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Comparison of Systemic Stress Response in Open Surgery Versus Laparoscopic Surgery in Children (Abstract)

Man Mohan Harjai, Anil Kumar
Department of Paediatric Surgery, Surgical Division
Base Hospital Delhi Cantt
(Affiliated to Army College of Medical Sciences), New Delhi, India


Introduction: Surgical trauma is associated with metabolic and endocrine responses characterized by hyperglycemia, increase in ACTH, cortisol, prolactin, ADH and a decrease in insulin. Minimal literature is available on the subject. We compared the metabolic response to surgical trauma in open and laparoscopic group to observe and validate the response in paediatric age group in our setup.
Material and methods: All children undergoing elective surgery were randomly divided into two groups. Each group consisted of 30 children undergoing laparoscopic or open surgery. Blood sample of 5 ml were collected at the time of admission (preoperative) and 6 hours after surgery (post-operative).

Results: Rise was seen in cortisol (statistically insignificant), insulin (p<0.003 in laparoscopic surgery and p<0.002 after open surgery), glucose (statistically insignificant), and TSH  (p<0.0035 in laparoscopic surgery and  p<0.003 in open surgery). Prolactin levels decreased after surgery in both (laparoscopic p<0.003 and open surgery p<0.002) groups. CRP level also rose after surgery significantly.
Conclusion: We found in our study that paediatric population responds to stress is similar to adults and stress response in open surgery is slightly more comparative to laparoscopic surgery. Thus, less invasive is the better. The laparoscopic surgery is preferable over open surgery as it involves less tissue trauma and less stress response. 
Key words: laparoscopic surgery, open surgery, stress response, tissue trauma, children.


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