The relationship between surgical stress response and outcome from laparoscopic cholecystectomy
The relationship between surgical stress response and outcome from laparoscopic cholecystectomy
The first experimental chapter compared the haemostatic acute phase responses of open and laparoscopic cholecystectomy. Fibrinolysis was enhanced in both groups of patients, although by different mechanisms. Laparoscopic surgery increased tissue plasminogen activator levels, whereas conventional cholecystectomy caused a reduction in plasminogen activator inhibitor 1 (PAI-1). Post-operative fibrinolytic shutdown, which is associated with an increased risk of thromboembolism, occurred earlier and to a greater extent after open than after laparoscopic cholecystectomy. Beneficial changes in coagulability have not previously been documented, and may protect patients from thrombo-embolic disease during laparoscopic surgery.
In the next study patients undergoing laparoscopic cholecystectomy were randomised to an intra-abdominal pressure of 15mmHg or 7mmHg. Patients were studied to identify differences in the haemodynamic, neuroendocrine and clinical response to surgery between the two groups. Haemodynamic function differed in the two groups and in particular there was enhancement of stroke volume and cardiac output beyond baseline values during low pressure insufflation. This is a finding which has been demonstrated in animal models, but not previously in humans. High pressure insufflation resulted in prolonged activation of the vasopressin ACTH axis, compared with low pressure insufflation, but other neuroendocrine parameters and post operative fatigue and quality of life were similar.
Clinical evaluation determined that the low pressure insufflation did not limit the ability to perform laparoscopic cholecystectomy, and could be applied routinely, particularly in high risk surgical patients.
University of Southampton
Dexter, Simon Patrick Laurence
1999
Dexter, Simon Patrick Laurence
Dexter, Simon Patrick Laurence
(1999)
The relationship between surgical stress response and outcome from laparoscopic cholecystectomy.
University of Southampton, Doctoral Thesis.
Record type:
Thesis
(Doctoral)
Abstract
The first experimental chapter compared the haemostatic acute phase responses of open and laparoscopic cholecystectomy. Fibrinolysis was enhanced in both groups of patients, although by different mechanisms. Laparoscopic surgery increased tissue plasminogen activator levels, whereas conventional cholecystectomy caused a reduction in plasminogen activator inhibitor 1 (PAI-1). Post-operative fibrinolytic shutdown, which is associated with an increased risk of thromboembolism, occurred earlier and to a greater extent after open than after laparoscopic cholecystectomy. Beneficial changes in coagulability have not previously been documented, and may protect patients from thrombo-embolic disease during laparoscopic surgery.
In the next study patients undergoing laparoscopic cholecystectomy were randomised to an intra-abdominal pressure of 15mmHg or 7mmHg. Patients were studied to identify differences in the haemodynamic, neuroendocrine and clinical response to surgery between the two groups. Haemodynamic function differed in the two groups and in particular there was enhancement of stroke volume and cardiac output beyond baseline values during low pressure insufflation. This is a finding which has been demonstrated in animal models, but not previously in humans. High pressure insufflation resulted in prolonged activation of the vasopressin ACTH axis, compared with low pressure insufflation, but other neuroendocrine parameters and post operative fatigue and quality of life were similar.
Clinical evaluation determined that the low pressure insufflation did not limit the ability to perform laparoscopic cholecystectomy, and could be applied routinely, particularly in high risk surgical patients.
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Published date: 1999
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Local EPrints ID: 464403
URI: http://eprints.soton.ac.uk/id/eprint/464403
PURE UUID: 190f34ff-e43b-47fd-bcd2-afdd86db2bdc
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Date deposited: 04 Jul 2022 23:35
Last modified: 04 Jul 2022 23:35
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Author:
Simon Patrick Laurence Dexter
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