Effect of LaparoscopIC ChoLecystectomy on PLatelet . Aggregation

Abstract

Laparoscopic cholccvstcctmnv has proven to be a gold standmd fi.>r treatment of patients with c:1lculous cholecystitis. 1lthough manv other operations have come to be :pcri<Jrmcd laparoscopically in recent •years. (Rasmusseu et al., 199S, .luuglwus et al., 1997).

This study investigates the effect of laparoscopic chulecystectomv 011 platelet aggregation in 20 patients compared to 20 patients snbjectcd to open cholecystectomy as control group. All of the patients were oper:1ted under general anesthesia aller preoperative investigations and appropri;1te criteria including drug intake and bleeding disorders.

Platelet aggregation was studied using A.D.P, Collagen and Ristocetin bef(,re and aller open and lapilrosc<>pic chnlecvstectomv. There w;1s si!•nillc:n1t inc1casc in plalclct aggrcg;Jiion alic1 lapar<lSCnpic cholcc •:;lccllHll)'which \\';J not observed aller open cholecystectomy.

Venous hemodynamic studies during laparoscopic cholccvstectomv demonstrated that C02 insunlatinu to pressure 12mm llg e<1uscd il signilic:mt decrease in ICmoral blood flow velocity and accompanied bv significant increase in femoral vein di;nnetcr. (.lmgensen et al., 1994, Soholewsfii et rrl.. 1995).

According to" Virchow's tri<rd ".the risk of venous thrombosis increases under certain conditions: stasis and vnscular endothelial d;rnwee that occurred ' ; due to increase in the intrabdominal pressure. (Goldstrmc et al.. 1988).

Several li1ctors may be responsible i(x increased p!Jtelet aggreg;1tion aller laparoscopic cholecystectonw

1- Re1 ersed Trendlenberg position in lapmoscopic cholecvstectomy that allm1• more time for platelet aggregation. 2- Increase intra-abdomimrl pressure that causes venous stasis in splilllchnic ;rnd lo\\•er limb veins. 3- Endothelial damage due lo c<llllprcssion on vessel wallm:ry cnr;c intcr:1cti'"' between platclc! and 1'011 Willhr:HHI1i1ct<Jrthatlocalcd 1111dcr the endothelium, which pl;1y illl important role in platelet adherence ai1d aggregiltion plus its role in protection pf lnctor VIII lio111 i111111atnrc in nctivation.