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

Effect of increased intra-abdominal pressure due to pneumoperitoneum on liver functions and liver histopathology in a rat model with intra-abdominal sepsis

Intra-abdominal sepsis was induced by open cecal ligation and puncture [OCLP] technique. Sixty rats were randomly divided into three equal groups each of 20. G1 was used as a control. G2 were subjected to laparotomy and closure after 12 hours from [OCLP] via the same incision. In G3, pneumoperitoneum was induced 12 hours after OCLP and maintained at 12 mmHg for about 30 minutes. Blood samples were taken for liver functions after 12 and 24 hours from OCLP procedure, and Liver biopsies were taken for histopathological examination after 24 hours. The results showed that liver functions were markedly increased in G3 after pneumoperitoneum, compared to Gs 1 and 2. The histopathological changes in liver biopsies due to sepsis were more marked in cases exposed to pneumoperitoneum than that exposed to conventional laparotomy. The intra-abdominal sepsis affected liver functions and caused pathogenesis. The increased intra-abdominal pressure induced more liver insults, compared to that gained after open surgery

Dose related effect of systemic antibiotics in prevention of postoperative intra-abdominal adhesion formation in experimental animals

Sixty hamsters weighing 100-120 g were randomly assigned to 2 equal groups. GI was injected intramuscularly with saline, half an hour preoperatively as control, and GII was injected with 50 mg/kg Cefepime HC1 and 7.5 mg/kg Metronidazole. After a midline lapparo-tomy, abdominal adhesions were induced in GI and GII Post-operration, animals in GI was divided according to the numbers of intramuscular saline injections into 2 subgroups. GIa[15] in which animals were injected every 12 hours for 2 doses and GIb [15] where animals were injected every 12 hours for 5 days. Similarly, the antibiotic group was subdivided into GIIa [15] and GIIb [15]. On the 14[th] day, the hamsters were sacrificed and the adhesion score was determined. The 5 day antibiotics course revealed significant reduction in incidence [P < 0.01], extent [P < 0.001] and severity [P < 0.01] of the postoperative peritoneal adhesions, while the short course failed

Gastrointestinal stromal tumors [GISTS]: clinical presentation, diagnosis, surgical treatment and its outcome

This study included 13 selected patients treated by surgical excision for lesions that proved postoperatively to be gastrointestinal stromal tumors [GISTs] by histopathological and immunohistochemistry studies. The demographic, clinical and operative reports data were collected. Eight cases were gastric GISTs, four cases were small bowel GISTs [jejunum 1 and ileum, 3] and GIST of the sigmoid colon was in one patient. Eight cases presented at the emergency department due to hematemesis [3], gastrointestinal obstruction [3], bowel perforation [1] and severe bleeding per rectum [1]. Three cases presented with a feeling of abdominal fullness and ill-defined palpable abdominal mass. Two cases were discovered incidentally during GIT endoscopy for dyspepsia. Diagnosis of GISTs was presumed on clinical basis and operative findings from gross morphological features. Complete resection [RO] was achieved for 12 tumors [92.3%]. The immunohistochemistry profile was positive for C-kit for all cases. One operative death was due to massive pulmonary embolism. Postoperative complications occurred in three [23%] as upper GIT bleeding [1], biliary gastritis [1] and wound infection [1], and one [7.69%] of ileum tumor recurrence

Mesh repair of non-complicated umbilical hernia in ascitic patients with liver cirrhosis

The policy of elective repair of umbilical hernia in cirrhotic ascetic patients has long been a subject of debate and is still a major health problem. This study evaluated the role and outcome of elective mesh repair of umbilical hernia in cirrhotic ascetic patients, compared with the conventional two layers fascial repair technique. Forty cases with a small to medium sized umbilical hernia defects in ascetic cirrhotic patients were divided into two groups [GI and GII] of 20 patients each. After proper control of ascites in both groups, patients in GI were subjected to elective umbilical hernia onlay mesh repair. In GII, hernia were managed by conventional two layers fascial repair. In GI, transient early postoperative ascetic fluid leakage occurred in 3 [15%] cases and mild superficial wound infection in 5 [25%] cases which was controlled by antibiotics. Two [10%] cases developed hernia recurrence during follow up period. In GII, ascetic leakage occurred in 6 [30%] cases that responded well to conservative management except only one case needed re-exploration and repair reinforcement. Drainage was significantly less than in GI in among [P

New approach in surgical management of complicated umbilical hernia in the cirrhotic patient with ascites

A total of 23 consecutive patients operated upon on emergency basis for the treatment of complicated umbilical hernias associated with liver cirrhosis and ascites. The hernia was complicated by strangulation in 11 and ascitic fluid leak in twelve of the patients. Patients were assigned randomly in two groups. In the first group [GI, n = 12] peritoneal drainage at the conclusion of their surgery was done but no drainage was applied in the second group [Gil, n=12]. All patients were operated upon and when closed system peritoneal drainage was done, it was brought to outside of the abdomen through a separate stab. No negative pressure was applied. The main outcome measures were postoperative wound healing, control of ascites, complications, and hernia recurrence rate at follow up. The male/female ratio, Child's class, ascites severity, and mode of hernia complication were almost matched in both groups. Postoperative wound dehiscence occurred in four patients in G II [23.5%] but in none of GI. Control of ascites was achieved in all patients of GI. The overall mean hospital stay was significantly lower in-patient of GI than those of the G II [P < 0.0 1]. Recurrences of the hernia occurred in one patient only of the G I and in three of the G II on a mean follow- up of 19 +/- 3 months. So, postoperative closed peritoneal drainage in the management of complicated umbilical hernias associated with liver cirrhosis and ascites safe and effective in assuring postoperative wound healing, control of ascites and the prevention of hernia recurrence. It is specifically indicated in cases with bowel resection anastomosis and in patients with low preoperative serum albumin and history of rapid ascites re-accumulation under medical therapy

Modified laparoscopic appendectomy

Background: Appendectomy accounts for 1% of all surgical procedures. Laproscopic appendectomy has incited considerable controversy since its evolution. The purpose of this clinical study is to evaluate the results of some modifications added to the operation of laparoscopic appendectomy

Patients and Methods: Two groups of patients undergoing appendectomy were studied. In the first group 50 patients were subjected to open appendectomy. While the second group included another 50 patients whom were subjected to modified laparoscopic appendectomy. We compared the patients’ operative data, operative findings, postoperative complications, length of hospital stay and recovery variables

Results: Patients’ demographics, history of previous abdominal surgery and operative findings were similar in both groups. There were no intra or postoperative complications in the modified laparoscopic appendectomy group, due to the use of two 5 mm ports, ligation of the appendicular stump with ligatures, copious irrigation of the abdomen with saline and cleaning of the port sites with Povidone Iodine 10%

Conclusion: We conclude that with the new modifications added in our study, the incidence of postoperative complications were much lower than in other techniques. Also modified Iaparoscopic appendectomy offers considerable advantages primarily because of its ability for better scope of vision, good exploration, reduction of incidence of wound infection and its cost effectiveness