Hepatocyte growth factor and interleukin - 6 as markers for evaluation of tissue trauma and stress response after laparoscopic and open cholecystectomy

The present prospective r and omized study was planned to compare the clinical outcome and tissue trauma after two cholecystectomy techniques; namely, open and laparoscopic surgical procedures. Forty patients were r and omized to either laparoscopic or open approaches. Blood samples were drawn preoperatively as well as at 12 and 36 hours following the operation. Hepatocyte growth factor [HGF] and interleukin-6 [IL-6] levels were used to evaluate cytokine release, while C-reactive protein [CRP] and morning cortisol were used to clarify the inflammatory response. It was found that hepatocyte growth factor and interleukin-6 elevation in response to stress and tissue trauma is an inevitable metabolic response in both laparoscopic and open approaches, this is associated with increased acute phase reactants [CRP and stress hormones as morning cortisol]. However, laparoscopic surgery exhibited significant lower levels of both hepatocyte growth factor and interleukin-6 at 36 hours postoperatively, which can be attributed to the amelioration of tissue trauma on using the laparoscopic approach. Thus, it can provide less perception of pain as well as shorter convalescence time and postoperative hospital stay

Pre-operative port sites infiltration and intraperitoneal administration of bupivacaine: Does it effectively reduce pain after laparoscopic cholecystectomy?

To examine the efficacy of preoperative port sites infiltration and /or intraperitoneal administration of bupivacaine in alleviating pain after laparoscopic cholecystectomy [LC], 80 patients scheduled for elective laparoscopic cholecystectomy were recruited. They were blindly r and omized to 4 groups, 20 patients each. Group A received bupivacaine infiltration in port sites before skin incision as well as intraperitoneal instillation, group B received bupivacaine in port sites only, group C received bupivacaine intraperitoneally only and group D served as a control group and had no treatment. Postoperative pain [viscer al and somatic] and nausea were studied at 1, 2, 3, 6, 9, 12, 24, 36 and 48 hours after operation. The study showed that the combination of preoperative port sites infiltration and intraperitoneal administration of bupivacaine significantly reduces postoperative nausea, port sites pain and shoulder tip pain, but does not affect headache or other types of pains after laparoscopic cholecystectomy

Laparoscopic versus open repair of inguinal hernia: a prospective randomised trial

Inguinal hernia repair is one of the most common elective operations performed in general surgery, but the most effective surgical technique is unknown. The aim of this study is to compare laparoscopic repair with open repair of inguinal hernias. 40 patients with inguinal hernias from Misr University for Science and Technology hospital were randomly assigned to open repair with mesh fixation [n=20] and laparoscopic repair with mesh fixation [n=20]. Both groups were compared regarding operative time, intra-operative complications, and duration of hospital stay and as regards postoperative complications in the first week after surgery. The mean operative time for laparoscopic inguinal hernia repair was much longer than that for open repair [p<0.001] but hospital stay was much shorter for the laparoscopic group than for the open group [p<0.001]. Intra-operative complications were more common in the laparoscopic than in the open group but still not statistically significant. Postoperative complications in the first week after surgery were more common in the open group than in the laparoscopic group especially the local wound complications and especially in the recurrent cases. Laparoscopic inguinal hernia repair is an accepted method of repair especially for recurrent cases

Recurrent laryngeal nerve exploration in thyroid gland surgery: a prospective randomized trial

To determine whether intra-operative identification of the Recurrent Laryngeal Nerve reduces the incidence of permanent recurrent laryngeal nerve paralysis [RLNP] and its influence on temporary RLNR. In Misr University for Science and Technology Hospital during the period from September2000 to September 2002. Prospective blind randomized clinical study. Fifty consecutive patients undergoing thyroid surgery; were randomized to two groups 25 patients each. In group [A], recurrent laryngeal nerve was explored routinely while in group [B] no nerve exploration was done. Indirect laryngoscopy was done for vocal cords examination preoperatively and was repeated at one week, one month, and six months after the operation. Permanent recurrent laryngeal nerve palsy was defined as clinical dysphonia lasting for 6 months with proven immobile vocal cords on indirect laryngoscopy. In group [A] two patients had temporary symptomatic recurrent laryngeal nerve palsy [8%], both improved during the 6 months follow up period Incidence of permanent RLNP was therefore 0%. In group [B] also two patients bad symptomatic RLNP [8%] one continued to have symptomatic recurrent laryngeal nerve palsy at the 6 month postoperative examination i.e. permanent RLNP. Indirect Iaryngoscopy should be performed routinely for patient undergoing thyroid surgery prior to surgery and revised at least during ex-tubation. Whenever extracapsular thyroid surgery is performed, RLN exploration should be done

Haemorrhoidectomy as a day case procedure: evaluation and cost effectiveness

In an attempt to evaluate the feasibility of local anesthesia [infiltration] as an alternative to general anesthesia in hemorrhoidectomy to estimate the cost-effectiveness. Two groups of patients had the same surgical procedure [hemorrhoidectomy]. One group received local [n = 36] and the second received general anesthesia [n = 20]. Both groups were subjected to the same evaluation as far as perioperative monitoring, evaluation and procedure success. Any postoperative pain was scored using a visual analog scale [VAS] in the first three postoperative days. All patients were evaluated at two weeks and two months postoperatively. The cost of the operative procedure for both groups was compared and documented. Apart from one patient from group B who developed sinus tachycardia prior to surgery and opted to have the procedure performed under local anesthesia rather than re-schedule, both groups had successful surgical procedures with no observed difference in the outcome