Pulmonary functions, pain and metabolic response after laparoscopic banding versus open gastroplasty in morbid obesity

The present study compares postoperative pulmonary functions, pain and stress responses between laparoscopic group [n = 15] and open surgical groups [n = 15] in morbidly obsess patients. Pulmonary functions [forced vital capacity FVC, forced expiratory volume in 1 second FEV1% and peal expiratory flow rate PEFR] were performed and Spo2 was measured preoperatively [control], 4h after surgery and on days 1, 2 and 3 after the operation. Postoperative pain measured using a 100-mm visual analogue scale VAS and narcotic consumption were recorded every 8 hours for the first three days after operation. Also, endocrine metabolic response was measured via assay of serum cortisol and serum glucose levels preoperatively, 30 min, after induction, 2h and days 1,2 and 3 postoperatively. Pulmonary function showed that 4 h post surgery, a significant difference between the two groups being less for laparoscopic group. This difference continued over day 1,2 and 3 where the same results were still obtained for Spo2. Pain intensity at rest, during mobilization and on coughing was significantly less after laparoscopy. Requirements for postoperative opioid were 50% less in laparoscopic group. In both groups, plasma glucose and cortisol increased after surgery compared with baseline reaching the peak at 4 h without significant difference between both groups. This continued postoperatively but with significant difference between the two groups being less in laparoscopic group

Immediate discontinuation of intravenous fluids after common surgical procedures

This study was done to evaluate the results and impact of immediate discontinuation of intravenous fluids and acceptance of early oral hydration after commonly performed operations. The responses obtained in 100 patients underwent appendicectomy, laparoscopic cholecystectomy, hernial repair and diagnostic laparoscopy were analyzed. The early oral hydration and the non-use of routine i.v. fluids after commonly performed operations proved to be a simple and safe technique to the treatment of the possible complications of i.v. fluids and enabling a rapid return to normal activity

Conservative management of hepatic trauma

In this study, the conservative management of 54 patients [37 males and 17 females with a mean age of 28 + 12.6 years] with liver trauma [40 cases of blunt trauma and 14 cases of penetrating injury] in the last six years was reviewed. Guided by clinical signs and CT scan, 28 patients were successfully managed without operation [22 with blunt injury and six with penetrating injury]. Most of the operatively managed patients after the failure of the conservative treatment were of grade IV and V liver injury. The complication rate was lower in the nonoperatively managed patients. Only two patients died in the operative group, but no mortality occurred in the nonoperative one. When surgery was done, the simplest maneuver to control bleeding was followed to reduce the morbidity and mortality rates. The clinical assessment and radiological monitoring may reduce the number of unnecessary laparotomies