Colecistectomia tradizionale vs laparoscopica. Modificazione del profilo coagulativo

Lo scopo di questo studio, prospettico non randomizzato, è quello di investigare le alterazioni del sistema emostatico in pazienti sottoposti a colecistectomia laparoscopica e tradizionale e, inoltre, di valutarne il profilo citochinico al fine di determinare l'esistenza di correlazioni tra modificazioni dello stesso stato coagulativo nel postoperatorio.

The aim of this prospective, non-randomised study was to investigate haemostatic system alterations in patients undergoing open (OC) and laparoscopic cholecystectomy (VLC). In addition, we also measure the plasma cytokine profile to explore any relationship between changes in plasma cytokine levels and the postoperative coagulation profile. From July 2005 to March 2007, 71 patients were non-randomly assigned to open (group 1) or laparoscopic cholecystectomy (group 2). Prothrombin fragment 1.2 (F1.2), thrombin-antithrombin (TAT), fibrinogen, soluble fibrin, antithrombin III (AT), protein C, plasminogen and D-dimer levels were measured at baseline and at 1, 24, 48 and 72 hours postoperatively. Serial serum levels of IL-1 beta and IL-6 were measured by colorimetric ELISA. Plasma levels of F1.2, TAT, fibrinogen, soluble fibrin and D-dimer increased significantly in group 1. Plasma levels of AT, protein C, plasminogen decreased in both groups. In the OC group, the serum IL-1 beta and IL-6 levels began to increase significantly as early as 1 hour after the start of the operation, peaking at hour 6. The surge in circulating cytokine levels, commonly found in the postoperative period, is shown to be capable of inducing a hypercoagulability state and there is a positive correlation between IL-6 levels and hypercoagulability. In our study only mild hypercoagulability was observed in patients undergoing laparoscopic cholecystectomy. In conclusion, the correlation between cytokine levels and coagulation activation may be related to the type of surgery performed. Our present knowledge of the effect of laparoscopy upon coagulation and fibrinolysis is incomplete and based on only a few studies; for this reason further studies are required to investigate these aspects.