REVIEW ARTICLE M. Halei et al. Moldovan Medical Journal. March 2021;64(1):29-34 DOI: 10.5281/zenodo.4527068 UDC: 616.366-003.7+616.34-007.43-031:611.957]-089.832 Stress before and after surgery in patients with laparoscopic treatment of gallstone disease and inguinal hernia 2Mekola Halei, 2Ivan Marchuk, *1Andrii Prodan, 1Ihor Dzubanovskyi 1Department of Surgery by Educational and Scientific Institute of Postgraduate Education I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine 2Volyn Regional Clinical Hospital, Lutsk, Ukraine Authors’ ORCID iDs, academic degrees and contributions are available at the end of the article *Corresponding author: [email protected] Manuscript received November 27, 2020; revised manuscript January 11, 2021; published online February 22, 2021 Abstract Background: Laparoscopic surgery for combined surgical pathology demands technique of simultaneous operations. The technique of simultaneous treatment of inguinal hernia (IH) and gallstone disease (GD) has been developed and tested. Material and methods: Prospected parameters were: heart rate (HR), variation range (∆X), mode of the amplitude (AMo), and duration mode (Mo). The level of Index of Nervous Tension (INT) was evaluated by Baevsky method for estimating stress level and tension of sympathetic nervous system. Parameters were compared between control group (No1, n=76 one operation for IH) and simultaneous surgery group (No 2, n=58 IH+GD). In all cases laparoscopic transabdominal periperetoneal alohernioplasty was performed. Results: Heart rate was increasing after surgery, maximum after 2 h (by 26.3% and 23.3%, p>0.05); the ∆X in both groups decreased after 2 h (by 12.4% and 12.1%, p<0.05) and after 2 days (5.3% and 6.8%, p<0.05); Mo did not differ in both groups (p>0.05); the dynamics of the AMo increased with a maximum after 2 h (by 20.2% and 20.6%, p<0.05); the INT rate was increasing up to 2 hours postoperative (by 93.6% and 93.4% (p<0.05)). All indicators were back to normal rates within two days and did not differ in both groups. Conclusions: No difference in the level of tension in sympathetic nervous system and the degree of centralization of heart rate regulation was registered in both groups. Our developed technique has been shown safe and effective. Key words: laparoscopy, gallstone disease, inguinal hernia, simultaneous. Cite this article Halei M, Marchuc I, Prodan A, Dzubanovskyi I. Stress before and after surgery in patients with laparoscopic treatment of gallstone disease and inguinal hernia. Mold Med J. 2021;64(1):29-34. doi: 10.5281/zenodo.4527068. Introduction complications [4]. These factors demand additional equip- ment of operating rooms and skills for the surgeon. It is Gallstone disease is a common surgical pathology. Each necessary to use technique that provides minimum trauma year gallstone disease is diagnosed in 1-2% of adult popula- and invasiveness of surgical interventions, anesthesiological tion in USA and EU [1]. Chronic cholecystitis is well-treat- support and management of patients in the postoperative ed by using laparoscopic surgical treatment. Nowadays lap- period [5]. This prompted us to develop a new laparoscopic aroscopic cholecystectomy is the main recommended tactic technique for simultaneous surgical treatment of inguinal for use [2]. Also, it is shown that early laparoscopic chole- hernia gallstone disease (GD). Under these conditions, be- cystectomy is the most acceptable approach if complications cause of increasing admeasurement of surgical trauma, one are considered (mechanic jaundice, choledocholytiasis, gall- of the important criteria for the effectiveness and safety of bladder cancer etc.) [2]. At the same time 27% of males and simultaneous operations compared to mono-interventions 3% of females develop a groin hernia at some time of life is the severity of operational stress [6]. Adaptive adjustment [3]. Up-to-date fast-track surgery strategic demands min- of the cardiovascular system is one of the first to note while imal hospital stay time. Considering all these factors it is talking about stress. Stress can be valued through the vari- acceptable to perform laparoscopic cholecystectomy simul- ability of heart rate [6, 7]. taneously with other operations if comorbid cholecystitis is Aim of the work: Using the variability of cardiac rhythm diagnosed. One-staged treatment reduces total cost of treat- to evaluate the intensity of postoperative stress in patients ment because of reducing terms of general hospital stay. that underwent transabdominal preperitoneal patch tech- The main problem of simultaneous operations may become nique (TAPP) and simultaneous laparoscopic cholecystec- their additional trauma and duration, which theoretically tomy. To compare their result with the one in patients that may influence the surgical stress and rate of postoperative underwent only TAPP. 29 M. Halei et al. Moldovan