Hormonal and hyperglycemic response in laparoscopic and open cholecystectomy

The aim of the study is to evaluate the intensity of the operative trauma during laparoscopic and open cholecystectomy measured by hormonal (cortisol level) and metabolic (blood sugar level) response. Prospective randomized study was conducted in seventy patients with cholelithiasis. They were divided in two groups: thirty five underwent laparoscopic cholecystectomy and thirty five underwent open cholecystectomy (control group). Mean cortisol concentration and glucose concentration were measured preoperatively and postoperatively after 2, 4, 8, 12, 24 and 48 hours. The examined groups were comparable in age and sex. Preoperative plasma cortisol concentration was within normal range in both groups. Postoperatively plasma cortisol level increased in the laparoscopically operated group, and peak level occurred eight hours after surgery (692.6 +/- 27.2 nmol/L). Peak plasma cortisol level in control group developed 8 hours postoperatively (841.1 +/- 33.2 nmol/L). The mean cortisol concentration was significantly higher (p < 0.05) following open procedure between fourth and 48th postoperative hour. Mean plasma glucose concentrations after laparoscopic and open cholecystectomy were significantly higher (p < 0.05) than preoperative values. The mean glucose concentration during the initial 24 hours was significantly higher (p < 0.05) following open cholecystectomy.