<b>Surgical trauma and metabolic changes induced by surgical laparoscopy versus laparotomy</b>

Abstract

Objective The aim of the research was to compare local and systemic reactions of the body to laparotomy and laparoscopy. Design In a prospective randomized study the operative trauma and metabolic changes in 40 patients were investigated and compared in laparoscopy and laparotomy. Main outcome measures Metabolic changes were registered by indirect calorimetry. In order to quantify intraperitoneal trauma, short‐term and medium‐term pH measurements of the peritoneal surface were made. Results In the case of laparoscopy a severe intraoperative chemical acidosis occurred that disappeared a short time after operation. As a result, a short‐term increase of metabolic rate was observed. Following laparotomy an increase in metabolic acidosis was registered during the first postoperative hours and had not returned to normal after 24 h. A prolonged catabolism lasted over 48 h. Conclusion In patients undergoing laparotomy the intraperitoneal trauma is more marked than in laparoscopy. Long‐term metabolic intra‐abdominal acidosis with resulting catabolism may cause increased impairment of the organism.