ABSTRACT
Background: Increased intra-abdominal pressure due to laparoscopic surgery has a harmful effect on liver enzymes and stress response, particularly in patients with compromised liver functions. Minilaparotomy cholecystectomy avoid these effects
Objective: To compare the effect on liver enzymes and stress hormones and to evaluate the outcome of laparoscopic and minilaparotomy cholecystectomy in patients with compromised liver functions
Patients and methods: Twenty four patients with compromized liver functions and symptomatic gallstones were assigned into two groups; 12 patients underwent laparoscopic cholecystectomy [LC], and another 12 patients underwent minilaparotomy cholecystectomy [MC]. We compared the two groups according to patient characteristics; operative details; liver enzymes; prothrombin time; plasma levels of cortisone and noradrenaline; and postoperative outcome [length of hospital stay, convalescence, postoperative complications, morbidity, mortality]
Results: There was a significant reduction in operative time in MC group. In LC group, the liver enzymes were significantly increased through the first 72 hours postoperatively. However, in MC group, the liver enzymes were significantly increased only through the first 24 hours. Also, there was a significant increase in the plasma levels of cortisone and noradrenaline 8 hours after operation, then these levels reduced to be near the preoperative [baseline] levels, in each group
Conclusion: There is a high deleterious effect on liver enzymes and stress hormones due to pneumoperitoneum in patients with compromised liver functions subjected to laparoscopic cholecystectomy. However, minilaparotomy cholecystectomy has a reversible, little effect, thus, it should replace the use of laparoscopic cholecystectomy in those patients
ABSTRACT
Undescended testis is a common problem with high risk of infertility and cancer. Early surgical correction is important for prevention of those risks. In the last year 1999, multi-disciplinary projects were done between surgical, dermatological and pediatric departments aiming to re-explore the histological and morphological changes in cryptorchid testis and its relation to age. Twenty four [24] male patients were recruited from El-Minia University Hospital and were divided into 4 main groups. Group A included 6 infants under the age of 2 years; group B included 4 patients aged from 2-9 years [pre-pubertal]; group C included 6 patients aged from 9 to 14 years [pubertal]; and group D included 8 patients aged from 14 to 21 years [post-pubertal]. Orchiopexy was done for all patients in one stage and bilateral testicular biopsy was taken and fixed immediately in Baun's solution and then stained by H and E for histopathological preparations. Our results showed that, for boys under the age of 2 years, there was no change from the normal spermatogonia and Sertoli cells with no thickening of their basement membrane. In pre-pubertal children, we found that changes were evident by the age of 7 and 8 years in the form of decreased number of spermatogonia, delayed maturation of Sertoli cells, widening of interstitial spaces and increased number of fibroblasts in the interstitium. In pubertal patients, the spermatogonia became rare and Sertoli cells were immature. Biopsy specimens from post-pubertal patients showed marked reduction of spermatogonia and arrest of spermatogenesis at primary spermatocyte stage. We concluded that early correction of cryptorchidism is vital for preservation of testicular integrity and maintenance of fertility