ABSTRACT
Background: Choledocholithiasis is one of the most common GI diseases seen in clinical therapeutic endoscopy practice. No unanimous consensus has been achieved for the ideal management of gall bladder and CBD stones. So both of the old and new approaches for the treatment including open surgery, laparoscopy and endoscopy are now available
Aim of the Work: This study was conducted to compare the success rate, length of hospital stay and clinical result between three modalities used for management of common bile duct stones
Patients and Methods: A total of 60 patients with symptomatic gall stones and common bile duct stones were randomized to either treatment option. Preoperative diagnosis was done by ultrasound and confirmed by ERCP. The patients were randomized into 3 groups [20 patients, each]. Group ? underwent laparoscopic cholecystectomy and open common bile duct exploration [CBDE] at the same time. Group II underwent endoscopic sphincterotomy [ES] with stone clearance, followed by laparoscopic cholecystectomy 4-6 week later. Group III underwent surgical open cholecystectomy with open exploration of common bile duct [CBD] and removal of stones with stent of CBD
Results: The ductal stone clearance rates were higher in Group I and III when compared to Group II [90%, 80% and 95%, respectively]. There were no statistically significant differences as regard postoperative stay. Mean hospital stay was significantly shorter in Group I compared with Groups II and III 4.7+/-2.4 days [range 2-9days], 9.9+/-7.7 days [range 2-34 days] and 4.8 +/-1.7dayes [range 3-10days]. As regard postoperative mortality and morbidity. There was only one case of postoperative mortality [5%] in a patient belonging to Group III. This patient developed renal failure after surgery. Wound infection was much more frequent in Group II patients [10%] than in group 1 and 3 [5%]. The post-operative morbidity was more frequent in Group III [25%] than in Group I and II [10 and 22.5 %, respectively]
Conclusion: When compared LCBDE during LC with preoperative ERCP with ES followed by LC and open surgery, LCBDE during laparoscopic cholecystectomy allow high rate of CBD clearance, decrease of morbidity, also it was shorter hospital stay. So LCBDE during LC solve 2 problems during same anesthesia with high success rate and may be employed successfully
ABSTRACT
Cytokines are polypeptides exhibiting a variety of biological activities including metabolic, inflammatory, hematopoietic and immunologic properties. They play an important role in the pathogenesis of various diseases. Inflammation is commonly observed in liver diseases and is frequently complicated by fibrosis and cirrhosis in end-stage disease. The only curative treatment for cirrhotic patients is liver transplantation. Cytokines play a key role in the regulation of immune responses. In viral hepatitis the production of inappropriate cytokine level appears to contribute to viral persistence and to affect response to therapy. The aim of this study is to investigate the level of endogenous IL-1B, IL-6 and IL-10 to determine their relation with liver fibrosis. Forty patients with chronic liver disease and 10 normal adults as control group were studied. Patients in this study were classified into four groups according to etiology of chronic liver disease: Group I [10 patients with bilharzia liver disease],Group II [10 patients with chronic hepatitis C], Group III[10 patients with chronic hepatitis B]and Group IV [10 patients with chronic hepatitis B and C]. All patients with chronic liver disease [n=40] showed highly significant elevation of serum IL-1B, IL-6, IL-10 mean +/- SD were [106.4 +/- 47.8] [P<0.01] [26.3 +/- 11.1] [P<0.01] [135.4 +/- 73.9] [P<0.01] respectively when compared to control group. After classifying the patients into 4 groups each group showed highly significant elevation of serum IL-1B, serum IL-6 and serum IL-10 in each group when compared to control group[p < 5051]. Regression analysis showed negative significant correlation between serum IL-10 and IL1B [r=-0.64, P<0.05], highly negative significant correlation between IL-10 and IL-6 [r=-0.72, P<0.01] in all patients with chronic liver diseases, also there was highly significant positive correlation between serum IL-1B and serum IL-6 [r=0.83, P<0.01]. Ten patients with bilharzia liver disease [group I] showed highly negative significant correlation between serum IL-10 and each of serum IL-1B and serum IL-6 [r=-0.9, P<0.01] [r=0.8, P<0.01] respectively, and there was highly significant positive correlation between serum IL-1B and serum IL-6 [r=0.96, P<0.01] .There was significant correlation between prothrombin concentration and each of serum IL-10, serum IL-1B and IL-6 [r=0.7, P<0.05], [r=0.68, P<0.05], [r=0.74, P<0.05] respectively. Ten patients with chronic hepatitis C virus [group II] also showed highly negative significant correlation between serum IL-10 and each of serum IL-1B and serum IL-6 [r=-0.9, P<0.01] [r=-0.9, P<0.01] respectively. There was highly significant positive correlation between serum IL-1B and serum IL-6 [r=0.83, P<0.01] and significant correlation between serum IL-1B and serum ALT[r=0.63, P<0.05]. As regard [group III] patients with chronic hepatitis B virus there was negative significant correlation between serum IL-10 and IL-1B [r=-0.63, P<0.05], but no significant correlation between serum IL-10 and serum IL-6 and there was highly positive correlation between serum IL-1B and serum IL-6 [r=0.90, P<0.01]. Ten patients with chronic hepatitis C and B virus [group VI] showed highly negative significant correlation between serum IL-10 and each of serum IL-1B and serum IL-6 [r=-0.82, P<0.01] [r=-0.80, P<0.01] respectively. There was highly significant positive correlation between serum IL-1B and serum IL-6 [r=0.88, P<0.01] and significant correlation between serum IL-1B and serum ALT[r=0.63, P<0.05], and prothrombin concentration [r=0.67, P<0.05]. A significant correlation between the level of serum IL-1B, IL-6, and serum IL-10 and degree of fibrosis was found. The increase in serum level of IL-1B, IL-6 was associated with increase the degree of fibrosis but the mild and moderate fibrosis were associated with higher level of IL-10 while patients with marked degree of fibrosis were associated with lower level of IL-10