@article{3137275,
    title = "Alterations of hemostasis after laparoscopic and open surgery",
    author = "Diamanti, T. and Tsiminikakis, N. and Skordylaki, A. and Samiotaki, F. and and Vernadakis, S. and Bongiorni, C. and Tsagarakis, N. and Marikakis, and F. and Bramis, I. and Bastounis, E.",
    journal = "Hematology (United States)",
    year = "2007",
    volume = "12",
    number = "6",
    pages = "561-570",
    publisher = "TAYLOR & FRANCIS LTD LONDON",
    doi = "10.1080/10245330701554623",
    keywords = "coagulation activation; laparoscopic surgery; open surgery;
thromboembolic",
    abstract = "Background: After tissue injury caused by trauma or surgery, alterations
of hemostasis are observed and there is a risk for postoperative
thromboembolic complications. Laparoscopic surgery, by causing limited
tissue injury, appears to be associated with a lower risk for
thromboembolism than open surgery. We conducted a prospective randomized
study in order to detect potentially existing differences in activation
of coagulation and fibrinolytic pathways between open and laparoscopic
surgery.
Methods: Forty patients suffering from chronic cholelithiasis were
randomly assigned to undergo open (group A n = 20) or laparoscopic
cholecystectomy (group B n = 20) by the same surgical and anesthesiology
team. Demographic data were comparable. Blood samples were taken (a)
preoperatively, (b) at the end of the procedure, (c).24 h
postoperatively and (d) 72 h postoperatively. The following parameters
were measured and compared within each group and between groups:
platelets (PLT), soluble fibrin monomer complexes (SFMC), fibrin
degradation products (FDP), D-dimers (D-D), fibrinogen (FIB), activated
partial thromboplastin time (APTT), prothrombin time (PT).
Thrombin-antithrombin III complexes (TAT) were measured at 24 and 72h
postoperatively. Prothrombin fragment 1 + 2 (F1 + 2) was measured at 24
and 72h postoperatively in 11 patients of group A and 13 patients of
group B, respectively.
Results: Demographics were comparable between groups. Immediately
postoperatively, TAT and F1 + 2 were significantly higher in group A as
compared to group B (p < 0.05). They also increased significantly
postoperatively as compared to preoperative levels within each group (p
< 0.05).
D-dimers were significantly higher in group A as compared to group B (p
< 0.01) immediately postoperatively. D-dimers also increased
significantly postoperatively in group B as compared to preoperative
levels (p < 0.001).
FIB decreased slightly in both groups at 24 h postoperatively but there
was a significant increase in group A as compared to group B (p < 0.01).
SFMC were detected twice in group A and only once group B.
FDP levels over 5 mu g/ml were detected more often in group A than in
group B (p < 0.05). No patient from either group suffered
thromboembolism or abnormal bleeding as a postoperative complication.
Conclusions: Open surgery as compared to laparoscopic procedures leads
to activation of the clotting system of a higher degree. Although of a
lower degree, hypercoagulability is still observed in patients
undergoing laparoscopic surgery and, therefore, routine thromboembolic
prophylaxis should be considered."
}