Evaluation of stress-related hormones after surgery by laparoscopy or laparotomy

Study Objective. To evaluate the stress hormone response after pelvic surgery performed by laparoscopy versus laparotomy. Design. Prospective study. Setting. A tertiary care university hospital. Patients. Ten women were scheduled to undergo laparoscopic surgery and 10 laparotomy for either tubal disease or endometriosis. Interventions. Surgical procedures were performed by laparoscopy or laparotomy for stage III-IV endometriosis, pelvic adhesions, or distal tubal occlusion. The following hormones were measured before the induction of anesthesia in the ward, 60 minutes after the beginning of surgery, at the end of surgery after extubation, and 2 hours and 6 hours after the end of the operation: norepinephrine (NE), epinephrine (E), dopamine (D), adrenocorticotropic hormone (ACTH), cortisol, prolactin (PRL), and GH. Measurement and Main Results. The mean duration of surgery was not significantly different between the two groups. Surgery-related adrenergic activation (E, NE, D) appears more pronounced in the laparotomy group (p < 0.005) during surgery and in the postoperative period. More elevated values for laparotomy were observed also for the other stress hormones (ACTH, cortisol, PRL, GH), even though statistical significance was not always reached. Conclusions. Compared with laparotomy, activation of stress-related factors during laparoscopy seems to be less intense and of shorter duration.