Surgical injury: comparing open surgery and laparoscopy by markers of tissue damage

Abstract

BackgroundMajor abdominal surgery (MAS) is high-risk intervention usually accompanied by tissue injury leading to a release of signaling danger molecules called alarmins. This study evaluates the surgical injury caused by two fundamental types of gastrointestinal surgical procedures (open surgery and laparoscopy) in relation to the inflammation elicited by alarmins.Patients and methodsPatients undergoing MAS were divided into a mixed laparoscopy group (LPS) and an open surgery group (LPT). Serum levels of alarmins (S100A8, S100A12, HMGB1, and HSP70) and biomarkers (leukocytes, C-reactive protein [CRP], and interleukin-6 [IL-6]) were analyzed between the groups. The secondary objectives were to compare LPT and LPS cancer subgroups and to find the relationship between procedure and outcome (intensive care unit length of stay [ICU-LOS] and hospital length of stay [H-LOS]).ResultsA total of 82 patients were analyzed. No significant difference was found in alarmin levels between the mixed LPS and LPT groups. IL-6 was higher in the LPS group on day 2 (p=0.03) and day 3 (p=0.04). Significantly higher S100A8 protein levels on day 1 (p=0.02) and day 2 (p=0.01) and higher S100A12 protein levels on day 2 (p=0.03) were obtained in the LPS cancer subgroup. ICU-LOS and H-LOS were longer in the LPS cancer subgroup.ConclusionThe degree of surgical injury elicited by open MAS as reflected by alarmins is similar to that of laparoscopic procedures. Nevertheless, an early biomarker of inflammation (IL-6) was higher in the laparoscopy group, suggesting a greater inflammatory response. Moreover, the levels of S100A8 and S100A12 were higher with a longer ICU-LOS and H-LOS in the LPS cancer subgroup.

Intraoperative Peritoneal Interleukin-6 Concentration Changes in Relation to the High-Mobility Group Protein B1 and Heat Shock Protein 70 Levels in Children Undergoing Cholecystectomy

“…Despite the type of the surgery, both operations include mechanical tissue injury, local hemorrhage, ischemia, ischemia-cellular stress, and hypoxia-reperfusion injury which altogether cause the activation of innate and adaptive immunity. The most common implications of these events are impaired wound healing and infections leading to longer hospitalization time, impaired long-term cognitive functions, and increased mortality [ 6 ].…”

Enhanced Recovery after Surgery (ERAS) at cesarean delivery to reduce postoperative length of stay: some details need to be improved

“…So, there was not likely to be significant variation in the operative times between cases. (3) We agree that a larger study would be beneficial in evaluating the clinical significance of enhanced recovery, specifically…”

“…As we all know, different doctors have different technical proficiency and different surgical trauma. The greater the trauma is, the greater the stress response will be, 3 which will inevitably affect the postoperative recovery and prolong the postoperative length of stay.…”

Gynecological endoscopic society of malaysia statement and recommendations on gynecological laparoscopic surgery during COVID-19 pandemic

“…Laparoscopy offers minimal direct tissue handling or exposure to the blood, which would be safer for surgeons in the presence of viremia. [ 1 ] In contrast, laparotomy exposes the surgeon to a higher risk of blood and plasma contamination. [ 1 2 ] Laparotomy also may expose the surgeon to more surgical smoke than laparoscopy, which would be more confined intrabdominally.…”