Effects of pneumoperitoneum of laparoscopic cholecystectomy on the coagulation system of patients： a prospective observational study

BacKground Laparoscopic cholecystectomy has been widely used in clinical practice during the recent decades; however, the effects of pneumoperitoneum and the surgery on the coagulation system are largely unknown. This clinical study aimed to observe any possible effects of pneumoperitoneum and the surgery on the coagulation system of patients. Methods This was a prospective observational study. The inclusion criteria included （1） patients with chronic cholecystitis and/or cholecystic polyps and （2） patients in the relief stage of acute cholecystitis. The exclusion criteria included （1） patients in the episodic stage of acute cholecystitis and those complicated with cholangiolithiasis; （2） patients with concomitant hematologic diseases, damages to the liver function, malignant tumors or immune system diseases, or patients complicated with thrombotic or hemorrhagic disorders; and （3） patients who had taken anticoagulant medication within a week before surgery. Fifty patients who were hospitalized into our department for elective laparoscopic cholecystectomy between November 2011 and February 2013 were eligible and enrolled into this study. Of the 50 patients, 22 were male and 28 female. The age of the patients ranged from 29 to 78 （mean 56.7±11.5） years. The surgery for each of the 50 patients was performed with the same equipment and conditions. The surgeries for all the patients were performed under general anesthesia with the patients in a 30-degree head-up tilted posture, and the pressure of pneumoperitoneum was maintained at 13 mmHg. Venous blood specimens were taken from each patient before and at the end of pneumoperitoneum （i.e., 0 hour after surgery） and at 8 hours after surgery for determination of prothrombin time （PT）, activated partial thromboplastin time （APTT）, fibrinogen （Fib）, thrombin time （TT）, and D-dimer （DD）. The results of the determinations of these parameters were compared. Results （1） All the patients recovered well without any complications. （2） The pre-pneumoperitoneum values of the parameters of coagulation had normalized. （3） The PT values slightly increased （P 〉0.05） at the end of pneumoperitoneum （i.e., 0 hour after surgery） and decreased by 0.5 seconds at 8 hours after surgery as compared to the pre-pneumopedtoneum values （P 〈0.05）. （4） APTT at 0 and 8 hours decreased by 1.4 seconds （P 〉0.05） and 3.7＇ seconds （P 〈0.05） respectively as compared to pre-pneumoperitoneum values, while the difference between the APTT values at 0 a