ABSTRACT
OBJECTIVE: To find out if concentrations of tumour necrosis factor a (TNF alpha) and interleukin-6 (IL-6) play a part in the pathophysiology of intra-abdominal infection, and try to identify patients who would benefit from immunotherapy against TNF alpha. DESIGN: Prospective open study. SETTING: University hospital. SUBJECTS: 19 consecutive patients (septic shock, n = 4; sepsis syndrome, n = 6; and no sepsis syndrome, n = 9, classified by the APACHE II score and the criteria of the Methyl-prednisolone Severe Sepsis Study Group) who were to undergo their first operation for intra-abdominal infection. MAIN OUTCOME MEASURES: Correlation between median (interquartile) concentrations of TNF alpha and IL-6 (pg/ml), and APACHE II score, plasma lactate concentration, and organ function. RESULTS: Perioperative concentrations of both TNF alpha (p = 0.001) and IL-6 (p = 0.006) were significantly higher in patients with septic shock. Preoperative cardiovascular and respiratory failure were associated with significantly raised TNF alpha (p < 0.001 in both cases) and IL-6 concentrations (p = 0.02 and p < 0.001, respectively). The preoperative APACHE II score correlated with the increased TNF alpha concentration (r = 0.5, p < 0.001) and plasma lactate concentration with that of IL-6 (r = 0.7, p = 0.003). CONCLUSION: Perioperative TNF alpha and IL-6 concentrations correlated with the severity of intra-abdominal infection, so it is possible that patients who present with either septic shock or the sepsis syndrome may benefit from immunotherapy against TNF alpha.
Subject(s)
Abdomen/surgery , Gram-Negative Bacterial Infections/immunology , Gram-Negative Bacterial Infections/surgery , Interleukin-6/blood , Shock, Septic/immunology , Shock, Septic/surgery , Tumor Necrosis Factor-alpha/analysis , Adolescent , Adult , Aged , Female , Humans , Lactates/blood , Male , Middle Aged , Prospective Studies , Severity of Illness Index , SyndromeABSTRACT
We report on three patients with iatrogenic lesions of the common bile duct after laparoscopic cholecystectomy. In one patient, an additional occlusion of the hepatic artery was found. The leading postoperative signs were jaundice and cholangitis. Endoscopic and radiologic intervention failed to correct the common bile duct stenosis in all three patients. Surgical correction by hepaticojejunostomy was successful, although the postoperative follow-up is still short.
Subject(s)
Cholecystectomy, Laparoscopic , Cholecystitis/surgery , Cholelithiasis/surgery , Common Bile Duct/injuries , Postoperative Complications/surgery , Adult , Cholangiopancreatography, Endoscopic Retrograde , Cholestasis, Extrahepatic/surgery , Common Bile Duct/surgery , Female , Humans , Iatrogenic Disease , Male , Middle Aged , ReoperationABSTRACT
A report is presented on 105 patients who underwent laparoscopic cholecystectomy because of symptomatic gallstone disease. Preoperative and intraoperative findings, complications and results were prospectively documented. In four (3.8%) patients the laparoscopic procedure had to be converted into open cholecystectomy. There were only minor surgical complications such as wound infection and a subhepatic haematoma. On average, patients were discharged on the second postoperative day. The operating time decreased from a median of 98 minutes in the first half to 73 minutes in the second half of the study, despite augmentation of the number of surgeons and of the indications to include patients with acute cholecystitis (n = 11), previous upper abdominal surgery (n = 7) and cirrhosis (n = 2).
