Factors affecting the outcome after hepatic resection

This study included 24 cases of major hepatic resection which were performed for various indication. The study examined the influence of predictor variables upon morbidity and mortality after hepatic resection. These factors included age, sex, preoperative risk factors as diabetes mellitus and cardiovascular disease, serum total bilirubin, plasma retention rate of indocyanine green [ICG] at 15 minutes in patients with chronic liver disease, operative blood loss, operation time and vascular occlusion time. After hepatic resection, the mortality rate was 16.6% and the morbidity rate was 45.8%. The study also revealed the following criteria; affected postoperative morbidity and mortality, serum total bilirubin, ICG 15 value, operative blood loss and presence or absence of chronic liver disease

Comparative study of liver function tests after laparoscopic and open cholecystectomy

This study included 80 patients with gallstones disease n whom cholecystectomy was indicated. Forty patients underwent laparoscopic cholecystectomy [LC] and the other forty patients underwent open cholecystectomy [OC]. Liver function tests were measured 2 days preoperatively, 2 days and 4 days postoperative. It was found that total bilirbin and ALP significantly increased at the 2nd day after LC. Total and indirect bilirubin, ALT and GGT significantly increased after OC. The rise of total bilirubin 2 days after OC was significantly higher than the rise after LC. At the 4th postoperative day most of the parameters declined to near their preoperative value in both groups. Cholecystectomy had minor effect upon liver function tests. LC induced less disturbances of liver function tests than OC

Endoscopic sclerotherapy for the management of acute variceal haemorrhage

Acute variceal hemorrhage is a common cause of hematemesis in Egypt. Endoscopic sclerotherapy for the control of esophageal and gastric variceal bleeding, followed by regular sessions to obliterate the varices, has gained enthusiastic supporters laterly. To study the efficacy of variceal sclerotherapy as regard control of hemorrhage, survival rate and complications, 128 consecutive non selected patients with acute variceal bleeding were treated in the Surgical Emergency Department, Kasr-El-Aini Hospital during the period from May 1992 to May 1994 by endoscopic sclerotherapy and followed up for up to two years. They were 68 males and 24 females [mean age 39.5 + 17.8 and 36.7 + 15.9, respectively] with esophageal varices, and 25 males and 11 females [mean age 38.4 + 16.9 and 35.5 + 18.4, respectively] with gastric varices. On grading the esophageal varices, 63%, 20% and 17% of the patients were in grade III, II and IV, respectively. The results of the study showed that 51%, 35% and 14% of the patients were Child C, B and A consecutively. The initial control of bleeding was achieved in 91% of cases with esophageal varices after 3.08 sessions. Rebleeding occurred in 62%, 5% and 12.5% in Child C, B and A patients, respectively, necessitating further injections. Failure of initial control of bleeding was 14%. No portal vein thrombosis was found by ultrasound. Transient dysphagia and esophageal ulceration were found in 5.6% and 60%, respectively. Esophageal stricture that could be controlled by dilatation occurred in two patients. The mortality rate was 24.5% over the two years study due to failure of initial control of bleeding, rebleeding and liver failure in 11, 7, and 14 patients, respectively. Sclerotherapy for esophageal and gastric variceal bleeding is easy and effective with low morbidity provided that patients with failure of initial control and recurrent bleeding are referred to surgery early enough

Bacteroides wound infection following gastrointestinal tract operations

Bacteroides infection was studied in 266 patients with postoperative wound sepsis following different types of surgery. The incidence of bacteroides infection was significantly greater following gastrointestinal operations compared with operations elsewhere [P <0.01]. Bacteroides fragilis were the most common bactcroides isolated from septic wounds after gastrointestinal surgery. A significant finding was the frequency of associated organisms [66.6%], particularly the gram-negative aerobic E. coli and Klebsiella. Postoperative bactcroides sepsis was .common following surgical procedures on the colon and appendix [40%]. The incidence was relatively higher after appendicectomy for perforated appendicitis [63.6%]. Several antibiotics including clindamycin, chloramphenicol, rifampicin and, to a less extent, metronidazole were found effective against bacteroides especially bacteroides fragilis. Proper culturing for aerobes and anaerobes seems therefore necessary for adequate management of wound sepsis that follows gastrointestinal surgery. As bacteroides infection is possibly initiated during operation, prophylactic administration of a suitable antibiotic, preferably commenced just before or at the time of surgery, may probably reduce the incidence of such infections