Résumé
This study aimed at estimation of serum levels of insulin-like growth factor-1 [IGF-1], insulin-like growth factor binding protein-3 [IGFBP-3] and interleukin-6 [IL-6] in patients undergoing open [OC] or laparoscopic [LC] cholecystectomy so as to evaluate the impact of surgical procedure on their serum levels. The study comprised 30 patients [7 males and 23 females] assigned to undergo cholecystectomy for calcular cholecystitis. Laparoscopic cholecystectomy was performed according to the European "four-puncture" technique Blood samples were taken preoperatively and one [POD1] and 2 [POD2] days after surgery for determination of complete blood picture and estimation of serum IGF-1, IGFBP-3 and IL-6. The mean operative time was non-significantly prolonged in LC group, while, the mean wound length and duration of postoperative hospital stay were significantly [p<0.05] decreased in LC compared to OC group. Total leucocytic count [TLC] and the percentage of neutrophils showed progressive increase in both groups at POD1 and POD2 compared to preoperative counts; leucocytosis and neutrophilia were significant [p<0.05] at POD2 compared to levels estimated at POD1 in OC group but were non-significant in LC group and were significantly [p<0.05] higher in OC group compared to LC group at both POD1 and POD2. Serum IGF-1 was significantly [p<0.05] decreased in both groups at both POD1 and POD2 in comparison to preoperative levels, with a significant [p<0.05] increase at POD2 compared to levels estimated at POD1 in LC group, while the difference was non-significant [p>0.05] in OC group. Moreover, serum IGF-1 was significantly [p<0.05] higher in LC compared to OC group at both POD1 and POD2. Serum IGFBP-3 was decreased significantly [p<0.05] in OC group and non-significantly [p>0.05] in LC group in comparison to preoperative levels at both POD1 and POD2, with a significant [p<0.05] decrease in OC group compared to LC group at both PODI and POD2. Serum IGFBP-3 showed progressive decrease but with non-significant difference between its serum levels estimated at POD1 and POD2 in both groups. Serum IL-6 was increased significantly [p<0.05] in both groups in comparison to preoperative levels at both POD1 and POD2, with a significant [p<0.05] increase in OC compared to LC group at both POD1 and POD2. Serum IL-6 showed progressive increase but with non-significant difference between its serum levels estimated at POD1 and POD2 in both groups. There was a positive significant correlation between serum IL-6 and percentage of neutrophils at POD1 in both groups and a positive correlation with percentage of neutrophils at POD2 that was significant in OC group but was non-significant in LC group. Moreover, serum IL-6 levels showed a negative correlation with serum IGFBP-3 at both POD1 and POD2 that correlation was significant in OC and non-significant in LC group. It could be concluded surgery induces postoperative increased serum levels of IL-6 associated with decreased levels IGF-1 and IGFBP-3, such effect was minimized in patients underwent laparoscopic surgery and explain the shortened postoperative catabolic stage
Résumé
This study was designed to evaluate the outcome of combined laparoscopic cholecystectomy and fundoplication during one single laparoscopic procedure. The study included only patients assigned to undergo cholecystectomy for calcular cholecystitis and had symptomatic gastroesophageal reflux disease [GERD], 22 patients [7 males and 15 females] were enrolled in the study. All patients underwent clinical history taking including duration of symptoms, physical examination and upper gastrointestinal endoscopy. Esophageal manometry was performed preoperatively and 2 and 6 months after surgery. Laparoscopic procedures were performed through 5-port access. Operative time and the frequency of conversion to open surgery, time till initiation of oral intake, postoperative hospital stay and complications and time to recover full activity were recorded. Through a monthly visit for 6 months after surgery, patients were monitored for the extent of resolution of GERD-related symptoms. There was a significant increase [p<0.001] of postoperative lower esophageal sphincter [LES] pressure compared to preoperative pressure with a non-significant difference between pressures estimated at 2 and 6 months. No intraoperative complications were encountered and there was no need for conversion to open surgery in any case. The mean operative time was 78.3+/-9.7; range: 60-90 minutes. All patients tolerated oral ingestions after the first 48 hours. The mean duration of postoperative hospital stay was 4+/-0.8; range: 3-5 days and 9 patients [40.9%] were discharged on the 3[rd] postoperative day. The mean duration till resumption of full daily activities was 11.6+1.4 [10-14] days. Clinically, a marked resolution of symptoms due to reflux was observed, only one patient developed dysphagia for solid food and a sensation of trapped air occurred in two patients causing discomfort, however, these three patients were asymptomatic at 6 months after the surgery. It could be concluded that combined laparoscopic surgery for cholelithiasis and GERD is an appropriate procedure, when indicated, giving excellent short-term outcome results and could be managed during one single laparoscopic procedure
Résumé
The aim of this study was to evaluate the immediate and short-terme follow-up results of one-stage subtotal or total colectomy and anastomosis for patients with malignant left colon obstruction. The study comprised 21 patients [10 males and 11 females] with age range of 36-81 years; presented by acute large bowel obstruction with clinical and radiological evidence of obstruction. The choice of the extent of resection was determined by the extent of fecal load, the presence of colonic perforation, serosal tears of the cecum and/or massive colonic distension with concomitant ischemia: the presence of these features in a hemodynamically stable patient favored subtotal or total colectomy and ileo-colic or ileo-rectal anastomosis. The site of obstruction was at the sigmoid colon in 9 patients [42.9%], rectosigmoid in 8 patients [38.1%], splenic flexure in 3 patients [14.3%] and descending colon in one patient [4.7%]. Ileosigmoid anastomoses were done in 13 patients [61.9%] and 8 patients [38.1%] had ileorectal anastomoses. The mean operative time was 201+/-33.2; range: 150-270 minutes, the mean operative blood loss was 633.3+/-408.2; range: 250-1800 cc; 11 patients [45.8%] required blood transfusion with a mean number of blood bags used was 2.8+/-1.2; 1-5 bags. Oral feeding was resumed after a mean period of 4.9+/-0.9; range: 4-7 days and the mean postoperative hospital stay was 10+/-2.2; range: 8-18 days. Overall, after 12-months follow-up only one patient had anastomotic line recurrence with a recurrence rate of 4.75%, one patients died of acute liver failure secondary to hepatic metastasis with mortality rate of 4.75% and 19 patients had follow-up free of morbidity with no-local recurrence or metastasis and a follow-up free rate of 90.5%. Thus, it could be concluded that one-stage subtotal or total colectomy and ileo-colic or ileo-rectal anastomosis are safe procedure with satisfactory outcome for management of obstructing malignant lesions of the left colon