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Metabolic responses after laparoscopic or open hernia repair
P Schrenk1, P Bettelheim, R Woisetschläger
1Second Department of Surgery and Ludwig Boltzmann Institute for Surgical Laparoscopy, AKH Linz, Krankenhausstrasse 9, A-4020 Linz, Austria.
Surgical Endoscopy
|June 1, 1996
Summary
Laparoscopic hernia repair showed reduced postoperative pain compared to open surgery. However, laparoscopic procedures led to a significant increase in polymorphonuclear elastase, indicating potential inflammatory responses.
Area of Science:
- Surgical innovation
- Minimally invasive surgery
- Hernia repair techniques
Background:
- Comparing surgical trauma between laparoscopic and open hernia repair is crucial for patient outcomes.
- Understanding the metabolic and inflammatory responses to different surgical approaches is essential.
Purpose of the Study:
- To prospectively compare surgical trauma in patients undergoing laparoscopic versus open inguinal hernia repair.
- To evaluate postoperative pain, analgesic use, and metabolic responses in both surgical groups.
Main Methods:
- A prospective randomized study involving 30 patients undergoing unilateral inguinal hernia repair.
- 15 patients in group I underwent laparoscopic repair, and 15 patients in group II underwent open Shouldice repair.
- Postoperative pain (VAS), analgesic consumption, and levels of inflammatory markers were assessed.
Main Results:
- Laparoscopic repair patients experienced reduced pain on mobilization on the operative day (P = 0.02).
- No significant differences were observed in pain at rest, analgesic requirements, or most inflammatory markers (IL-1, IL-6, TNF-alpha, CRP, etc.).
- A significant increase in polymorphonuclear (PMN) elastase was noted in the laparoscopic group on postoperative days 1 and 2, unlike the open repair group.
Conclusions:
- Herniorrhaphy, particularly open repair, demonstrated no major surgical trauma compared to laparoscopic repair.
- While laparoscopic repair may offer pain benefits, the increase in PMN elastase warrants further investigation into potential inflammatory effects.