ABSTRACT
Improved laparoscopic experience and techniques have made laparoscopic cholecystectomy [LC] feasible options in cirrhotic patients. This study was designed to compare the risk and benefits of open cholecystectomy [OC] versus LC in compensated cirrhosis. A randomized prospective study, in the period from October 2002 till December 2006, where 110 cirrhotic patients with symptomatic gallstone were randomly divided into OC group [55 patients] and LC group [55 patients]. There was no operative mortatity. In LC group 4[7.33%] patients were converted to OC. Mean surgical time was significantly longer in OC group than LC group [96.13+17.35m vs. 76.13+15.12] P<0.05, associated with significantly higher intraoperative bleeding in OC group [P<0.01], necessitatating blood transfusions to 7 [12.72%] patients in OC group. The time to resume diet was 18.36+8.18h in LC group which significantly earlier than in OC group 47.84+14.6h P<0.005. Hospital stay was significantly longer in OC group than LC group [6+1.74 days vs. 1.87+1.11 days] P<0.01 with low postoperative morbidity. LC in cirrhotic is still complicated and highly difficult which associates with significant morbidity compared with that pf patients without cirrhosis. However, it offers lower morbidity, shorter operative time, early resume dieting with less need for blood transfusion and reducing hospital stay than OC.
Subject(s)
Humans , Male , Female , Cholecystectomy, Laparoscopic , Liver Cirrhosis , Prospective Studies , Comparative StudyABSTRACT
Aim: Lymphorrhea and seroma formation are disabling and serious complications of axillary lymphadenectomy. The role of octreotide in control of post axillary dissection lymphorrhea will be assessed in this study
Methods: Fifty female patients with cancer breast of different stages were subjected for modified radical mastectomy and divided into two groups; the first group was given octreotide [Sandostatin, Novartis Pharma AG, Basie, Switzerland] 0.1 mg subcutaneous 18 hours for 7 days, the other group was the control group. Both groups were evaluated for amount and duration of lymphorrhea as well as infection and hematoma formation
Results: A significant difference in the amount and duration of lymphorrhea between the two groups was observed [P = 0.0003]. In the first 8 days, the mean amount of lymphorrhea was 145.0 +/- 45.8 cc per day and mean duration of drainage was 27.0 +/- 7.59 days in control group. In the treatment group, the mean amount of lymphorrhea was 104.0 +/- 29 cc per day and the mean duration of drainage was 12.7 +/- 6.74 days
Conclusion: Octreotide could be used successfully for control of post-axillary lymphadenectomy lymphorrhea and this may lower the incidence of lymphedema and lymphosarcoma
ABSTRACT
The role of postoperative enteral feeding has been well documented. The objective of this study was to assess the benefits of early feeding via a transgastric jejunal tube after primary repair of congenital esophageal atresia [EA] with tracheo-esophageal fistula [TEF]. Thirty patients were treated at Mansoura University Children's Hospital during the period from July 2002 and January 2005. Following thoracotomy and primary esophageal anastomosis, Stamm's gastrostomy was constructed, through which a jejunal tube was passed. Twenty four patients survived, six cases died. Four patients developed esophageal leaks, which were treated conservatively, one of them developed anastomotic stricture later and another developed a recurrent fistula. We observed improved infant's weight profile and increases IL-12 levels. Diminished glutathione peroxidase levels were detected postoperatively. Early enteral feeding improves the survival, decreases the morbidity, maintains the body weight and the hydroelectrolytic equilibrium and builds up the immunologic response