Swidan Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
  • Ahmed M. Ali Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
  • Mohamed S. Sweed Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt http://orcid.org/0000-0003-1221-9600

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20204324

Keywords:

Abdominal hysterectomy, Cancer antigen 125, C-reactive protein, Lactic dehydrogenase, Laparoscopic hysterectomy, Surgical stress

Abstract

Background: Laparoscopic surgery is associated with more favorable clinical outcome than conventional open surgery. This might be related to the magnitude of tissue trauma and tissue stress response. This study compares the intensity of tissue injury by assessing plasma C-reactive protein (CRP), lactic dehydrogenase (LDH), and cancer antigen 125 (CA 125) in patients undergoing laparoscopic hysterectomy compared to abdominal hysterectomy.

Methods: This study was conducted at Ain Shams University Maternity Hospital from May 2018 to February 2020. 74 women candidate for hysterectomy were recruited and randomized into two groups: group A included 37 cases who underwent abdominal hysterectomy, and group B included 37 cases that underwent laparoscopic hysterectomy.

Results: CRP, LDH and CA125 significantly increased post-operatively in both groups. Postoperative mean serum CRP, LDH and CA125 were significantly higher in the laparotomy group (10.84±2.47, 262.21±76.77, and 13.41±2.6 respectively) compared to laparoscopy group (7.92±2.25, 148.53±43.56, 11.79±2.77 respectively) (p<0.05).

Conclusions: Surgery is a significant cause of tissue injury that can be assessed by specific markers. We suggest that laparoscopic surgery causes less tissue damage as assessed by lower postoperative CRP and LDH values, which might account for the earlier recovery and reduced hospital stay in laparoscopic surgery.

References

Lundin ES, Wodlin NB, Nilsson L, Theodorsson E, Ernerudh J, Kjølhede P. Markers of tissue damage and inflammation after robotic and abdominal hysterectomy in early endometrial cancer: a randomised controlled trial. Sci Rep. 2020;10(1):7226.

Oksuzoglu A, Seckin B, Turkcapar AF, Ozcan S, Gungor T. Comparison of tissue trauma after abdominal, vaginal and total laparoscopic hysterectomy. Ginekol Pol. 2015;86(4):268-73.

Wu JM, Wechter ME, Geller EJ, Nguyen TV, Visco AG. Hysterectomy rates in the United States, 2003. Obstet Gynecol. 2007;110(5):1091-5.

Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2009;3:003677.

Schindlbeck C, Klauser K, Dian D, Janni W, Friese K. Comparison of total laparoscopic, vaginal and abdominal hysterectomy. Arch Gynecol Obstet. 2008;277(4):331-7.

Kim T, Lee Y, Cha HH, Kim C, Choi CH, Lee J, et al. Single-port-access laparoscopic-assisted vaginal hysterectomy versus conventional laparoscopic-assisted vaginal hysterectomy: a comparison of perioperative outcomes. Surg Endosc. 2010;24(9):2248-52.

Watt DG, McSorley ST, Horgan PG, McMillan DC. Enhanced Recovery After Surgery: Which Components, If Any, Impact on The Systemic Inflammatory Response Following Colorectal Surgery? A Systematic Review. Medicine (Baltimore). 2015;94(36):1286.

Demir A, Bige O, Saatli B, Solak A, Saygili U, Onvural A. Prospective comparison of tissue trauma after laparoscopic hysterectomy types with retroperitoneal lateral transsection of uterine vessels using ligasure and abdominal hysterectomy. Arch Gynecol Obstet. 2008;277(4):325-30.

Drahonovsky J, Haakova L, Otcenasek M, Krofta L, Kucera E, Feyereisl J. A prospective randomized comparison of vaginal hysterectomy, laparoscopically assisted vaginal hysterectomy, and total laparoscopic hysterectomy in women with benign uterine disease. Eur J Obstet Gynecol Reprod Biol. 2010;148(2):172-6.

Atabekoglu C, Sönmezer M, Güngör M, Aytaç R, Ortaç F, Unlü C. Tissue trauma in abdominal and laparoscopic-assisted vaginal hysterectomy. J Am Assoc Gynecol Laparosc. 2004;11(4):467-72.

Ellström M, Bengtsson A, Tylman M, Haeger M, Olsson JH, Hahlin M. Evaluation of tissue trauma after laparoscopic and abdominal hysterectomy: measurements of neutrophil activation and release of interleukin-6, cortisol, and C-reactive protein. J Am Coll Surg. 1996;182(5):423-30.

Inal ZO, Inal HA. Comparison of abdominal, vaginal, and laparoscopic hysterectomies in a tertiary care hospital in Turkey. Ir J Med Sci. 2018;187(2):485-91.

Giannoudis PV. Current concepts of the inflammatory response after major trauma: an update. Injury. 2003;34(6):397-404.

Härkki-Sirén P, Sjöberg J, Toivonen J, Tiitinen A. Clinical outcome and tissue trauma after laparoscopic and abdominal hysterectomy: a randomized controlled study. Acta Obstet Gynecol Scand. 2000;79(10):866-71.

Labib M, Palfrey S, Paniagua E, Callender R. The postoperative inflammatory response to injury following laparoscopic assisted vaginal hysterectomy versus abdominal hysterectomy. Ann Clin Biochem. 1997; 34(5):543-5.

Uccella S, Cromi A , Serati M, Casarin J, Sturla D, Ghezzi F. Laparoscopic hysterectomy in case of uteri weighing ≥1 kilogram: a series of 71 cases and review of the literature. J Minim Invasive Gynecol. 2014;21(3):460-5.

Brøchner AC, Toft P. Pathophysiology of the systemic inflammatory response after major accidental trauma. Scand J Trauma Resusc Emerg Med. 2009;17:43.

Guven HE, Oral S. Liver enzyme alterations after laparoscopic cholecystectomy. J Gastrointestin Liver Dis. 2007;16(4):391-4.

Mrksić M, Cabafi Z, Feher I, Mirković M. Surgical trauma in laparoscopic and classical cholecystectomy. Med Pregl. 2001;54(7-8):327-31.

Van der Zee AG, Duk JM, Aalders JG, Boontje AH, ten Hoor KA, de Bruijn HW. The effect of abdominal surgery on the serum concentration of the tumour-associated antigen CA 125. Br J Obstet Gynaecol. 1990;97(10):934-8.

Downloads

Published

2020-09-25

Issue

Section

Original Research Articles