Changes in fibrinogen levels in patients undergoing open and laparoscopic nissen fundoplication

Background: Venous thromboembolic complications may be more common after laparoscopic surgical techniques, possibly due to changes in venous now and blood coagulability. Methods: This study assessed fibrinogen, cross-linked fibrin degradation products (D-dimer), prothrombin international normalized ratio (INR), activated partial thromboplastin time (APTT) and platelets, during and after both open and laparoscopic Nissen fundoplication to determine whether coagulability is increased by the laparoscopic approach. Results: Seven patients underwent open and thirteen underwent laparoscopic Nissen fundoplication. Fibrinogen levels following open fundoplication fell from 7.8 +/- 0.3 g/L pre-operatively to 2.0 +/- 0.3 g/L following shin incision, and then increased to 4.1 +/- 0.4 on the first postoperative day. Similar changes in fibrinogen occurred following laparoscopic fundoplication (2.7 +/- 0.2, 2.5 +/- 0.3 and 3.8 +/- 0.4 g/L, respectively). No significant changes in the other coagulation indices were observed. Conclusions: These results demonstrate hypercoagulabilty on first postoperative day, irrespective of the operative technique. No differences between the results following laparoscopic and open fundoplication were demonstrated.