Coagulation and Fibrinolysis during Laparoscopic Cholecystectomy

Changes in Haemostasis after Laparoscopic Surgery in Gynaecology: Contribution of the Thrombin Generation Test

“…The increase in postoperative fibrinolytic activity found in our study in women undergoing gynaecologic surgery under laparoscopy is in line with recent results published in laparoscopic cholecystectomy, where the global fibrinolytic activity was found to be increased postoperatively [8,9] and where an increase in t-PA activity was described during intervention [10]. There appears a discrepancy in the course of fibrinolysis after laparoscopic and after open surgery [11].…”

“…The ETP of these patients is not further increased after surgery (as inherently related to the definition of the patient group), but is in fact decreased, as if the surgeryinduced alterations which are regularly encountered (such as the increase in TAT complex due to the stimulation of the coagulation process at the surgical area) may no longer occur. Similarly, the laparoscopy-induced stimulation of fibrinolysis reported by different authors [8][9][10] was not significant in this group of patients, whereas in the other group, fibrinolysis was strongly stimulated by laparoscopy. The ETP results of the present study are in line with those obtained in our laboratory in patients with hypercoagulability due to malignant colic diseases and submitted to abdominal surgery: elevated baseline ETP values were followed by a significant decrease in ETP one day postoperatively (publication in progress).…”

Thrombosis of the splenoportal axis after splenectomy

“…In the OS group, splenic hilar vessels were ligated conventionally, while these structures were divided close to the splenic parenchyma with an endoscopic vascular stapler or with the LigaSure Vessel Sealing System during LS. Previous studies showed that pneumoperitoneum may cause a hypercoagulable state during laparoscopic surgery [37,38]. Changes in intrabdominal pressure during splenectomy decrease portal vein blood flow and induce stasis [39].…”

A combination of heparin and an intermittent pneumatic compression device may be more effective to prevent deep-vein thrombosis in the lower extremities after laparoscopic cholecystectomy

“…As to the hypercoagulable state, prothrombin fragment 1 + 2, soluble fibrin, D-D, and fibrin degradation products increase after laparoscopic cholecystectomy [16]. Tissue-type plasminogen activity is also increased against the hypercoagulability during surgery.…”

“…Therefore, either pharmacological or mechanical methods of thromboprophylaxis are generally used during LC [l, 3,13,14,16,17]. Low-molecular-weight heparin (LMWH) or dextran is used as a pharmacological method for the prevention of venous thrombosis.…”