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Coagulation modifications after laparoscopic and open cholecystectomy in a swine model
N T Nguyen1, J D Luketich, M R Shurin
1Department of Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
Surgical Endoscopy
|June 20, 1998
Summary
Open cholecystectomy causes significant postoperative hypercoagulation, while laparoscopic cholecystectomy shows a diminished response. This suggests laparoscopic surgery may lower the risk of venous thrombosis.
Area of Science:
- Surgical outcomes
- Hemostasis and thrombosis
- Minimally invasive surgery
Background:
- Surgical trauma triggers transient hypercoagulation.
- Laparoscopic surgery typically elicits a reduced stress response compared to open surgery.
- Postoperative hypercoagulability is a known complication of abdominal surgery.
Purpose of the Study:
- To compare the extent of postoperative hypercoagulability after laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC).
- To investigate the impact of surgical approach on coagulation parameters and antithrombin III levels.
Main Methods:
- Twenty-one pigs underwent either LC (N=10) or OC (N=11).
- Thromboelastography (TEG) was used to analyze viscoelastic changes in whole blood collected preoperatively and on postoperative days 1, 2, and 3.
- Antithrombin III (AT III) levels were measured preoperatively and on postoperative day 1.
Main Results:
- Open cholecystectomy (OC) led to significant changes in three of four TEG parameters, indicating hypercoagulation.
- Laparoscopic cholecystectomy (LC) resulted in significant changes in only one TEG parameter (maximal amplitude).
- No significant differences in TEG parameters or AT III levels were observed between the OC and LC groups when directly compared, despite distinct responses within each group.
Conclusions:
- Open cholecystectomy (OC) induces significant postoperative hypercoagulation.
- Laparoscopic cholecystectomy (LC) appears to result in a diminished hypercoagulable state.
- Reduced postoperative hypercoagulation following LC may decrease the risk of venous thromboembolism.