ACTA FAC. MED. NAISS. 2004; 21 (4): 215-224

     Original article

Srđan Denčić¹, Jelena Denčić², Aleksandar Lilić¹, Aleksandar Ćirić³, Jovica Janković⁴
 

¹Department of Surgery, General Hospital-Health Center Pirot, Serbia and Montenegro
²Department of Internal Diseases, General Hospital-Health Center Pirot
³Department of Anaesthesiology, General Hospital-Health Center Pirot
⁴Biochemistry Laboratory, General Hospital-Health Center Pirot

    SUMMARY

    By monitoring the post laparoscopic cholecystectomy (LC) & open cholecystectomy (OC) cortisolemia we have objectified neuroendocrine reaction to a surgical trauma and confirmed the LC is a weaker stimulus for cortisol secretion. Recorded higher and prolonged post OC cortisolemia is consonant with the intensity of the surgical trauma. Our study suggests that the laparoscopic approach in the perioperative period results in the diminished neurodocrine response to the surgical trauma. As for the indicators of the muscular-tissue destruction, we have shown that the LC represents the smaller surgical trauma, i.e. during OC, lesions of tissues rich with CK, AST, ALT enzymes (skeleton muscules, liver) are more pronounced. The results of both gas analysis of capillary blood and spirometry suggest the following advantages of the LC: 1-less decline of pCO₂ postoperative values 2-better O₂ saturation, 3‡improved postoperative spirometry, meaning less and shorter disturbance of pulmonary function. The laparoscopic surgery, however, involving CO₂-pneumoperitoneum, can lead to undesired hemodynamic effects and significant complications. With more abdominal surgeries performed by laparoscopic technique, it became clear that surgeons must be more informed and aware of disadvantages, taking corresponding measures to prevent possible Co2‡pneumoperitoneum related complications.

    Key words: laparoscopic cholecystectomy, neuroendocrine reaction, physiological response