Konstantinos Tsimogiannis, MSc, Konstantinos Tellis, Maria Mpakola, Alexandros Tselepis, PhD, Evangelos Tsimoyiannis, PhD FACS, Michalis Pitiakoudis. ‘G.HATZIKOSTA” GENERAL HOSPITAL OF IOANNINA,GREECE, UNIVERSITY OF IOANNINA, GREECE
Introduction: Laparo-Endoscopic Single-Site (LESS) Surgery is an evolution of laparoscopic surgery aiming at decreasing patients’ parietal trauma associated with abdominal operations. LESS has been found so far to be efficient and with the same good results, or even better in some cases ( i.e. when pain is concerned ), as the standard 4 port laparoscopic cholecystectomy. A-defensins are antimicrob peptides of the organism. They are the first cell components against pathogens. Cytokines, such as CRP, are also mediators to the response in trauma.
Aim: To compare the inflammatory reaction in LESS and 4 port Laparoscopic cholecystectomy and through that try to explain the difference in results between these two types of procedure.
Material and methods: 40 patients with non complicated chololithiasis, were randomly assigned in two groups. Group A for the patients that would be operated with 4 port laparoscopic cholecystectomy and group B for the patients that would undergo LESS cholecystectomy. These patients had BMI<30 ,were ASA I or II and had no previous upper GI surgery. Blood was taken preoperatively and 6 and 24 hours postoperatively. hsCRP ( with automated analyzer ) and a-defensins ( using ELISA ) were calculated for each sample. The same postoperative protocol was followed for both groups. Mann-Whitney U test was used to analyze the results. Pain was calculated with VAS for shoulder and abdomen at 6 and 24 hours. Hospital stay, nausea and pain medication needed was noted.
Results: The a-defensins value was statistically significant higher in the 24 hours samples (p<0.001) for LESS cholecystectomy. No statistical significant difference was shown for hsCRP even though p was 0.05 for the 24hours samples with the values of LESS higher. Student t-test gave a p=0.019 for the same samples. No LESS was converted to classical Laparoscopic cholecystectomy and none of the patients of neither groups needed conversion to open cholecystectomy. Pain was statistically significant less for the LESS at the 24hour interval (p<0.0001). Less medication was needed for LESS patients after the 6th postoperative hour (p=0.007)
Discussion: Inflammatory response is higher for LESS cholecystectomy patients. This could be due to the trauma in the abdomen which does not seem to be less than in the 4 port laparoscopic cholecystectomy. More to that, the maneuvers in LESS are more vigorous, maybe due to lack of experience, adding to the inflammatory reaction of the organism. Despite that, LESS cholecystectomy patients have less pain and do not need as much pain medication as the ones with classic cholecystectomy.
Program Number: S107