ABSTRACT
Background: There is a controversy about the relation between anti-hepatitis B [anti-HBs] antibody level and obesity. We designed this study to compare the vaccine efficacy in obese/overweight and non-obese cases
Methods: In this cross-sectional study, 242 obese/overweight and 85 non-obese individuals were participated. Cases were selected from a referral clinic for obesity and a referral hepatology clinic, both in Tehran, Iran
Results: Obese cases had lower percentage of liver diseases [66.9% vs. 100%, P<0.001] but higher hepatitis B vaccination history [74.9% vs. 51.2%, P<0.001]. Median+/-inter-quartile range of anti-HBs titer in obese cases was significantly lower than controls [48.5+/-194.5 vs. 100+/-557.6, P=0.012]
Conclusion: The level of anti-HBs surface antigen antibody's titer in obese cases without liver disease is lower than control group. Therefore, a suitable strategy is needed to overcome this problem, which can be the use of longer needles for vaccination
ABSTRACT
To evaluate the effect of pre-operative indomethacin suppository on postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. A double blind placebo-controlled randomized clinical trial. Hazrat Rasoul Akram Hospital, Tehran, Iran, from February 2010 to September 2012. One hundred and thirty patients, scheduled for laparoscopic cholecystectomy, were randomly divided into case and control groups. Sixty-five patients received indomethacin suppository and 70 patients received rectal placebo in the case and control groups respectively. All patients underwent the same protocol in laparoscopic surgery and anesthesia, then nausea and vomiting was recorded after 1, 6, 12 and 24 hours postoperatively and compared between the two groups. Independent-sample t test or Mann-Whitney tests were used for statistical analysis. Level of statistical significance was set at P
Subject(s)
Humans , Male , Female , Postoperative Nausea and Vomiting/drug therapy , Cholecystectomy, Laparoscopic , Double-Blind Method , Preoperative Care , Administration, RectalABSTRACT
Background: Nowadays, new methods are emerging each month for a better operation with fewer complications. Laparoscopic surgery have remarkable advantages, Compared to open, such as smaller incision, less manipulation of the digestive system, less postoperative pain, fewer wound complication and faster discharge from the hospital
Therefore it is preferred by patients and surgeons and is replacing the traditional open surgical methods. However, any operation causes significant panic for patients and lack of knowledge about the surgical method is found to cause poor surgical outcomes, such as recovery time after the surgery we evaluated the effect of preoperative education on the recovery time of laparoscopic cholecystectomy candidates
Methods'. This randomized clinical control trial was performed at Imam Khomeini and Alborz Hospitals in Karaj from February 2010 till January 2011. Using randomized sampling method, 100 female candidates for laparoscopic cholecystectomy were divided into two equal groups of case and control
The case group received detailed information about operating room's condition, surgical equipment, anesthesia method, advantages and disadvantages of laparoscopic procedures, and patient's role in self-care at recovery, whilst the control group received no education before the surgery. The two groups were compared regarding recovery time based on Aldrete modified checklist and mean time to reach the Aldrete consciousness score of 9 and the incidence of nausea was assessed among them
Results: The analysis showed that there was a significant difference between the mean time to reach Aldrete consciousness modified checklist score of 9 between the case and control group [18.04+/-3.87 vs. 29.66+/-5.44, respectively, P<0.001], therefore the case group had shorter recovery time than the control group. 10 of the case group [20%] and 3 of the control group [6%] had nausea after recovery [P=0.037, OR=0.255 [CI 95%: 0.066-0.992]]
Conclusion: Preoperative education of patients can significantly decrease the recovery time after laparoscopic cholecystectomy surgery
Therefore, it is strongly recommended to include the preoperative education in routine care of laparoscopic cholecystectomy patients for better surgical outcomes
ABSTRACT
There are controversies among surgeons about prophylaxis of deep vein thrombosis [DVT] in laparoscopic cholecystectomy. The aim of this study was the assessment of patients' condition after laparoscopic cholecystectomy without any prophylactic measure. 100 cases of laparoscopic cholecystectomy without DVT prophylaxis were followed by duplex scanning in the first postoperative day and by physical examination and patient history at the first to second postoperative week however no clinical sign was found for DVT. Only one case of partially thrombosis [1%] was found by duplex scanning which was managed conservatively. Laparoscopic cholecystectomy may consider as a low-risk procedure and routine prophylaxis may not be justified in the absence of other risk factor
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Ultrasonography, Doppler, Duplex , Venous Thrombosis , Postoperative Period , Prospective Studies , Cross-Sectional StudiesABSTRACT
Deep Venous Thrombosis [DVT] is a major risk of morbidity and mortality in morbid obese patients underwent bariatric surgery. There are some controversies in different kind of prophylactic strategies for DVT in laparoscopic bariatric surgeries. Unfractionated heparin [UFH] is an available and reversible anticoagulant used for DVT prophylaxis. This study aimed to compare clinical results of two different dosage regimes of unfractionated heparin for short term prophylaxis of DVT after bariatric surgery. 139 patients with morbid obesity who underwent laparoscopic bariatric surgery [laparoscopic Roux-en-Y gastric bypass, sleeve gastrectomy, and laparoscopic gastric banding] were evaluated in two groups: group A received 5000 IU unfractionated heparin q12h and group B received the same dose but q8h [preliminary dose received before induction of anesthesia followed by 2 or 3 times daily]. All patients were evaluated by physical examination and Doppler ultra sound for DVT before and 10 days after surgery. There was no statistically significant difference between two groups in venous thrombosis. No thrombotic events were observed before and after operations. There were no heparin induced thrombocytopenia and no meaningful difference between two groups in postoperative bleeding. This study showed that in combination with non-pharmacologic methods for prevention of thromboembolic events, both regimes of UFH prophylaxis had similar clinical effects
Subject(s)
Humans , Female , Male , Bariatric Surgery , Heparin/administration & dosage , Laparoscopy/adverse effects , Postoperative Complications , Heparin , Prospective Studies , Randomized Controlled Trials as Topic , Drug Therapy, CombinationABSTRACT
The aim of this study was to compare operating time and short-term complications of laparoscopic transabdominal preperitoneal hernia repair during reperitonealization in Trendelenburg versus reverse-Trendelenburg positions. Thirty-nine patients with inguinal hernia were enrolled in this clinical trial. Study was done in Milad and Rasoul Akram hospitals in Tehran, Iran, during 2008-2010. The patients neither were pregnant nor did they have any signs of peritonitis, strangulation, perforation or infection. Moreover, they had a Body Mass Index [BMI] below 35 kg/m2 and were physically fit for general anesthesia. The participants were divided into two groups by block randomization. The first [20] and the second [19] groups of patients underwent laparoscopic herniorrhaphy in Trendelenburg and reverse-Trendelenburg positions. Respectively all the operations were performed by one surgeon. The patients were visited one day and one week after the surgery. Most frequent complications were rupture in peritoneal repair in 9 patients [23%], skin site bleeding in one patient [2.6%], and peritoneal tension in 33 patients [84.6%] patients. Duration of surgery and peritoneal repair took a significantly longer time in Trendelenburg versus the reverse-Trendelenburg position. There were no differences in duration for returning to work or resumption of daily activities between the two groups. Pain in the first day following surgery was statistically more severe in the Trendelenburg group. This study demonstrated that reverse-Trendelenburg position took less time for herniorrhaphy and peritoneal repair than Trendelenburg position, although the complications were the same