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Systemic stress response after laparoscopic and open gastric bypass
Ninh T Nguyen1, Charles D Goldman, Hung S Ho
1Department of Surgery, University of California, Davis, Medical Center, Sacramento 95817-1814, USA.
Journal of the American College of Surgeons
|May 23, 2002
Summary
Laparoscopic gastric bypass (GBP) shows a reduced stress response compared to open GBP, with lower levels of norepinephrine, ACTH, C-reactive protein, and IL-6. This suggests less operative injury with the laparoscopic approach.
Area of Science:
- Bariatric surgery
- Surgical stress response
- Minimally invasive surgery
Background:
- The systemic stress response correlates with operative trauma severity.
- Laparoscopic gastric bypass (GBP) was hypothesized to induce less trauma than open GBP, leading to a reduced stress response.
Purpose of the Study:
- To compare the systemic stress response between laparoscopic and open gastric bypass (GBP).
- To evaluate metabolic, acute phase, and cytokine responses following different GBP approaches.
Main Methods:
- Forty-eight patients with BMI 40-60 were randomized to laparoscopic (n=26) or open (n=22) GBP.
- Blood samples were analyzed for metabolic markers, C-reactive protein, cytokines (IL-6, IL-8, TNF-alpha), and nitrogen balance.
- Measurements were taken preoperatively and at 1, 24, 48, and 72 hours postoperatively.
Main Results:
- Both groups showed increased insulin, glucose, epinephrine, dopamine, and cortisol.
- Norepinephrine, ACTH, C-reactive protein, and IL-6 levels increased but were significantly lower after laparoscopic GBP (p < 0.05).
- IL-8, TNF-alpha, and nitrogen balance showed no significant intergroup differences.
Conclusions:
- Laparoscopic GBP elicits a similar systemic stress response to open GBP.
- Laparoscopic GBP is associated with lower levels of norepinephrine, ACTH, C-reactive protein, and IL-6.
- These findings suggest a potentially lower degree of operative injury with laparoscopic GBP.