Medical Journal. March 2021;64(1):29-34 REVIEW ARTICLE Material and methods Table 1 Sample includes patients that underwent TAPP (control Heart rate of patients in both groups (Me (LQ; Uq) – group No 1, n=76) and patients that underwent TAPP (as median and upper and lower rate) one of recommended procedure for inguinal hernia (IH) Period of mea- Control group Research р repair [8, 9]) and simultaneous cholecystectomy (research surement (No 1) group (No 2) group No 2, n=58). Patients underwent surgical treatment Day before surgery 72.2 (64; 75) 71.7 (66; 75) >0.05 during 2015-2019 year time period. Survey and all the op- erations were performed in the Volynian regional clinical Postoperative period hospital in the laparoscopic surgery unit. In every case lapa- 1 hour 85.8 (81; 90) 83.6 (78; 87) >0.05 roscopic transabdominal preperitoneal alogernioplastic was 2 hours 91.2 (83; 96) 88.4 (82; 92) >0.05 performed. In group No 1 in each case standard technique 6 hours 83.6 (77; 89) 84.2 (77; 88) >0.05 was used. In group No 2 in each case our developed tech- 12 hours 75.9 (71; 81) 76.1 (68; 78) >0.05 nique of simultaneous operations was used. Selection into 1 day 74.8 (68; 77) 75.5 (67; 78) >0.05 groups was performed exclusively on the principles of surgi- 2 days 72.2 (66; 76) 72.8 (67; 77) >0.05 cal comorbidity. All patients underwent routine conserva- 3 days 70.8 (65; 75) 71.4 (66; 75) >0.05 tive treatment before and after surgery. The average length Note: here and further p – possibility of difference for rate in the con- of stay of the patient in the hospital before surgery was 1 trol group from the research group hospital day. Exclusion criteria: patients with progressive coronary son groups, the indicator decreased and, starting from the heart disease in combination with severe heart failure and 12 hours of postoperative period, did not differ statistically severe chronic kidney disease, isolated obliterating athero- significantly from the value of the indicator before surgery sclerosis of the vessels of the lower extremities, chronic pul- (p>0.05). The same reactions on pain and trauma were reg- monary diseases in the acute stage, cancer of various local- istered in other researches [13, 14]. Also common reaction ization. was shown in patients after cholecystectomy [15]. It is note- To measure the operative stress by a variation of pulso- worthy that the value of heart rate in all periods of the post- gram, was used cardiocomplex “CardioLab +” (designed operative period in the group of patients that underwent and manufactured by HAI-MEDICA, Kharkiv/Ukraine) TAPP with laparoscopic simultaneous cholecystectomy and for all patients in the control group and the main group the patients that underwent only TAPP did not differ signifi- day before surgery and 1, 2, 3, 6, 12 hours and 1, 2 and 3 cantly (p>0.05). days postoperatively. The recording was performed in the patient’s ward in a supine position not earlier than after 7-10 131 minutes of adaptation to this position. At least 100 cardio 126.3 126 intervals were recorded with subsequent determination of Control group Research group the main statistical characteristics according to the method 121 118.8 123.3 of R.M. Baevsky [10-12]. 117.4 Recorded data was used to determine heart rate (HR), 116 117 115.8 variation range (∆X) – the difference between the maxi- 111 mum and minimum duration of cardio intervals, mode of 106.1 105.3 the amplitude (AMo) – the percentage of the most common 106 105.1 cardio intervals, as well as their duration – mode (Mo). 101.2 99.6 101 103.6 100 100 According to the obtained data, the voltage index of 100 98 regulatory systems, index of nervous tension (INT) was cal- 96 1 h. 2 h. 6 h. 12 h. 1 d. 2 d. 3 d. culated by R.M. Baevsky, which reflects the degree of cen- Before Period after surgery tralization of heart rate control: INT = АМо / (2 ´ Мо ´ DХ). surgery Estimation of the probability of differences between the Fig. 1. Heart rate dynamics (in percent to the control level) control and main groups was performed using the nonpara- (Note: here and further * – differences for the terms before operation are metric Mann-Whitney test. statistically possible р<0.05). Results and discussion Analysis of the variation scale (∆X) (tab. 2, fig. 2) had Data analysis was performed. According to the results of shown that before the operation the indicator did not dif- the research there was no statistically significant difference fer significantly between the control and the main groups in heart rate between groups. (p>0.05). Worth to notice that intraoperative and postop- Records of heart rate are shown in tab. 1 and fig. 1. erative (up to 2 hours) heart rate and its variations in both Heart rate was increasing and reached its maximum in groups were similar between groups as well as from other 2 hours after surgery in both groups (26.3% in group 1 and studies [16].