ABSTRACT
This study was carried out to quantify and compare the ventilatory effects with the metabolic and inflammatory responses after laparoscopic and abdominal hysterectomy. Forty patients with no major medical disease requiring abdominal hysterectomy for benign disorders were randomly assigned to have laparoscopic hysterectomy [n = 15] and abdominal hysterectomy [n = 25]. Bed side pulmonary function tests were done preoperanvely and at 2, 4, 6 and 8 hours post operatively using portable vitalograph-compact spirometer. Venous blood samples were collected the day before operation and for each of the first 2 post operative days for estimation of serum interleukin-6, C-reactive protein, plasma glucose and white blood cell count. The results of the study showed no differences in demographic characteristics and operating time in the two groups. No major complications were also encountered. The laparoscopic hysterectomy group had a significantly lower febrile morbidity rate [16% vs 46%, P < 0.05] and shorter hospital stay [Median 4 vs 6 days, P < 0.001]. The study showed also that all measurements of pulmonary function tests that require patient effort like forced expiratory volume in one second [FEVI] and peak expiratory flow rate [PEFR] and which are influenced by the strength of the respiratory muscles are better in case of laparoscopic hysterectomy compared to the abdominal hysterectomy group. The study demonstrated a significant elevations of C-reactive protein and interleukin-6 in both groups and this elevation denotes a less intense stress response in the laparoscopic hysterectomy group compared to the abdominal hysterectomy group as the serum interleukin-6 [median 42.2 vs 83.2 pgi, P < 0.001], C-reactive protein [Median 26.1 mglL vs 45.3 mglL, P < 0.001] and white blood cell count [Median 59.5 vs 69.0 10[9]/L, P = 0.009]. No significant difference was detected in plasma glucose [median 40.5 vs 45.6 mmol /L]. So, we can conclude that laparoscopic hysterectomy is very beneficial in keeping the standard of the pulmonary function post operatively and also, it is associated with a less intense stress response than abdominal hysterectomy for benign diseases