Perioperative acute phase response and outcome of hepatic resection, an experimental study

Identification of patients at risk of postoperative complications could have an impact on the indications for a procedure as well as permitting modifications of treatment to reduce the surgical risk. This experimental study evaluated the correlation between peri-operative acute phase response and outcome of hepatic resection. The study was conducted on sixty healthy golden hamsters, which underwent partial hepatectomy. They were arranged in 3 groups [20 per each]. One day prior to resection, fracture of the left hind leg was done in group I [GI] and wound infection had been created in group II [GII]; while nothing done in group III [GIII] that acted as a control. Blood samples to estimate SGPT and serum albumin [as basic investigations for hamsters liver function] and serum IL-6 and CRP [as acute phase reactants] were taken preoperatively, immediately after resection and for the consecutive 3 days post operatively. The mean serum level of both acute phase reactants increased in GI and GII preoperatively and continues to rise immediately after resection. Post-operatively; among the three groups, the mean serum level of both reactants was higher in GI than in GII that was in turn higher than in GIII except when the postoperative complications were more severe than the other group, then this relation changed

Experience in postoperative enterocutaneous fistula

This study included 16 cases of postoperative enterocutaneous fistulae managed at kasr El-Aini Hospital in the period from 1987 to 1989. Of the 16 cases 2 were jejunal 6 ilial and 8 colonic fistulae. 6 were of the high output variety and 10 of the low output variety. Conservative treatment was the sole line of management in 9 cases, 8 of them were of the low output variety and 1 was a high output fistula. Spontaneous closure occurred after 18-40 days with an average of 29 days. Immediate surgery [48 hours] was carried out in 1 case of high output jejunal fistulae. Early surgery [before 6 weeks] was carried out in 3 cases. Delayed surgery [after 6 weeks] was carried out in 3 cases. In this limited series we had a cure rate of 87.5% and a mortality rate of 12.5%. In this work we have applied a practical conservative approach using the medical measures available. Special emphasis was given to the role of surgery especially as regards the timing and desirability of surgical intervention