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[Changes in the hemostatic system after laparoscopic cholecystectomy].

G Di Vita1, M Frazzetta, C Sciumè

  • 1Dipartimento di Discipline Chirurgiche Anatomiche ed Oncologiche, Scuola di Specializzazione in Chirurgia Generale, Università degli Studi di Palermo.

Il Giornale Di Chirurgia
|June 22, 2000
PubMed
Summary

Laparoscopic cholecystectomy (LC) may reduce blood clot risk compared to open cholecystectomy (OC). While both procedures increase clot markers, LC

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Area of Science:

  • Surgical Innovation
  • Minimally Invasive Surgery
  • Surgical Outcomes

Background:

  • Laparoscopic cholecystectomy (LC) involves specific patient positioning (reverse Trendelenburg) and pneumoperitoneum.
  • These factors can lead to hemodynamic changes, affecting venous return and potentially causing venous stasis in the lower limbs.
  • Venous stasis is a known risk factor for hypercoagulability and thrombosis.

Purpose of the Study:

  • To evaluate the changes in hemo-coagulative and fibrinolytic factors during LC and open cholecystectomy (OC).
  • To compare the thrombotic risk associated with LC versus OC.
  • To investigate the impact of surgical approach on blood coagulation and fibrinolysis.

Main Methods:

  • 18 patients with symptomatic gallstones were divided into two groups: 9 for LC and 9 for OC.

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  • Prothrombin time (PT), activated partial thromboplastin time (PTT), Antithrombin III (AT III), and fibrinogen degradation products (FDP) were measured.
  • Measurements were taken before surgery and at 6, 12, 24, and 48 hours post-operation. Statistical analysis used Student's t-test.

    • Main Results:

    • No significant alterations in PT, PTT, or AT III were observed in either group post-surgery.
    • Fibrinogen degradation products (FDP) increased in both groups after surgery.
    • A significant increase in FDP was noted at 24-48 hours post-operation, particularly in the OC group (p < 0.05).

    Conclusions:

    • While both LC and OC can increase markers of clot formation, the effect appears more pronounced with OC.
    • The reduced invasiveness and potential for earlier mobilization associated with laparoscopy may mitigate thrombotic risks.
    • Laparoscopic techniques, despite positional challenges, may offer a safer profile regarding coagulation activation compared to open surgery.