KADAR KORTISOL, TISSUE PLASMINOGEN ACTIVATOR (tPA) SERTA DERAJAT ADHESI PASCA LAPAROSKOPI DAN LAPAROTOMI (PENELITIAN EKSPERIMENTAL PADA KELINCI YANG DILAKUKAN ABRASI ILEUM)

Abstract

Background: Intraperitoneal adhesions after abdominal and pelvic surgery procedures occurred 95% cases. Laparoskopy has advantages reducing the risk of intraperitoneal adhesions. This research has done to know the difference between laparoscopy and laparotomy in rabbit regarding peritoneal adhesion degree by cortisol and tPA level. Material and Method: Randomized control trial post test only design was done on two groups of 12 New Zealand rabbits was done. The 1st group (R1) was performed laparotomy and ileum abration and the 2nd group (R2) was performed laparoscopy and ileum abration under general anastesia. On both groups, blood sample was taken just before and 6 hours after operation to asess the cortisol levels. Seven days after operation, both groups were terminated by cervical dislocation and then performed laparotomy, to assessed the tPA levels from its peritoneal fluid and peritoneal adhesion. The differences regarding in cortisol and tPA levels were analyzed by independent t-test, while peritoneal adhesion was analyzed by Mann Whitney. The correlation between cortisol and tPA was use Pearson’s correlation, while the correlation between tPA and the adhesion degree analyzed by Spearman’s correlation. Result: There were lower increasing level of cortisol in R2 group (mean ∆ cortisol laparotomy 20,03 ± 1,550 ng/ml, mean ∆ cortisol laparoskopy 11,4 ± 3,253 ng/ml with p= 0,021), lower of tPA level in R2 group (24,353 ± 6,371 pg/ml laparotomy, 55,982 ± 6,043 pg/ml laparoskopy with p<0,05) and lower of adhesi level in R2 group (3.17 ± 0.408 laparotomy, 0.33 ± 0.516 laparoskopy, with p=0,002). There were negatif strong correlation between the level of cortisol with tPA (p= 0,030, r=-0,679) and negatif strong correlation between the level of tPA with the degree of adhesion (p= 0,001, r=-0,811). Conclusion : Laparoscopic surgery can minimize the effects of systemic stress and level tPA, so as to lower the incidence of adhesion. Key words : Degrees of adhesion, cortisol, tPA, laparotomy , laparoscopy.